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Comparison of Breast Augmentation Incisions and Common Complications

Abstract

Background

Incisions for insertion of breast implants are most commonly placed in the inframammary fold, areola, or axilla. Previous studies have evaluated selection of incision location preoperatively and for nipple–areola complex sensation retention after primary augmentation mammaplasty. This study compares the most common postoperative complications for each incision location in patients who underwent primary breast augmentation.

Methods

A retrospective chart review was performed on 619 patients who underwent primary breast augmentation, excluding simultaneous mastopexy, within a single group practice from July 1994 to June 2009. Incision location, postoperative complications (capsular contracture, hematoma formation, rippling, infection, and rupture), and total reoperation rates were recorded. Incision locations were also compared with respect to implant fill type (saline or silicone gel) and pocket location (subglandular or submuscular).

Results

A statistically significant association was identified between total reoperation and incision location (p = 0.0054). The highest rate of total reoperation occurred when using an inframammary fold incision compared to either the transaxillary or periareolar. This relationship with total reoperation was not attributed to the five complications analyzed, but rather with patient desire for size/style change, asymmetry, or ptosis. No statistically significant association was observed between incision location and specific complications such as capsular contracture, rippling, implant rupture, hematoma, or infection.

Conclusions

None of the five complications analyzed correlated with incision location. The data generated from this study will assure the surgeon that all three incision locations are safe. Preoperative examination, patient preference, and surgeon comfort should remain the mainstays of incision planning in augmentation mammaplasty.

Level of Evidence IV

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References

  1. Cosmetic Surgery National Databank Statistics (2010) American Society for Aesthetic Plastic Surgery. http://www.surgery.org/sites/default/files/Stats2010_1.pdf. Accessed 2 Nov 2011

  2. Spear SL, Bulan EJ, Venturi ML (2004) Breast augmentation. Plast Reconstr Surg 114(5):73e–81e

    PubMed  Google Scholar 

  3. Hoehler H (1973) Breast augmentation: the trans-axillary approach. Br J Plast Surg 26:371

    Google Scholar 

  4. Jones FR, Taura AP (1973) A periareolar incision for augmentation mammaplasty. Plast Reconstr Surg 51(6):641–644

    PubMed  Article  CAS  Google Scholar 

  5. McKinney P, Shedbalker AR (1974) Augmentation mammaplasty using a non-inflatable prosthesis through a circum-areolar incision. Br J Plast Surg 27(1):35–38

    PubMed  Article  CAS  Google Scholar 

  6. Pacella SJ, Codner MA (2009) The transaxillary approach to breast augmentation. Clin Plast Surg 36(1):49–61, vi

    Google Scholar 

  7. Tebbetts J, Adams W (2006) Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision process. Plast Reconstr Surg 118(7S):35S–45S

    PubMed  CAS  Google Scholar 

  8. Courtiss EH, Goldwyn RM (1976) Breast sensation before and after plastic surgery. Plast Reconstr Surg 58(1):1–13

    PubMed  Article  CAS  Google Scholar 

  9. Mofid MM, Klatsky SA, Singh NK et al (2006) Nipple–areola complex sensitivity after primary breast augmentation: a comparison of periareolar and inframammary incision approaches. Plast Reconstr Surg 117(6):1694–1698

    PubMed  Article  CAS  Google Scholar 

  10. Okwueze MI, Spear ME, Zwyghuizen AM et al (2006) Effect of augmentation mammaplasty on breast sensation. Plast Reconstr Surg 117(1):73–83

    PubMed  Article  CAS  Google Scholar 

  11. Alpert BS, Lalonde DH (2008) MOC-PSSM CME Article: breast augmentation. Plast Reconstr Surg 121(4):1–7

    PubMed  Google Scholar 

  12. Hildago DA (2000) Breast augmentation: choosing the optimal incision, implant, and pocket plane. Plast Reconstr Surg 105(6):2202–2216

    Article  Google Scholar 

  13. Adams WP (2008) The process of breast augmentation: four sequential steps for optimizing outcomes for patients. Plast Reconstr Surg 122(6):1892–1900

    PubMed  Article  CAS  Google Scholar 

  14. Wiener TC (2008) Relationship of incision choice to capsular contracture. Aesthet Plast Surg 32(2):303–306

    Article  Google Scholar 

  15. Bengston BP, Van Natta BW, Murphy DK et al (2007) Style 410 highly cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg 120(Suppl 1):40S

    Google Scholar 

  16. Spear SL, Murphy DK, Slicton A, Walker PS; Inamed Silicone Breast Implant U.S. Study Group (2007) Inamed silicone breast implant core study results at 6 years. Plast Reconstr Surg 120(Suppl 1):8S–16S; discussion 17S–18S

    Google Scholar 

  17. Cunningham BL (2007) The Mentor core study on silicone MemoryGel breast implants. Plast Reconstr Surg 120(Suppl 1):19S–29S

    PubMed  CAS  Google Scholar 

  18. Cunningham B, McCue J (2009) Safety and effectiveness of Mentor’s MemoryGel implants at 6 years. Aesthet Plast Surg 33(3):439–444

    Article  Google Scholar 

  19. Handel N, Cordray T, Gutierrez J et al (2006) A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg 117(3):757–767

    PubMed  Article  CAS  Google Scholar 

  20. Hipps CJ, Raju DR, Straith RE (1978) Influence of some operative and postoperative factors on capsular contracture around breast prostheses. Plast Reconstr Surg 61(3):384–389

    PubMed  Article  CAS  Google Scholar 

  21. Reece EM, Ghavami A, Hoxworth RE et al (2009) Primary breast augmentation today: a survey of current breast augmentation practice patterns. Aesthet Surg J 29(2):116–121

    PubMed  Article  Google Scholar 

  22. Fanous N, Tawilé C, Brousseau VJ (2008) Minimal inframammary incision for breast augmentation. Can J Plast Surg 16(1):14–17

    PubMed  Google Scholar 

  23. Allen S (2004) FDA breast implant consumer handbook—2004. U.S. Food and Drug Administration, Washington, DC

    Google Scholar 

  24. Transcript of the FDA Panel, Mentor hearings (April 2005). http://www.fda.gov/ohrms/dockets/ac/05/transcripts/2005-4101t3.doc. Accessed 2 Nov 2011

  25. FDA Summary Panel Memorandum: Mentor P030053. http://www.fda.gov/ohrms/dockets/ac/05/briefing/2005-4101b1_Tab-1_fda-Mentor%20Panel%20Memo.pdf. Accessed 2 Nov 2011

  26. Puckett CL, Croll GH, Reichel CA, Concannon MJ (1987) A critical look at capsular contracture in subglandular versus subpectoral mammary augmentation. Aesthet Plast Surg 11(1):23–28

    Article  CAS  Google Scholar 

  27. Biggs TM, Yarish RS (1990) Augmentation mammaplasty: a comparative analysis. Plast Reconstr Surg 85(3):368–372

    PubMed  Article  CAS  Google Scholar 

  28. Barnsley PG, Sigurdson LJ, Barnsley SE (2006) Textured-surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials. Plast Reconstr Surg 117(7):2182–2190

    PubMed  Article  CAS  Google Scholar 

  29. McCurdy JA Jr (2009) Capsular contracture following augmentation mammaplasty: etiology and pathogenesis. In: Shiffman MA (ed) Breast augmentation principles and practice, 1st edn. Springer, Berlin, pp 525–540

    Chapter  Google Scholar 

  30. Snell L, Brown M (2009) Breast implant capsules and subclinical infection. Plast Reconstr Surg 124(4S):38

    Google Scholar 

  31. Tran VT, Del Pozo JL, Petty PM et al (2009) Bacteria on breast implants are associated with capsular contracture. Plast Reconstr Surg 124(4S):38–39

    Google Scholar 

  32. Adams WP Jr (2009) Capsular contracture: What is it? What causes it? How can it be prevented and managed? Clin Plast Surg 36:119–126

    PubMed  Article  Google Scholar 

  33. Tamboto H, Vickery K, Deva AK (2010) Subclinical (biofilm) infection causes capsular contracture in a porcine model following augmentation mammaplasty. Plast Reconstr Surg 126(3):835–842

    PubMed  Article  CAS  Google Scholar 

  34. Pajkos A, Deva AK, Vickery K et al (2003) Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg 111(5):1605–1611

    PubMed  Article  Google Scholar 

  35. Wong C, Samuel M, Tan B et al (2006) Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review. Plast Reconstr Surg 118(5):1224–1236

    PubMed  Article  CAS  Google Scholar 

  36. Schaub T, Ahmad J, Rohrich RJ (2010) Capsular contracture with breast implants in the cosmetic patient: saline versus silicone—a systematic review of the literature. Plast Reconstr Surg 126(6):2140–2149

    PubMed  Article  CAS  Google Scholar 

  37. Araco A, Caruso R, Araco F et al (2009) Capsular contracture: a systematic review. Plast Reconstr Surg 124(6):1808–1819

    PubMed  Article  CAS  Google Scholar 

  38. Burkhardt BR, Eades E (1995) The effect of Biocell texturing and povidone-iodine irrigation on capsular contracture around saline-inflatable breast implants. Plast Reconstr Surg 96(6):1317–1325

    PubMed  Article  CAS  Google Scholar 

  39. Al-Sabounchi S, De Mey AM, Eder H (2006) Textured saline-filled breast implants for augmentation mammoplasty: Does overfilling prevent deflation? A long-term follow-up. Plast Reconstr Surg 118(1):215–222

    PubMed  Article  CAS  Google Scholar 

  40. Handel N, Jensen JA, Black Q et al (1995) The fate of breast implants: a critical analysis of complications and outcomes. Plast Reconstr Surg 96(7):1521–1533

    PubMed  Article  CAS  Google Scholar 

  41. Codner MA, Mejia JD, Locke MB et al (2011) A 15-year experience with primary breast augmentation. Plast Reconstr Surg 127(3):1300–1310

    PubMed  Article  CAS  Google Scholar 

  42. Nahabedian M, Patel K (2008) Management of common and uncommon problems after primary breast augmentation. Clin Plast Surg 36:127–138

    Article  Google Scholar 

  43. Cunningham B (2007) The Mentor study on contour profile gel silicone MemoryGel breast implants. Plast Reconstr Surg 120(7):33S–39S

    PubMed  CAS  Google Scholar 

  44. Cunningham BL, Lokeh A, Gutowski KA (2000) Saline-filled breast implant safety and efficacy: a multicenter retrospective review. Plast Reconstr Surg 105(6):2143–2149

    PubMed  Article  CAS  Google Scholar 

  45. Walker PS, Walls B, Murphy DK (2009) Natrelle saline-filled breast implants: a prospective 10-year study. Aesthet Surg J 29:19–25

    PubMed  Article  Google Scholar 

  46. Araco A, Gravante G, Araco F et al (2007) Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients. Aesthet Plast Surg 31(4):325–329

    Article  CAS  Google Scholar 

  47. Collis N, Sharpe DT (2000) Silicone gel-filled breast implant integrity: a retrospective review of 478 consecutively explanted implants. Plast Reconstr Surg 105:1979

    PubMed  Article  CAS  Google Scholar 

  48. Collis N, Sharpe DT (2000) Recurrence of subglandular breast implant capsular contracture: anterior versus total capsulectomy. Plast Reconstr Surg 106:792

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

The authors thank Dr. T. Roderick Hester, Dr. Foad Nahai, Dr. Farzad Nahai, and Paces Plastic Surgery for allowing the use of patient data in this study.

Conflict of Interest

M. A. Codner has served as a consultant to Mentor Worldwide LLC. He has also received educational grants from Mentor and receives royalties for books published by Quality Medical Publishing and Elsevier Publishing Company. R. L. Stutman, A. Mahoney, and A. Amei have no conflicts of interest to disclose.

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Correspondence to Ross L. Stutman.

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Stutman, R.L., Codner, M., Mahoney, A. et al. Comparison of Breast Augmentation Incisions and Common Complications. Aesth Plast Surg 36, 1096–1104 (2012). https://doi.org/10.1007/s00266-012-9918-x

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  • DOI: https://doi.org/10.1007/s00266-012-9918-x

Keywords

  • Breast augmentation
  • Breast augmentation incision
  • Breast augmentation complications
  • Capsular contracture