Why Do Patients Seek Revisionary Breast Surgery?

Abstract

In 2011, according to the American Society for Aesthetic Plastic Surgery (ASAPS), 316 848 American women underwent breast augmentation and 112 964 underwent breast reduction surgery.1 These 2 procedures rank in the top 10 among all procedures (surgical and nonsurgical) performed annually. Breast surgery patients desire symmetry, softness, and longevity of results. Over a lifetime, the majority of those breast surgery patients who do seek secondary revisions are attempting to correct ptosis, capsular contracture (CC), malposition, or simply to make a change in size and shape.With reoperation, there is an increased risk of complication, and good cosmetic outcomes may be difficult to achieve.2,3 Correcting the problem requires an understanding of the primary operation and the endurance of the Why Do Patients Seek Revisionary Breast Surgery? Navanjun S. Grewal, MD; and Jack Fisher, MD Abstract Background: Patient motivations for revisionary breast surgery following breast augmentation, mastopexy-augmentation, and breast reduction are often overlooked. Most patients presenting for a revision do so because they desire a subsequent improvement in their appearance or wish to correct a problem resulting from the primary operation.Objective: We present and analyze the clinical indications for revisionary breast surgery in a series of 134 consecutive cases. Methods: We retrospectively reviewed the charts of 134 patients who underwent revisionary breast surgery in a single clinic from 1994 to 2009. Patients were grouped based on operative procedure: augmentation (n = 110), mastopexy-augmentation (n = 10), bilateral breast reduction (n = 15), breast malformation correction (n = 1). Three categories were also specified according to the cause for secondary surgery: (1) the surgeon's operative plan was flawed and/or involved a technical error, (2) an independent factor occurred such as ptosis or capsular contracture, or (3) there was a combination of both factors. Results: The most frequent reasons for revisionary surgery among aesthetic implant patients were the development of ptosis (42%), capsular contracture (29%), and lower-pole deformities (19%). Twenty-six percent of patients had a combination of problems. Revision among breast reduction patients was due to volume loss from overresection (40%), nipple-areola loss (27%), and breast asymmetry (27%). The average time between the first surgery and reoperation was 8.9 years for augmentation, 4.3 years for mastopexy-augmentation, and 2.9 years for reduction. In implant patients, the biggest problem leading to revisionary surgery was natural progression (66% augmentation, 90% mastopexy-augmentation). However, among breast reduction patients, 73% of revision requests were a result of problems with surgeon judgment or technique. Conclusions: Our study demonstrates that although the rate of surgeon-specific problems was high in reduction patients, overall, independent factors were the primary reason patients sought revisionary breast surgery. This may be contrary to commonly held ...

Risk Factor Analysis for Capsular Contracture, Malposition, and Late Seroma in Subjects Receiving Natrelle 410 Form-Stable Silicone Breast Implants

“…6,7 In the long-term study, these complications occurred at lower rates with Natrelle 410 compared with prior reports of standard round gel implants. 4,5,8,9 Late seroma is a rare complication that manifests as fluid collection in the periprosthetic space occurring more than 1 year after implantation.…”

The development of SERI® Surgical Scaffold, an engineered biological scaffold

“…Revision rates as high as 25% have been reported in postmarketing studies evaluating breast implants, with higher rates typically associated with a prior revision or in complex reconstruction procedures . The most common drivers of revision in the breast include ptosis, capsular contracture, and lower pole deformities . The characteristics and clinical qualities of SERI Surgical Scaffold are well suited to support weak tissues and to reinforce repairs, rendering SERI Surgical Scaffold potentially valuable for a variety of procedures.…”

Cadaveric Study of Breast Measurements during Augmentation with Implants

“…(3) measurements were obtained in the supine position, and the upward nipple movement may be counteracted in cases of living patients (i.e., placing the breasts in the upright position); (4) we used saline and not silicone implants; (5) for some measurements, the implants had to be overfilled, which may have changed their configuration and thus effect; and (6) placing and replacing several implants of different sizes might have led to stretch of the overlying skin, ultimately confounding the obtained measurements. Nevertheless, this study provides examination of a concept and presents a starting point to help plastic surgeons prepare for immediate changes in breast measurements following breast augmentation.…”