Copyright © 2016 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited. www.PRSJournal.com 406 B ilateral reduction mammaplasty is a com- mon procedure performed in the United States, with 25 percent of these occurring in women younger than 35 years. 1 Most of these women undergo the procedure for relief of symp- tomatic macromastia, which manifests as neck and back pain, shoulder grooving, intertrigo, and poor self-image. 2,3 A majority of women with macromastia develop symptoms early on in ado- lescence shortly after puberty, leading them to undergo surgery during their late teenage years and second decade of life. 4,5 There are numerous studies showing the physiologic and emotional Disclosure: The authors have no financial interest to declare in relation to the content of this article. Copyright © 2016 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000475748.02721.3d Mariela M. Lopez, M.D. Alexander Chase Castillo, M.D. Kyle Kaltwasser, B.S. Linda G. Phillips, M.D. Clayton L. Moliver, M.D. Galveston, Texas Background: Young female subjects are known to have the highest baseline menstrual hormone levels of any female age group. Studies have found an association between hormone levels and wound healing. This has been re- searched in the orthopedic, gynecologic, and dermatologic literature, and more recently, in young patients undergoing augmentation mammaplasty. The purpose of this study was to determine whether the timing of surgery relative to the menstrual cycle plays a role in surgical complications following bilateral reduction mammaplasty. Methods: All female patients aged 25 years or younger with a documented last menstrual cycle undergoing a bilateral reduction mammaplasty from 2005 to 2013 were reviewed. Surgical timing and postoperative complications relative to the last menstrual cycle were recorded. The preovulatory phase referred to days 1 to 14 after the patient’s last menstrual cycle, whereas the postovulatory phase referred to days 15 to 28. Results: Forty-nine patients met inclusion criteria. Undergoing bilateral reduc- tion mammaplasty during the postovulatory phase was associated with develop- ment of wound dehiscence and hypertrophic scarring (p < 0.005), which were the most common postoperative complications. Surgery in the preovulatory or postovulatory phase did not affect hematoma, seroma, wound infection, or nipple-areolar complex necrosis rates (p > 0.05). Age, race/ethnicity, body mass index, large resection mass, and medical comorbidities did not affect wound dehiscence or scar hypertrophy rates (p > 0.05). Conclusions: Young patients undergoing bilateral reduction mammaplasty dur- ing the postovulatory phase of the menstrual cycle have an increased risk of wound healing issues and poor scarring. This may be attributable to hormonal fluxes occurring during this phase and the already high hormone levels in this population. (Plast. Reconstr. Surg. 137: 406, 2016.) From the Department of Surgery, Division of Plastic Surgery, University of Texas Medical Branch. Received for publication April 8, 2015; accepted September 16, 2015. Presented, in part, at the Texas Society of Plastic Surgeons 2014 Annual Meeting, in San Antonio, Texas, September 26, 2014, and awarded second place for Best Scientific Paper; and Plastic Surgery The Meeting 2014: Annual Meeting of the American Society of Plastic Surgeons, in Chicago, Illinois, October 10 through 14, 2014. Surgical Timing and the Menstrual Cycle Affect Wound Healing in Young Breast Reduction Patients A “Hot Topic Video” by Editor-in-Chief Rod J. Rohrich, M.D., accompanies this article. Go to PRSJournal.com and click on “Plastic Surgery Hot Topics” in the “Videos” tab to watch.” On the iPad, tap on the Hot Topics icon. BREAST