Incision Location Predicts 30-Day Major Adverse Events after Cosmetic Breast Augmentation: An Analysis of the Tracking Outcomes and Operations for Plastic Surgeons Database

Abstract

Background: Enhanced understanding of early postoperative adverse events will improve patient counseling and preoperative risk modification to decrease complications in implant-based breast augmentation. This study seeks to evaluate the early major adverse events following cosmetic breast augmentation. Methods: A retrospective cohort analysis of the Tracking Outcomes and Operations for Plastic Surgeons database was performed to identify any women undergoing augmentation mammaplasty with an implant between 2008 and 2016. Results: A total of 84,296 patients were studied. Major adverse events were identified in 0.37 percent. Seroma requiring drainage was observed in 0.08 percent, hematoma requiring drainage was observed in 0.15 percent, deep wound disruption was observed in 0.09 percent, and implant loss was observed in 0.11 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m 2 (relative risk, 2.05; p < 0.001), tobacco use (relative risk, 2.25; p < 0.001), and diabetes mellitus (relative risk, 1.8; p < 0.05). Use of a periareolar incision significantly increased the risk of developing an early postoperative complication (relative risk, 1.77; p < 0.001). Conclusions:The findings of this study indicate an early major adverse event rate following cosmetic breast augmentation with implants of 0.37 percent. The authors identified multiple independent predictors of major adverse events, including body mass index greater than 30 kg/m 2 , tobacco use, and diabetes mellitus. In addition, when controlling for other factors, periareolar incision significantly increased the risk for major adverse events, when compared to an inframammary incision.

Incision and Capsular Contracture Risk

“…Ten publications were identified that compared capsular contracture rates by the incision. [11][12][13][14][15][16][17][18][19][20] Most were retrospective chart reviews. [12][13][14][15][16][17] Three were prospective core studies.…”

“…[11][12][13][14][15][16][17][18][19][20] Most were retrospective chart reviews. [12][13][14][15][16][17] Three were prospective core studies. [18][19][20] A 2005 Danish study found an advantage for an inframammary incision over other approaches, but the sample sizes were small.…”

“…18,20 Bresnick 17 recently concluded that adding a separate inframammary incision for breast implant placement at the time of a vertical augmentation/ mastopexy reduced the capsular contracture rate. Valente et al 16 reviewed the TOPS (Tracking Outcomes and Operations for Plastic Surgeons) database. These authors found an increased risk of complications using a periareolar incision, but not specifically for capsular contracture.…”

“…There appears to be an error in the rate calculated for the vertical group (4/172 breasts = 2.33%, not 3.48%). Other publications report capsular contracture rates per patient, [11][12][13][14][15][16][17][18][19][20][23][24][25][26][27][28][29][30] including the author's previous study. 28 Obviously, the same denominator is needed when comparing results with other published studies.…”

Laser-Assisted Liposuction for Autologous Fat Grafting Following Elective Breast Explant Surgery

“…Due to the increasing concern from patients about the risks of adverse events following breast augmentation with implants, such as breast implant-associated anaplastic large cell lymphoma and Autoimmune Syndrome Induced by Adjuvants, or simply changes of aesthetic preference, explantation of breast implant surgery became an emerging surgical field [1][2][3]. Evidence suggests that breast explantation effectively improves silicone-related complaints and that the body's self-satisfaction increases with the placement of breast implants and remains increased after their removal [4][5][6].…”