Capsular contracture rate in a low-risk population after primary augmentation mammaplasty.

BACKGROUND: The safety of augmentation mammaplasty has increased dramatically in the past 20 years. Capsular contracture (CC) is the most commonly reported complication of augmentation mammaplasty. OBJECTIVES: The authors report the incidence of CC in a low-risk patient population after primary augmentation. METHODS: The authors retrospectively reviewed the charts of 856 consecutive patients who underwent primary augmentation mammaplasty between 1999 and 2009. This series did not include patients who underwent breast augmentation-mastopexy, secondary augmentation, revision, and/or reconstruction. Data points included demographics, functional and aesthetic outcomes, complications, and revision rate/type. RESULTS: The overall incidence of CC in 856 patients was 2.8%. Average follow-up time was 14.9 months. Antibiotic irrigation decreased CC rates from 3.9% to 0.4% (P = .004). Tobacco users had higher rates of contracture than nonsmokers (5.5% vs 1.9%; P = .036). Saline implants had a higher CC rate than silicone gel (4.3% vs 1.3%; P = .032). Using multivariate logistic regression, CC was 7.89 times more likely in saline implants than in silicone gel (P = .027, 95% confidence interval, 1.26-49.00). CONCLUSIONS: Based on our findings, it is apparent that the early CC rate in primary augmentation can be less than 1%. To avoid CC, we advocate an inframmamary approach, submuscular implant placement, and antibiotic irrigation of the breast pocket. LEVEL OF EVIDENCE: 3.

Vertical reduction mammaplasty utilizing the superomedial pedicle: is it really for everyone?

BACKGROUND: Classically, the vertical-style reduction mammaplasty utilizing a superomedial pedicle has been limited to smaller reductions secondary to concerns for poor wound healing and nipple necrosis. OBJECTIVES: The authors reviewed a large cohort of patients who underwent a vertical-style superomedial pedicle reduction mammaplasty in an attempt to demonstrate its safety and efficacy in treating symptomatic macromastia. METHODS: A retrospective review was performed of 290 patients (558 breasts) who underwent a vertical-style superomedial pedicle reduction mammaplasty. All procedures were conducted by one of 4 plastic surgeons over 6 years (JDR, MAA, DLV, DRA). RESULTS: The average resection weight was 551.7 g (range, 176-1827 g), with 4.6% of resections greater than 1000 g. A majority of patients (55.2%) concomitantly underwent liposuction of the breast. The total complication rate was 22.7%, with superficial dehiscence (8.8%) and hypertrophic scarring (8.8%) comprising the majority. Nipple sensory changes occurred in 1.6% of breasts, with no episodes of nipple necrosis. The revision rate was 2.2%. Patients with complications had significantly higher resection volumes and nipple-to-fold distances (P = .014 and .010, respectively). CONCLUSIONS: The vertical-style superomedial pedicle reduction mammaplasty is safe and effective for a wide range of symptomatic macromastia. The nipple-areola complex can be safely transposed, even in patients with larger degrees of macromastia, with no episodes of nipple necrosis. The adjunctive use of liposuction should be considered safe. Last, revision rates were low, correlating with a high level of patient satisfaction.

The influence of obesity and volume of resection on success in reduction mammaplasty: an outcomes study.

BACKGROUND: Indications for breast reduction surgery include neck pain, back pain, shoulder pain, and an intertriginous rash. Previous studies have established that bilateral breast reduction surgery is highly effective in relieving these symptoms. Third-party payers may refuse to cover breast reduction surgery for obese patients. In addition, some surgeons turn down obese breast reduction candidates, perhaps fearing that they will not achieve symptom relief or that the complication rate will be prohibitive. It is common for insurers to require an arbitrary minimum volume to be resected in order for them to reimburse for the procedure. This study was conducted to see whether patients with varying levels of obesity had any difference in surgical outcomes compared with nonobese patients with regard to symptom relief and complication rate. The authors also studied the relationship between volume of tissue resected and symptom relief and complication rate. METHODS: One hundred eighty-six consecutive patients underwent bilateral breast reduction surgery performed by a single surgeon using the inferior pedicle Wise pattern technique or the free nipple graft technique. Body mass index was calculated for each patient. RESULTS: Significant postoperative symptom relief occurred in 97 percent of patients. Statistical analysis demonstrated no difference among the various body mass index groups in terms of symptom relief or development of complications, nor was there any correlation between volume of tissue resected and relief of symptoms or complications. CONCLUSIONS: The authors conclude that there is no justification for discriminating against obese patients in either the performance of breast reduction surgery or the provision of insurance coverage for the same. The authors find no justification for denial of insurance coverage for patients in whom lesser tissue volumes are to be resected.