How Big Is Too Big? Exploring the Relationship between Breast Implant Volume and Postoperative Complication Rates in Primary Breast Augmentations

Abstract

Background: There is no consensus regarding implant size as an independent risk factor for complications in primary breast augmentation. Choosing appropriate implant volume is an integral part of the preoperative planning process. The current study aims to assess the relationship between implant size and the development of complications following augmentation mammaplasty. Methods: A retrospective chart review of patients undergoing primary breast augmentation at the Westmount Institute of Plastic Surgery between January 2000 and December 2021 was conducted. Demographics, implant characteristics, surgical technique, postoperative complications, and follow-up times were recorded. Univariate logistic regression was used to identify independent predictors, which were then included in multivariate logistic regressions of implant volume and implant volume/body mass index (BMI) ratio regarding complications. Results: A total of 1017 patients (2034 breasts) were included in this study. The average implant volume used was 321.4 ± 57.5 cm3 (range: 110–605). Increased volume and volume/BMI ratio were associated with a significant increase in risk of implant rupture (odds ratio = 1.012, P < 0.001 and 1.282, P < 0.001 respectively). Rates of asymmetry were significantly associated with increases in implant volume and volume/BMI ratio (odds ratio = 1.005, P = 0.004 and 1.151, P < 0.001, respectively). No single implant volume or volume/BMI ratio above which risks of complications significantly increase was identified. Conclusions: Implant rupture and postoperative asymmetries are positively correlated with bigger implant volumes. Implant size could likely be a useful independent predictor of certain complications, especially in patients with high implant to BMI ratios.

Breast Implant Volume and Complications: Is There a Link?

“…The authors’ takeaway message is that large implant volumes increase the risk of rupture and asymmetry, and that implant size may independently predict these complications, especially in leaner women. 1 It is not clear that this conclusion is reliably supported by the data, in view of statistical considerations. Notably, almost three times as many women (n = 59) returned to have their implants exchanged to larger sizes as opposed to smaller volumes (n = 21).…”

“…Medor et al 1 sought to evaluate whether complications are related to breast implant size. The authors, for the first time, report a link between implant rupture and larger volume, with an odds ratio of 1.012.…”

“…Notably, despite a greater risk of rupture and asymmetry, the authors report a trend toward fewer complications with larger implant volumes. 1 Other studies have confirmed that larger implant sizes do not pose greater risks. 3,4 Higher result ratings correlate with larger implant volumes.…”

“…5 Surprisingly, the authors also report an opposite "trend in complication rates that was significant with increased implant volume to height ratio and increased implant volume to body mass index ratio." 1 This finding is puzzling because it conflicts with a trend toward fewer complications overall for larger implants, and because the odds ratios for these comparisons did not show such a relationship.…”

“…2 Exclusion criteria were broad. 1 The inclusion rate is not reported. Confounders are increased by including augmentation/mastopexies.…”