Abstract: Implant-Based Breast Reconstruction In Previously Augmented Patients (Plastic Surgery 2012)

Sunday, October 28, 2012: 9:10 AM

Jason Roostaeian, MD , UCLA Medical Center, Los Angeles, CA

Ivan S Sanchez, BS , UCLA Medical Center, Los Angeles, CA

Paymon Rahgozar, MD , UCLA Medical Center, Los Angeles, CA

Charles Galanis, MD , UCLA Medical Center, Los Angeles, CA

Christopher Crisera, MD , UCLA Medical Center, Los Angeles, CA

Andrew Da Lio, MD , Los Angeles, CA

Jaco H. Festekjian, MD , UCLA Medical Center, Los Angeles, CA

Presentation PDF file

Purpose: It is estimated that more than 2 million women have undergone augmentation mammaplasty in the United States. As breast cancer continues to be the most common non-cutaneous malignancy in women, reconstructive surgeons will inevitably encounter patients with breast cancer that have had prior augmentation. Implant-based techniques represent the most common form of breast reconstruction currently practiced. The purpose of this study is to evaluate the outcomes of implant-based reconstruction in previously augmented women.

Methods: All patients who underwent immediate implant based breast reconstruction between 2004 and 2009 were reviewed. Patients with a history of prior augmentation (PA)(n = 38) were compared to a randomly selected cohort of patients with no prior augmentation (NPA)(n = 77) over the study period. Demographic variables, augmentation details, reconstruction type (immediate implant versus tissue expander), complication rates, and revision rates were evaluated.

Results: Demographic variables and surgical risk factors were noted to be similar between the two groups. At a mean follow-up of 15 months, overall complication rates were similar at 21.1% in the PA group versus 22.1% NPA (p-value = 0.85). Previously augmented patients did, however, trend toward higher capsular contracture rates at 15.8% versus 6.4% in the NPA group (p-value = 0.10). The need for revision surgery was found to be greater in the PA group compared to the NPA group (37.5% vs 14.8% p-value < 0.00). Subgroup analysis for this comparison revealed higher rates of secondary revision for asymmetry and contour deformity requiring fat grafting in PA vs the NPA group (p-values = 0.05 and 0.05 respectively).

Conclusion: Implant-based breast reconstruction is a safe option for previously augmented patients that are able to provide outcomes that are largely similar to non-augmented reconstruction patients. Previously augmented patients, however, should be counseled that they may have higher rates of capsular contracture and more frequently require an additional operation for revision when undergoing prosthetic reconstruction.

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