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with augmentation mammoplasty. [15] alone as compared to 19.4% reoperation rate in Mentor 6
years core data. [6,18]
Periprosthetic infection rate has been reported for
primary and secondary mammoplasties, respectively. [2,16] Earlier concerns about the safety of the procedure with
Wound breakdown of varying degree was less common exponential complication and revision rate were further
inaugmentation mammoplasty as compared to augmentation reviewed by Swanson in a prospective study in which
mastopexy [Figures 1 and 2, Table 2]. consecutive cases of augmentation mammoplasty,
simultaneous augmentation mastopexy, and mastopexy
In current series, periprosthetic and wound infection were
seen less commonly in augmentation mammoplasty when alone were analyzed. A single surgeon did all procedures,
compared with augmentation mastopexy [Figure 3, Tables 2 all implants were placed in a submuscular pocket, and all
and 3].
Implant size selection is an important part of the surgery,
especially when a vertical scar or wise pattern markings
are used for primary mastopexy augmentation [Table 1].
The skin envelope reductions in later two procedures
limit the size of the implants in primary procedures and is
due to the direct pressure and tension on newly sutured
wounds exerted by expanded skin envelope.

The high number of complications or revision rate in
combined augmentation with mastopexy is not exponential
as reported in the past. The simple reason is that,
[15]
in patients with augmentation mammoplasty alone, the Figure 1: (a) Preoperative picture of a patient interested in augmentation
known early complications are infection and hematoma mammoplasty; (b) postoperative picture showing left inframammary
[Table 4]. In this group, nipple areolar complex (NAC) size wound break down 4 weeks following augmentation mammoplasty when
and level asymmetry, NAC level under or over positioning, 300 mL round textured cohesive gel silicone implants were used; (c)
completely healed wound following conservative treatment; (d) final result
ischemia and necrosis of nipple, loss of nipple sensation, 3 months following augmentation mammoplasty
skin and wound breakdown, and scar-related complications
are not seen [Table 5]. Similarly, when a mastopexy alone is
performed, capsular contracture, implant rupture, revision
for size change, rippling, change for size, or other device-
related complications are not the reason for revision
surgeries. When the two are combined together, the
incidence is likely to be higher than the single component
performed separately. A long-term follow-up has shown a
revision rate of 15.5% when silicone gel round textured
implants were used alone, and a long-term tissue-related
[9]
revision rate of 8.6% is reported when mastopexy alone
was performed. A revision rate of 10% and 25.8% has
[11]
been shown in simultaneous augmentation mastopexy. [11,17]
Although the revision rate in augmentation mastopexy
is statistically significant, the increased rate of revision is Figures 2: (a) Two weeks following simultaneous mastopexy with
simply the sum of the two individual components. augmentation using 230 mL low profile round textured cohesive gel
silicone implants showing left partial nipple necrosis; (b) right vertical scar
In a retrospective study performed by Calobrace, it was breakdown in the same patient; (c) postoperative pictures taken 4 months
following conservative treatment with regular change of dressings and
reported that tissue-related reoperation rate in combined wound cleansing
procedures was 13.6% as compared to 10.2% for
mastopexy alone. Whereas the implant-related reoperation
rate was only 9.6% when the procedure was performed
Table 2: Complications between the two groups
Group A Group B P
(1,298) (%) (108) (%)
Wound breakdown 14 (1.1) 7 (6.5) 0.001
Hematoma 12 (0.9) 0 -
Revision surgery 18 (1.4) 12 (11.1) 0.001
Grade IV capsular 4 (0.3) 1 (0.92)
contractures Figure 3: (a) Postexplantation picture of a patient who developed right
Periprosthetic/wound 8 (0.6) 4 (3.7) 0.010 periprosthetic infection following augmentation mammoplasty; (b) results
following reimplantation using 360 mL round textured cohesive gel silicone
infection implants 6 months after explantation
28 Plast Aesthet Res || Vol 3 || Issue 1 || Jan 15, 2016