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Primary Breast Augmentation: A Single Surgeon 8 Year Experience with Nearly 1000 Cases
Mustafa Rehmani, BS1, Peter F. Koltz, MD2, Laura Koenig, MSN, RN1, William Koenig, MD1.
1Quatela Center for Plastic Surgery, Rochester, NY, USA, 2University of Rochester Medical Center, Rochester, NY, USA.


Background

Breast augmentation is one of the most popular plastic
surgery operations in the United States with about 317,000 operations performed in 2011. The popularity of breast augmentation has increased 45% since 2000 when 212,500 were performed but has decreased in frequency since 2007 when there were 400,000 augmentations done. Despite the popularity of breast augmentation, results suggest that the operation is unpredictable with published complication and reoperation rates ranging from 5 - 30%. We sought to review the senior author’s 8 year experience with primary breast augmentation in order to identify the frequency and cause of complications and re-operation.
Methods
A retrospective review of all primary breast augmentations performed by the senior author from September 2003 to September 2011 was
performed. Patient demographics including age, parity, BMI, history of weight loss, ideal body weight, exercise regimen, occupation, pre-op cup size and desired cup size were recorded. Medical comorbidities, smoking history, and patient’s chief complaints were detailed. Intraoperative variables captured included incision location, implant type, location of implant pocket, implant size, and operative time. Outcome measures
included time to return to work, post-operative narcotic usage and reoperation. Need for reoperation was divided into 3 groups; implant failure, communication failure, and surgical failure. Categorical
variables were compared using Fishers exact test to determine the effect of measured variables on outcomes.
Results
924 patients underwent primary breast augmentations over the study period with an average age of 35.2 years and average BMI of 21.9. The average implant size was 362cc. Only round smooth Allergan/Inamed-McGhan implants were used. All implants were placed using the “no touch” technique and powder free gloves were changed prior to implant handling. Pocket dissection was completed with monopolar cautery forceps. An inframammary incision was used in 97% of cases. The
average operative time was 55 minutes. Following 2007, 54% of patients chose silicone implants. 15% of patients underwent at least one concomitant procedure, with mastopexy occurring most commonly
(6.3%). Average return to work without restriction was 6 days. Average follow up was 1 year. 40 patients underwent reoperation over the study period (4%). 9 patients experienced saline implant failures occurring 2 to 7 years after implantation. 16 reoperations were secondary to
communication failures including 9 size changes (p=0.01), 5 explantations (p=0.13) and 2 changes from saline to silicone (p=0.49). No size changes occurred after 2008. 15 reoperations were secondary to surgical
failures including 6 capsular contractures(p=0.01), 3 IMF malposition(p=0.22), 1 hematoma, 2 implant exposures, 1 re-exploration for severe pain, 1 early deflation and 1 infection. Capsular contracture trended toward association with silicone implants (p=0.15). Need for reoperation was associated with saline implants (p=0.0001) and exercise frequency >3 days per week (p=0.07).
Conclusion
Primary breast augmentation, when performed with a consistent approach with careful pre-, intra-, and postoperative regimens can produce predictably low complication profiles. Our series suggests that size
changes are a significant cause of reoperation secondary to communication failures, and capsular contracture are a significant outcome of potentially surgeon related error.




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