Is a Higher Modified Frailty Index Associated with Increased Complications in Breast Reduction? A Single Center Retrospective Analysis of 1716 Patients
Joonas Virkalahti, Mira Laitala, Salvatore GiordanoAbstract
Background
Macromastia is associated with significant physical symptoms and reduced quality of life. Although reduction mammaplasty is an effective, the role of frailty in predicting postoperative complications remains uncertain.
Objectives
To evaluate whether the five-factor modified Frailty Index (mFI-5) predicts postoperative complications following reduction mammaplasty, and to identify independent risk factors.
Methods
This retrospective cohort study included 1,716 consecutive female patients who underwent bilateral breast reduction at a single center (2005–2024). Patients were stratified into low (mFI-5 ≤1, n=1,589) and high (mFI-5 ≥2, n=127) frailty groups. The primary outcome was any postoperative complication within 30 days. Secondary outcome were specific complications requiring surgical intervention. Multivariable logistic regression identified independent predictors.
Results
High frailty patients were older, had higher BMI, and more comorbidities. High frailty group had significantly higher overall complication rates (22.2% vs. 14.9%; p=0.031), including wound dehiscence, hemorrhage requiring transfusion, and nipple–areola complex necrosis. However, mFI-5 was not an independent predictor of complications (OR 1.20, 95% CI 0.62–2.33; p=0.588). Higher BMI (OR 1.09; p=0.007) and active smoking (OR 1.68; p=0.008) were the only independent predictors identified.
Conclusions
The mFI-5 was associated with postoperative complications in unadjusted analysis, but this association was substantially explained by the higher prevalence of obesity and smoking in the high-frailty group and did not persist after multivariable adjustment. BMI and smoking remain the principal modifiable risk factors for preoperative optimization, supporting the need for more comprehensive frailty assessment tools in future studies.