Cosmetic Breast Augmentation: Long-Term Study of Outcome and Revision Procedures in 56 Patients over 4 Decades

Abstract

Background: Cosmetic breast augmentation is one of the most commonly performed cosmetic procedures in the United States. Known complications have been described; however, there is a paucity of evidence-based data accurately characterizing the time frame for corrective measures and types of reoperative procedures required. This study aims to assess types of complications, define time to adverse events requiring intervention, and characterize types and frequency of operative interventions required over the life of patients receiving implants. Methods: Fifty-six consecutive patients undergoing revision procedures after initial cosmetic breast augmentation from January 2002 through December 2006 were identified from an institutional billing database. Procedures were performed at a single surgical center by surgeons (n = 5) board-certified in plastic and reconstructive surgery. A retrospective review of hospital records, operative sheets, pathology records, nursing notes, and office charts was performed. Patient-, operative-, and implant-related data were collected for all initial and subsequent revision procedures. Data were de-identified and descriptive statistics reported. Time to operative events and procedural ratios were calculated by decade. Results: Over a 37-year period, 95 operative sessions, which included 147 distinct procedural interventions, were performed on 56 patients undergoing primary cosmetic breast augmentation. Patient demographics reflected those of similar reports (mean age, 31 years; mean body mass index, 22.1, range, 15.6–30.6). All 56 women underwent a first-time revision procedure. In addition, 24, 10, and 5 patients underwent a second, third, and fourth revision procedure, respectively. The most frequent reasons for initial revision surgery were capsular contracture (24%) and mechanical failure from implant rupture (13%). Subsequent revisions were dictated mainly by implant failure and contracture, breast pathology, and breast aging over time. Mean time to revision operations was approximately 8 years (median ~3.5 years) to the first, 26 months to the second, 14 months to the third, and 8 months to the fourth. More immediate revisions occurred in 1 of 5 women who chose remove-and-replace procedures because of dissatisfaction with size-related aesthetic outcome. With increased patient satisfaction and decreased immediate perioperative morbidity, implants remained in situ for longer periods, which correlated with increased ratio of revision procedures per patient over time (2.33 in 1970 vs 1.77 in 2000). Conclusion: These data suggest that multiple revision procedures will likely be required during the life of a cosmetic breast implant to maintain implant integrity, aesthetic outcome, and overall breast health. The large variety of secondary corrective issues and small cohort of patients in this study preclude any uniform program of follow-up or revision technique.