Complications following breast reduction surgery—particularly infections—are more common in women older than 50, reports a study in the December issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons.

The increased complication rate in older women likely reflects age-related changes in hormone levels, according to the new research by Dr. Michele A. Shermak and colleagues of The Johns Hopkins Medical Institutions, of Baltimore.

Breast reduction surgery—also called reduction mammaplasty—is among the most commonly performed breast plastic surgery procedures. It's considered to be effective in relieving symptoms related to overlarge breasts, such as back, shoulder, and neck pain, posture problems, and bra strap compression.

The researchers evaluated about 1,200 women undergoing breast reduction surgery from 1999 to 2009. The researchers assessed rates and types of complications in three different age groups: under 40, 40 to 50, and over 50.

In an analysis controlling for other medical conditions, the infection rate was 2.7 times higher for women over 50, compared with the under-40 group.

Women over 50 also tended to have a higher rate of wound healing problems, leading to a higher rate of repeat surgery to remove areas of dead skin, called debridement. These trends were not statistically significant, however.

Women ages 40 to 50 also showed an insignificant trend toward an increased risk of infection. Other important types of complications were unaffected by age.

Previous studies have identified several risk factors for complications after breast reduction surgery, including obesity, extensive breast reduction, and smoking. However, the new study is the first to focus specifically on age.

The increased risk in women over 50 is likely related to age-related declines in hormone levels, Shermak and colleagues say. This is borne out by the trend toward increased infections among women in their 40s, when hormone levels start to decline.

In addition, infections tended to be less common in women who were using hormone replacement therapy. Meanwhile, the infection rate appeared higher in women who had undergone hysterectomy or oophorectomy (removal of the ovaries), which lead to sharp drops in hormone levels.

The new results suggest that age may act as a confounding factor in assessing the risk of complications after breast reduction surgery—especially in women over 50. Hormonal status may warrant special attention, Shermak and coauthors say.

The researchers suggest that plastic surgeons should ask women considering breast reduction about any factors potentially related to hormonal deficiency, including a history of hysterectomy or oophorectomy. They also suggest that "hormone replacement therapy may be worth considering in this group of patients." the infection rate was 2.7 times higher for women over 50, compared to the under-40 group.