Breast Striae After Cosmetic Augmentation

Abstract

Breast SurgeryBreast augmentation is the most popular cosmetic surgical procedure in the United States; 330 631 procedures were performed in 2012.1 Any complication can be a significant disappointment for the patient and the surgeon. A known but incompletely understood complication of breast augmentation is striae distensae, also called stretch marks.Striae are linear dermal scars that form in areas of dermal damage. The histology is similar to that of scar tissue formation, but the exact origin is still unknown. Investigators have hypothesized that these scars are precipitated by an inflammatory reaction that destroys collagen and elastic fibers, with ensuing regeneration in the direction of the mechanical forces. This results in flattening and atrophy of the epidermis. Many theories have been suggested to explain the etiology of striae formation, including infection, effects of mechanical stretching, hormonal influences, genetic factors, immunosuppressed states, and chronic liver disease. Objectives: The authors investigated their own patient population to discern risk factors for new-onset striae after cosmetic breast augmentation. Methods: A retrospective chart review was performed for patients who underwent primary breast augmentation from 2005 to 2012 in a single-surgeon practice. Initial chart review revealed that only patients aged ≤25 years exhibited new striae; therefore, only patients from this age group were included. Potential risk factors examined included age, body mass index (BMI), oral contraceptive use, time of last menstrual period (LMP), parity, smoking and alcohol status, diabetes mellitus, and personal history of striae. Implant and surgical factors examined included implant material (silicone vs saline), volume, and location (submuscular vs subglandular placement) and the site of incision. Results: Of the 549 patients included in the study, 17 (3.10%) had new-onset striae, observed at a mean of 58 days postoperatively. The risk of striae was statistically significantly higher (P < .05) among patients who were younger (3.3 times), were nulliparous (14.38 times), began their LMP >14 days before surgery (9.24 times), and had a history of striae (6.11 times). There was a strong correlation between new-onset breast striae and implant size, as well as BMI (P = .07). Conclusions: There is a strong correlation between new-onset striae and hormone levels, genetic factors, and tissue stretch components in patients who undergo cosmetic breast augmentation. This information can be utilized to better educate patients about this potential complication. Level of Evidence: 4

Lateral and Inferior Implant Malposition in Prosthetic Breast Reconstruction: Incidence and Risk Factors

“…Interestingly, a study looking at breast striae after augmentation similarly found that the risk of striae was higher in underweight women with larger implants, but also in overweight women with smaller implants. 18 Thus, this seems to indicate a problem with implant to breast tissue volume match rather than solely a problem of overwhelming implant volume. Although lower implant volumes are not a risk factor for revision or reoperation in cosmetic augmentation, after breast reconstruction, the goal is to adequately fill an empty space.…”

Breast Implant Selection: Consensus Recommendations Using a Modified Delphi Method

“…Although consensus was not established on the importance of implant texture, shape, and gel cohesivity in the risk of migration, there was a consensus (85.7%) on implant size, and all panelists reported texture to be at least moderately important or important as a risk factor in mitigating implant migration. Larger implants have been associated with increased complications compared with smaller implants, 30,31 and the added weight of a larger implant could result in downward displacement over time. 32 The responses to the role of texture in implant migration may reflect the greater use of textured implants in ANZ.…”

Management of stretch marks (with a focus on striae rubrae)

“…Stretch marks are most commonly seen on thighs, abdomen, female breasts, and upper arms in males. [ 1 2 3 4 5 6 ]…”