Striae Distensae as a Complication of Augmentation Mammaplasty

Abstract

Sir: Only 10 cases of striae distensae as a complication of breast augmentation have been reported in the plastic surgery literature thus far.1–6 Although the cause of striae distensae is not yet completely understood, it has been suggested that striae following augmentation mammaplasty are related to nulliparity, young age, and oral contraceptive use.2,4 Of the 10 cases reported, seven occurred in the subglandular position1,2,4,5 and only three occurred in the submuscular position.3,6 Implant size was not a factor. We present a case series of 22 patients who developed striae distensae following augmentation through a transaxillary subpectoral approach by a single surgeon. Of 1546 augmentation mammaplasties performed by the senior author (D.C.M.), 22 patients (1.4 percent) returned postoperatively with evidence of new onset striae distensae. All had undergone the transaxillary subpectoral approach to augmentation. A retrospective chart review was performed for these patients to ascertain their age, parity, history of breastfeeding, smoking, use of oral contraceptives, and preoperative breast volume. Prior personal history of stretch marks was determined by telephone survey and review of preoperative photographs. Postoperatively, newly developed striae were classified subjectively as mild, moderate, or severe (Figs. 1 and 2). Patients were counseled that the stretch marks would fade with time, but vitamin E, cocoa butter, or bag balm cream were also recommended.Fig. 1.: Moderate postoperative striae. This 19-year-old nulliparous nonsmoker developed moderate striae 10 weeks after placement of 460-cc implants.Fig. 2.: Severe postoperative striae. This 22-year-old nulliparous smoker developed severe striae 5 1/7 weeks after placement of 480-cc implants.All patients were healthy and ranged in age from 18 to 32 years (mean, 23 ± 4.3 years). Ninety-five percent of patients (n = 21) had not had term pregnancies, with 82 percent of patients (n = 18) specifically being nulliparous (Table 1). One patient (5 percent) had breastfed in the past. Twenty-one of the 21 patients for whom data were available had striae elsewhere on their body before augmentation. Twenty-eight percent (n = 6) were smokers and 45 percent (n = 10) used oral contraceptives at the time of surgery. Implant volume ranged from 345 to 600 cc (mean, 452.5 ± 58.8 cc). Time from surgery to onset of the striae ranged from 1 1/7 to 26 5/7 weeks (mean, 11.17 ± 5.25 weeks). Sixty-eight percent (n = 15) of the striae were classified as mild, whereas 27 percent (n = 6) were moderate and one case (5 percent) was severe. The mean follow-up period was 17.5 months (range, 2 to 76.5 months).Table 1: Summary of Patient DataBreast augmentation was the second most common cosmetic surgical procedure performed in the United States last year according to the American Society for Aesthetic Plastic Surgery. The development of striae following this procedure is a morbid complication that must be recognized, especially given the lack of effective therapies. In our case series, we confirm the roles of young age, nulliparity, and history of striae distensae as risk factors for the new development of striae following augmentation. All cases occurred in the subpectoral position, and association with oral contraceptives was not established. Although our series is small in number, it offers some insight into the character of striae distensae. Until a proven treatment is found for striae, we emphasize the importance of informing patients preoperatively of their risk factors to recognize the possibility that striae distensae may develop following breast augmentation. Georgeanna J. Huang, M.D. Thousand Oaks Clare E. York, M.P.A.S., P.A.-C. Aesthetic Plastic Surgical Institute, Inc. Laguna Beach Dan C. Mills, M.D. Department of Surgery Division of Plastic Surgery Loma Linda University Loma Linda, Calif. DISCLOSURES We hereby certify that, to the best of our knowledge, no financial support or benefits have been received by me or any coauthor, by any member of our immediate families, or by any individual or entity with whom or with which we have a significant relationship from any commercial source that is related directly or indirectly to the scientific work reported on in the article. We understand any example of such a financial interest would be a stock interest in any business entity that is included in the subject matter of the article or that sells a product relating to the subject matter of the article.