{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:23:38Z","timestamp":1792027418386,"version":"4.4.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Breast reduction surgery effectively alleviates symptoms of macromastia, but the impact of diabetes on surgical outcomes remains insufficiently studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The authors of this study aim to evaluate the effect of diabetes, stratified by treatment modality, on postoperative outcomes following breast reduction surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried (2017-2023) to identify female patients undergoing breast reduction. Patients were classified as nondiabetic or diabetic, with the latter further stratified into diabetes mellitus treated with oral agents (DM-ORAL) or with insulin (DM-INS). Preoperative characteristics and 30-day postoperative outcomes were compared, and multivariable confounder-adjusted regression analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The cohort included 29,346 female patients, of whom 4.3% (n = 1261) had diabetes. Among diabetic patients, 83% (n = 1046) had DM-ORAL and 17% (n = 215) DM-INS. Compared with nondiabetic patients, those with diabetes were significantly older (49.8 \u00b1 13.0 vs 39.0 \u00b1 14.5 years; P &amp;lt; .0001), had a higher body mass index (31.5 \u00b1 11.2 vs 28.4 \u00b1 10.0\u2005kg\/m2; P &amp;lt; .0001), and exhibited a greater overall burden of comorbidities. Multivariable analysis revealed that DM-INS was associated with a significantly increased risk of overall adverse events (odds ratio [OR] 1.9; P = .001), surgical complications (OR 1.6; P = .04), medical complications (OR 3.1; P = .02), and unplanned readmission (OR 4.9; P &amp;lt; .0001). In contrast, DM-ORAL did not correlate with an increased risk of postoperative complications (OR 1.1; P = .6).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>DM-INS is associated with an increased perioperative risk following breast reduction surgery. These findings underscore the need for tailored perioperative strategies and support risk-specific guidelines in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence: 3 (Therapeutic)<\/jats:title>\n                    <jats:p\/>\n                  <\/jats:sec>","DOI":"10.1093\/asj\/sjaf201","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T11:43:48Z","timestamp":1759578228000},"page":"269-276","source":"Crossref","is-referenced-by-count":6,"title":["Sugar-Coated Complications? The Impact of Diabetes on Outcomes of Breast Reduction"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5798-8003","authenticated-orcid":false,"given":"Samuel","family":"Knoedler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Schaschinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Kern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henriette","family":"Grundig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Moog","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Guenther","family":"Machens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamal","family":"Addagatla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fortunay","family":"Diatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5399-4166","authenticated-orcid":false,"given":"Martin","family":"Kauke-Navarro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"2026030212063163600_sjaf201-B1","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1007\/s00266-023-03676-6","article-title":"Superomedial-posterior pedicle-based reduction mammaplasty: evaluation of effectiveness and BREAST-Q outcomes of a rapid and safer technique","volume":"48","author":"La Padula","year":"2024","journal-title":"Aesthet Plast Surg"},{"key":"2026030212063163600_sjaf201-B2","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1097\/PRS.0b013e31824129ee","article-title":"Additional benefits of reduction mammaplasty: a systematic review of the literature","volume":"129","author":"Singh","year":"2012","journal-title":"Plast Reconstr Surg"},{"key":"2026030212063163600_sjaf201-B3","doi-asserted-by":"publisher","first-page":"e20171103","DOI":"10.1542\/peds.2017-1103","article-title":"The effect of reduction mammaplasty on quality of life in adolescents with macromastia","volume":"140","author":"Nuzzi","year":"2017","journal-title":"Pediatrics"},{"key":"2026030212063163600_sjaf201-B4","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1097\/01.prs.0000154212.10845.54","article-title":"Prospective study of outcomes after reduction mammaplasty","volume":"115","author":"Miller","year":"2005","journal-title":"Plast Reconstr Surg"},{"key":"2026030212063163600_sjaf201-B5","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1093\/asj\/sju017","article-title":"Patient-reported quality-of-life outcomes of breast reduction evaluated with generic questionnaires and the breast reduction assessed severity scale","volume":"35","author":"Kececi","year":"2015","journal-title":"Aesthet Surg J"},{"key":"2026030212063163600_sjaf201-B6","doi-asserted-by":"publisher","first-page":"e031804","DOI":"10.1136\/bmjopen-2019-031804","article-title":"Does breast reduction surgery improve health-related quality of life? A prospective cohort study in Australian women","volume":"10","author":"Crittenden","year":"2020","journal-title":"BMJ Open"},{"key":"2026030212063163600_sjaf201-B7","doi-asserted-by":"publisher","first-page":"2631","DOI":"10.1097\/js9.0000000000000511","article-title":"The surgical patient of yesterday, today, and tomorrow-a time-trend analysis based on a cohort of 8.7 million surgical patients","volume":"109","author":"Knoedler","year":"2023","journal-title":"Int J Surg"},{"key":"2026030212063163600_sjaf201-B8","doi-asserted-by":"publisher","first-page":"392e","DOI":"10.1097\/prs.0000000000008860","article-title":"American society of plastic surgeons evidence-based clinical practice guideline revision: reduction mammaplasty","volume":"149","author":"Perdikis","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"2026030212063163600_sjaf201-B9","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1007\/s00266-023-03258-6","article-title":"The impact of diabetes mellitus on breast reconstruction outcomes and complications: a systematic literature review and meta-analysis","volume":"47","author":"Mortada","year":"2023","journal-title":"Aesthet Plast Surg"},{"key":"2026030212063163600_sjaf201-B10","doi-asserted-by":"publisher","first-page":"311","DOI":"10.12788\/fp.0150","article-title":"Twenty years of breast reduction surgery at a veterans affairs medical center","volume":"38","author":"Coady-Fariborzian","year":"2021","journal-title":"Fed Pract"},{"key":"2026030212063163600_sjaf201-B11","doi-asserted-by":"publisher","first-page":"1793","DOI":"10.1016\/j.bjps.2022.02.053","article-title":"Impact of diabetes on outcomes in breast reconstruction: a systematic review and meta-analysis","volume":"75","author":"Liu","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026030212063163600_sjaf201-B12","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1016\/j.jvs.2012.04.011","article-title":"The impact of diabetes on postoperative outcomes following lower-extremity bypass surgery","volume":"56","author":"Wallaert","year":"2012","journal-title":"J Vasc Surg"},{"key":"2026030212063163600_sjaf201-B13","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.1016\/j.jvs.2018.01.055","article-title":"Outcomes after first-time lower extremity revascularization for chronic limb-threatening ischemia in insulin-dependent diabetic patients","volume":"68","author":"Darling","year":"2018","journal-title":"J Vasc Surg"},{"key":"2026030212063163600_sjaf201-B14","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1007\/s00270-021-02830-4","article-title":"Insulin-dependent status influences post-procedural outcomes in diabetic patients following lower extremity endovascular intervention for peripheral arterial disease","volume":"44","author":"An","year":"2021","journal-title":"Cardiovasc Intervent Radiol"},{"key":"2026030212063163600_sjaf201-B15","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1111\/j.0886-0440.2004.04007.x","article-title":"Coronary artery bypass surgery in diabetic patients","volume":"19","author":"Brandt","year":"2004","journal-title":"J Card Surg"},{"key":"2026030212063163600_sjaf201-B16","doi-asserted-by":"publisher","first-page":"4273","DOI":"10.1007\/s00266-025-04800-4","article-title":"Safety of combined versus isolated cosmetic breast surgery and abdominoplasty: insights from a multi-institutional database","volume":"49","author":"Knoedler","year":"2025","journal-title":"Aesthet Plast Surg"},{"key":"2026030212063163600_sjaf201-B17","doi-asserted-by":"publisher","first-page":"e312","DOI":"10.1016\/j.clbc.2024.12.004","article-title":"Unveiling inequities: racial disparities in risk-reducing mastectomy for breast cancer prevention","volume":"25","author":"Knoedler","year":"2025","journal-title":"Clin Breast Cancer"},{"key":"2026030212063163600_sjaf201-B18","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.bjps.2024.11.011","article-title":"Protein as a preoperative predictor\u2014impact of hypoalbuminemia on 30-day outcomes of breast reduction surgery","volume":"100","author":"Knoedler","year":"2025","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026030212063163600_sjaf201-B19","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000004234","article-title":"The use of acellular dermal matrix may not increase 30-day complications in direct-to-implant breast reconstruction: a multi-institutional analysis of 10,177 cases","author":"Knoedler","year":"2025","journal-title":"Ann Plast Surg"},{"key":"2026030212063163600_sjaf201-B20","doi-asserted-by":"publisher","first-page":"3688","DOI":"10.1007\/s00266-025-04743-w","article-title":"The impact of body mass index on breast reduction outcomes: a multi-institutional data analysis of 45,000 cases over 15 years","volume":"49","author":"Knoedler","year":"2025","journal-title":"Aesthet Plast Surg"},{"key":"2026030212063163600_sjaf201-B21","doi-asserted-by":"publisher","first-page":"e857","DOI":"10.1016\/j.clbc.2025.03.022","article-title":"Single-pedicled, supercharged, or bi-pedicled? A multi-institutional outcome comparison of pedicled TRAM flap for autologous breast reconstruction","volume":"25","author":"Knoedler","year":"2025","journal-title":"Clin Breast Cancer"},{"key":"2026030212063163600_sjaf201-B22","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.bjps.2024.09.027","article-title":"The impact of age on outcomes after breast reduction surgery\u2014a multi-institutional data analysis of 40,958 cases","volume":"98","author":"Knoedler","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026030212063163600_sjaf201-B23","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1093\/asj\/sjac320","article-title":"Perioperative outcomes and risk profile of 4730 cosmetic breast surgery cases in academic institutions: an ACS-NSQIP analysis","volume":"43","author":"Knoedler","year":"2023","journal-title":"Aesthet Surg J"},{"key":"2026030212063163600_sjaf201-B24","doi-asserted-by":"publisher","DOI":"10.1007\/s40615-025-02490-x","article-title":"Postoperative outcomes after breast reduction: do racial disparities exist?","author":"Knoedler","year":"2025","journal-title":"J Racial Ethn Health Disparities"},{"key":"2026030212063163600_sjaf201-B25","doi-asserted-by":"publisher","DOI":"10.1007\/s00266-025-05089-z","article-title":"Beauty under pressure: the impact of hypertension on outcomes in 54,000 cases of esthetic breast surgery","author":"Knoedler","year":"2025","journal-title":"Aesth Plast Surg"},{"key":"2026030212063163600_sjaf201-B26","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/j.bjps.2018.09.002","article-title":"Predictors of complications following breast reduction surgery: a national surgical quality improvement program study of 16,812 cases","volume":"72","author":"Simpson","year":"2019","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026030212063163600_sjaf201-B27","doi-asserted-by":"publisher","first-page":"228e","DOI":"10.1097\/PRS.0b013e31823ae949","article-title":"Body mass index as a predictor of postoperative complications in reduction mammaplasty","volume":"129","author":"Chun","year":"2012","journal-title":"Plast Reconstr Surg"},{"key":"2026030212063163600_sjaf201-B28","doi-asserted-by":"publisher","first-page":"157","DOI":"10.4274\/ejbh.galenos.2021.6336","article-title":"Evaluation of factors related to postoperative complications in patients who underwent reduction mammoplasty","volume":"17","author":"Toplu","year":"2021","journal-title":"Eur J Breast Health"},{"key":"2026030212063163600_sjaf201-B29","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1097\/PRS.0b013e318230c467","article-title":"Increasing age impairs outcomes in breast reduction surgery","volume":"128","author":"Shermak","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"2026030212063163600_sjaf201-B30","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1177\/1457496917748225","article-title":"Overweight is associated with increased incidence of minor complications after reduction mammoplasty: a retrospective analysis of 453 consecutive cases","volume":"107","author":"Sutinen","year":"2018","journal-title":"Scand J Surg"},{"key":"2026030212063163600_sjaf201-B31","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1016\/j.surg.2016.11.028","article-title":"Standardizing the complication rate after breast reduction using the Clavien-Dindo classification","volume":"161","author":"Winter","year":"2017","journal-title":"Surgery"},{"key":"2026030212063163600_sjaf201-B32","doi-asserted-by":"publisher","first-page":"1040","DOI":"10.1097\/PRS.0b013e3181b45410","article-title":"Risk factors and complications in reduction mammaplasty: novel associations and preoperative assessment","volume":"124","author":"Henry","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"2026030212063163600_sjaf201-B33","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1097\/prs.0000000000010828","article-title":"Superior pedicle breast reduction: multivariate analysis of complication risk factors and building a predictive score in 1306 patients","volume":"153","author":"Girard","year":"2024","journal-title":"Plast Reconstr Surg"},{"key":"2026030212063163600_sjaf201-B34","doi-asserted-by":"publisher","first-page":"10","DOI":"10.3109\/2000656x.2013.791625","article-title":"Risk factors for complications after breast reduction surgery","volume":"48","author":"Lewin","year":"2014","journal-title":"J Plast Surg Hand Surg"},{"key":"2026030212063163600_sjaf201-B35","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1016\/j.anplas.2024.06.010","article-title":"Assessment of risk factors for postoperative complications of breast reduction by superior or superomedial pedicle","volume":"69","author":"Xiong","year":"2024","journal-title":"Ann Chir Plast Esthet"},{"key":"2026030212063163600_sjaf201-B36","doi-asserted-by":"publisher","first-page":"2330","DOI":"10.1007\/s00266-023-03387-y","article-title":"Risk factors and complications in reduction mammaplasty: a systematic review and meta-analysis","volume":"47","author":"Liu","year":"2023","journal-title":"Aesthet Plast Surg"},{"key":"2026030212063163600_sjaf201-B37","doi-asserted-by":"publisher","first-page":"2760","DOI":"10.2337\/db15-1721","article-title":"Overexpressing IRS1 in endothelial cells enhances angioblast differentiation and wound healing in diabetes and insulin resistance","volume":"65","author":"Katagiri","year":"2016","journal-title":"Diabetes"},{"key":"2026030212063163600_sjaf201-B38","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1080\/10739680701283091","article-title":"Microvascular permeability in diabetes and insulin resistance","volume":"14","author":"Yuan","year":"2007","journal-title":"Microcirculation"},{"key":"2026030212063163600_sjaf201-B39","doi-asserted-by":"publisher","first-page":"1858","DOI":"10.1345\/aph.1D002","article-title":"Biochemical pathways for microvascular complications of diabetes mellitus","volume":"37","author":"Setter","year":"2003","journal-title":"Ann Pharmacother"},{"key":"2026030212063163600_sjaf201-B40","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1055\/s-0041-1731460","article-title":"Updates in diabetic wound healing, inflammation, and scarring","volume":"35","author":"Dasari","year":"2021","journal-title":"Semin Plast Surg"},{"key":"2026030212063163600_sjaf201-B41","doi-asserted-by":"publisher","first-page":"1935","DOI":"10.1016\/s0002-9440(10)63754-6","article-title":"Topical vascular endothelial growth factor accelerates diabetic wound healing through increased angiogenesis and by mobilizing and recruiting bone marrow-derived cells","volume":"164","author":"Galiano","year":"2004","journal-title":"Am J Pathol"},{"key":"2026030212063163600_sjaf201-B42","doi-asserted-by":"publisher","first-page":"101236","DOI":"10.1016\/j.molmet.2021.101236","article-title":"Insulin's actions on vascular tissues: physiological effects and pathophysiological contributions to vascular complications of diabetes","volume":"52","author":"Fu","year":"2021","journal-title":"Mol Metab"},{"key":"2026030212063163600_sjaf201-B43","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1016\/j.bjps.2024.06.016","article-title":"Quality of life and satisfaction after breast augmentation: a systematic review and meta-analysis of breast-Q patient-reported outcomes","volume":"95","author":"Knoedler","year":"2024","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"2026030212063163600_sjaf201-B44","doi-asserted-by":"publisher","first-page":"NP231","DOI":"10.1093\/asj\/sjac293","article-title":"Patient-reported outcomes after reduction mammoplasty using BREAST-Q: a systematic review and meta-analysis","volume":"43","author":"Wang","year":"2023","journal-title":"Aesthet Surg J"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/advance-article-pdf\/doi\/10.1093\/asj\/sjaf201\/64528554\/sjaf201.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/46\/3\/269\/64528554\/sjaf201.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/46\/3\/269\/64528554\/sjaf201.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,2]],"date-time":"2026-03-02T17:06:40Z","timestamp":1772471200000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/article\/46\/3\/269\/8276637"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,7]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,10,7]]},"published-print":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.1093\/asj\/sjaf201","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2025,10,7]]}}}