Background:

As the number of single stage augmentation/mastopexy procedures increases, the debate as to whether or not to stage the procedures continues due to the paucity of outcomes reviews.  The purpose of our study is to evaluate our experience with primary single-stage augmentation/mastopexy patients to determine frequencies and types of complications.  Secondarily, we identify patient demographics or surgical variables that may predict complications; we review data from a patient questionnaire to assess patient satisfaction, and we evaluate the added cost to our patients who experience a complication.

Methods:

177 patient charts from a four-surgeon group were retrospectively reviewed.  All patients underwent primary single-stage augmentation/mastopexy over a seven-year period.  Patient demographics included: age, body mass index, smoking status, American Society of Anesthesiologists (ASA) physical status score, Regnault ptosis grade, suprasternal notch to nipple (SSN-N) and inframammary fold to nipple (IMF-N) distances.  Surgical variables included: type of mastopexy (circumareolar or vertical), implant position/type/surface/volume, and the year of operation.  Major complications were defined as those requiring a subsequent operation while minor complications were managed conservatively.  Patient survey data was gathered via a telephone based questionairre.  SASñ (SAS Institute Inc., Cary, North Carolina) statistical analysis software was applied.  Categorical data was analyzed using chi-square; step-wise logistic regression examined adjusted associations of baseline factors as to the likelihood of complications.  Fischer's exact test look at the distributions of responses to survey questions for patient satisfaction in relation to complication.   Finally, a Mann-Whitney-Wilcoxon test examined distributions of resource costs (fee calculated from the sum of the operating room cost, anesthesia fee, surgeon's fee, and implant cost) to the patients according to complication status.

Results:

 The overall major and minor complication rates were 11.8% and 14.1%, respectively.  Both the ASA and vertical mastopexy group frequencies of minor complications were significant (p < .01).  Stepwise logistic regression demonstrates a 3.34 times increased likelihood of the vertical mastopexy group developing a minor complication and a 3.44 times increased likelihood of patients with a preoperative ASA ³ 2 having a minor complication.   Increases in BMI, ptosis grading, SSN-N and IMF-N distances demonstrated a rise in clinical frequencies of complications, with chi-square analysis of the IMF-N distribution statistically significant at p < 0.01.  Neither implant location, volume, surface or type were statistically significant independent risk factors for increased complications.  There were 105 respondents (59%) to the follow-up questionairre.  90% were either satisfied or extremely satisfied with respect to grading their overall results and to whether surgery met their goals.  Those patients who experienced any complication were significantly more dissatisfied (p < .01).

The median resource cost for patients who experienced a major complication versus those without a complication rose by $765; and those who experienced a minor complication incurred an additional $485 (p < .001).

Conclusions:

 Single-stage augmentation mastopexy can be performed with a relatively low incidence of both major and minor complications.  The results of this study highlight factors for both the surgeon and patient to be aware of in the pre-operative consultation that may help to set appropriate expectations.