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. 2025 Aug 11.
doi: 10.1007/s00266-025-05089-z. Online ahead of print.

Beauty Under Pressure: The Impact of Hypertension on Outcomes in 54,000 Cases of Esthetic Breast Surgery

Samuel Knoedler  1   2 , Thomas Schaschinger  3 , Sarah Friedrich  4 , Lena Schemet  4 , Dany Y Matar  1 , Tobias Niederegger  3 , Gabriele Storti  5 , Giuseppe Sofo  2 , Paul Fernando Fajardo Morales  2 , Francesco Mazzarone  2 , Dennis P Orgill  1 , Adriana C Panayi #  6   7 , Bong-Sung Kim #  8
Affiliations

Beauty Under Pressure: The Impact of Hypertension on Outcomes in 54,000 Cases of Esthetic Breast Surgery

Samuel Knoedler et al. Aesthetic Plast Surg. .

Abstract

Background: Hypertension affects nearly one-third of the global adult population and is associated with increased postoperative morbidity. However, its specific impact on outcomes of esthetic breast surgery (EBS) remains poorly understood.

Methods: Data from the multi-institutional American College of Surgeons National Surgical Quality Improvement Program between 2008 and 2022 were analyzed. Patients undergoing elective EBS procedures (breast augmentation, breast reduction, mastopexy, and augmentation-mastopexy) were classified as either medically treated hypertensive (MedHyp) or non-hypertensive (NoMedHyp). 30-day postoperative outcomes were compared between MedHyp and NoMedHyp patients.

Results: A total of 54,336 patients were included, of whom 83.5% (n = 45,373) underwent breast reduction (MedHyp: 7,625 [16.8%] vs. NoMedHyp: 37,748 [83.2%]), 12.1% (n = 6,548) breast augmentation (MedHyp: 209 [3.2%] vs. NoMedHyp: 6,339 [96.7%]), 2.3% (n = 1,237) augmentation-mastopexy (MedHyp: 90 [7.3%] vs. NoMedHyp: 1,147 [92.7%]), and 2.2% (n = 1,178) mastopexy (MedHyp: 136 [11.5%] vs. NoMedHyp: 1,042 [88.5%]). Multivariate analysis revealed a significant association between MedHyp and increased risk of medical complications (OR 1.6, 95% CI 1.1-2.2, p = 0.0070) as well as general (OR 1.5, 95% CI 1.3-1.8, p < 0.001) and any complications (OR 1.2, 95% CI 1.0-1.3, p = 0.0079) after breast reduction. MedHyp was also found to be an independent risk factor for complications after breast augmentation (OR 2.4, 95% CI 1.1-5.1, p = 0.026). No significant associations were observed for mastopexy or augmentation-mastopexy.

Conclusion: Medically treated hypertension appears to be an independent risk factor for postoperative complications following breast reduction and breast augmentation. These insights underscore the importance of thorough preoperative hypertension management to maximize patient safety and optimize outcomes in EBS.

Level of evidence ii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: ACS-NSQIP; Elective breast surgery; Esthetic breast surgery; High blood pressure; Hypertension; Mammoplasty.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethical Approval/Informed Consent: Brigham and Women’s Hospital, Boston, MA, USA; protocol number: 2013P001244.

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