Multisite Analysis of 177 Consecutive Primary Breast Augmentations: Predictors for Reoperation

Why is the overall reported revision rate so high (12-21%) for patients who have breast augmentation surgery for the first time? What is your reoperation rate for patients like me that want to have breast enhancement surgery with breast implants?

The clinical data reported to the FDA by the three implant manufacturers (Sientra, Silimed, Mentor, and Allergan/ Inamed) states that their reoperation rates or revision surgery for primary or first time breast augmentation patients is 12-21%. There are many factors that play a role in why a patient has a second operation (reoperation or revision surgery) after their first breast augmentation surgery. Each company had many subjects and physicians contributing to their data. If you look more closely at their data, the reason for reoperation can be divided into two main categories;

  1. Patient choice: 30-40% (typically a desire for an implant size change after their first surgery)
  2. Implant-related: 60-70% (capsular contracture (Baker III/IV), implant deflation, implant rupture, implant malposition, implant extrusion and asymmetry)

When the data was presented to the FDA in 2006 I was at the hearings testifying on behalf of ASERF (Aesthetic Surgery Educational and Research Foundation; http: www.aserf.org ) advocating for a women’s right to choose silicone breast implants.

Because the reoperation rates seemed very high and were not consistent with my practice experience, I decided to design a study to look for predictors for reoperation and to objectively evaluate my practice data. In 2006, I was the lead investigator in a multisite analysis of a consecutive series of primary breast augmentation patients from three different Plastic Surgeons practices (East coast 54 patients, West coast 21 patients and my Midwest 102 patients). I wanted to analyze our reoperation rates, time to reoperation, reason for reoperation, and the specific complications in a consecutive series collated from these three geographically located practices of which two were female Plastic Surgeons and on was a male Plastic Surgeon.

The data showed that two other practices and mine from the Midwest had lower reoperation rates (8 % vs. 12-21%) and capsular contracture rates (2% vs 6-9%) as compared to the manufacturer’s data. After careful analysis using logistic regression we found two predictors for reoperation: 1. When the patient had a simultaneous breast lift (mastopexy) at the time of primary breast augmentation, and 2.when the patient also had breast ptosis (saggy breasts) at the time of breast augmentation.

In my 24 years of experience I have found that the reoperation rate for size change is drastically reduced if you take the time during your consultation to analyze whether your expectations for breast enhancement can be achieved. Together with your Plastic Surgeon, and after you are examined, you should decide which exact implant will help you achieve the result you are looking for.

Sometimes because of your existing breast shape and size your desired shape cannot be achieved. It is always best to understand what result can be obtained before you have breast enhancement surgery. Disappointment after surgery can lead to unnecessary reoperation. Capsular contracture rates can clearly be reduced with meticulous intraoperative techniques and vigilant postoperative care. Be sure you choose the Plastic Surgeon who will help you select the best implant that will achieve your desired result and who will require you to participate in a structured postoperative regimen that will help to reduce the capsular contracture rate.