The reoperation cascade after breast augmentation with implants: What the patient needs to know

doi:10.1016/j.bjps.2012.09.033

Journal of Plastic, Reconstructive & Aesthetic Surgery

Volume 66, Issue 3, March 2013, Pages 313-322

https://doi.org/10.1016/j.bjps.2012.09.033 Get rights and content

Summary

Breast augmentation with implants is the most commonly performed aesthetic surgical procedure. However, the risk of complications requiring revision surgery with unsatisfactory final results is often underestimated.

In a 10-year retrospective study, patients receiving implant exchange or implant removal after breast augmentation were reviewed with regards to surgical technique, implant type and position, complications and follow-up interventions.

As many as 230 patients were included with a mean age of 40.23 years. A total of 192 (83.5%) had primary augmentation for aesthetic reasons, 24 (10.4%) patients were transsexuals and 14 (6.1%) were treated for malformations. The median primary implant size was 260, 224 and 327 g for aesthetic, malformation and transsexual patients, respectively. Capsular contracture was the leading cause for revision in aesthetic patients whereas size and shape were the main reasons for reoperation in transsexual and malformation patients, respectively. As many as 25% of patients required more than one revision procedure. The time between operations in aesthetic augmentation patients was significantly shorter for the second revision procedure (106.2 months vs. 11.4 months, p < 0.0001). The cumulative risk for needing a second revision procedure in aesthetic patients at 12 months was 24.5%. There was no correlation between implant site, size, position or type of complication and the number of revision procedures.

Our data highlight the high complication rate of revision surgery involving implant removal or replacement. We conclude that patients must be routinely informed of the high risk and arduous consequences of revision surgery, which should be stated as such in the written consent for the procedure.

Section snippets

Material and methods

In a retrospective study of patients treated at the Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Switzerland, between 1999 and 2010, the incidence of implant removal or replacement and their subsequent complications and follow-up interventions after primary augmentation mammoplasty were examined. Surgical technique, implant type and position, number of reoperations and complications were assessed. The patient cohort included patients having undergone primary

Results

During the retrospective observation period between 1999 and 2009, 1079 breast implant procedures, excluding reconstructive cases, were performed at the Department of Plastic and Hand Surgery, University Hospital Zurich, Switzerland. As many as 230 (21.3%) patients were identified as having had revision procedures, comprising either implant replacement or implant removal. Of these, 192 (83.5%) had sought primary augmentation purely for aesthetic reasons, 24 (10.4%) patients had received

Discussion

Despite significant advances in the development of safer cohesive gel breast implants, providing form-stable devices in a wide range of shapes and sizes to accommodate the aesthetic demands of women undergoing breast augmentation, even the most experienced surgeons continue to report high complication rates for the procedure. Whereas other common elective surgeries such as total hip replacement or even much less invasive aesthetic procedures such as blepharoplasty are associated reoperation

Disclosures

The authors have no financial interests or commercial associations to disclose. The study was conducted without outside funding.

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Citation Excerpt :
Scar tissue and distorted anatomy are major contributing factors to the incidence of complications. Moreover, with the additional progressive atrophy of the breast tissue in these often very slim patients, ensuring adequate soft tissue coverage of the implant becomes increasingly difficult, thus leading to both functionally and aesthetically inferior results.14 Suction drains are perceived as a tool to reduce the complication rate of seromas and hematomas, especially when a foreign body remains in the body at the end of surgery.
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A total of 256 women (504 breasts) met the inclusion criteria and were included in the study. The mean age was 44 ± 11 years. The mean operative time was 93 ± 40 min. The mean implant age at the time of the exchange was 10.3 ± 6.5 years. Suction drains were used in 229 breasts (45.4%) and were removed after 6 ± 7 days. Twenty (4%) breasts were diagnosed with SSI, of which 17 had suction drains. Suction drain use and days until drain removal were associated with a higher risk of SSI (85.0% vs. 43.8%, p < 0.001; 6.97 days vs. 12.07 days, p < 0.001, respectively). The use of suction drains remained an independent risk factor for SSI after adjustment for age, smoking, and previous capsular contracture (OR = 10.66, CI 95% 2.42–46.82).
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From January 2008 to May 2015, 62 patients were recruited in our study, and 37 patients were evaluated using a Breast-Q questionnaire after at least 6 months of follow-up. Breast implant-augmented patients were significantly more satisfied concerning the “satisfaction with breasts” module (p = 0.002) and the “satisfaction with outcome” module (p = 0.00008). A question-by-question analysis revealed several interesting and significant differences, showing higher scores in most of the questions in the breast implant group.
Patients in the lipofilling group, interestingly, had a mean of 1.6 interventions compared to the mean 1.36 interventions in the implant group (p = 0.23). This reflects the need to perform more surgical sessions in the lipofilling group to achieve a satisfactory result.
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^☆: The content of this manuscript has been presented at 1^st Chinese European Plastic Surgery Congress, Beijing, 27–29 October, 2011; Annual Congress of the Swiss Society of Plastic, Reconstructive and Aesthetic Surgeons (SGPRAC) 2011, Zurich, Switzerland.

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The reoperation cascade after breast augmentation with implants: What the patient needs to know☆

Summary

Section snippets

Material and methods

Results

Discussion

Disclosures

Aesthet Surg J

The safety of silicone gel-filled breast implants: a review of the epidemiologic evidence

Ann Plast Surg

The relationship of silicone breast implants and cancer at other sites

Plast Reconstr Surg

Cancer risk among Los Angeles women with cosmetic breast implants

Plast Reconstr Surg

Breast implants and breast cancer: a review of incidence, detection, mortality, and survival

Plast Reconstr Surg

Cancer among Scandinavian women with cosmetic breast implants: a pooled long-term follow-up study

Int J Cancer

Cancer incidence in a cohort of Ontario and Quebec women having bilateral breast augmentation

Int J Cancer

The Mentor core study on silicone MemoryGel breast implants

Plast Reconstr Surg

Inamed silicone breast implant core study results at 6 years

Plast Reconstr Surg