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Table 3: Management of early complications
Procedure (n) Hematoma Periprosthetic/wound infection Wound breakdown
Surgical Conservative Surgical Conservative Surgical Conservative
Group A (1,298) 2 10 6 2 0 14
Group B (108) 0 0 0 4 0 7
Table 4: Reasons for revisions in augmentation
mammoplasty group
Reason for revision n (%)
Capsular contracture 4 (0.3)
Hematoma 3 (0.23)
Explantation and replantation later for infection 3 (0.23)
Debridement, curettage, lavage and 3 (0.23)
immediate implant replacement for infection
Explantation without replacement 2 (0.15)
Bottoming out unilateral 1 (0.07)
Explantation with mastopexy 1 (0.07)
Bottoming out bilateral 1 (0.07)
Table 5: Reasons for revision surgery in mastopexy
with augmentation
Reason for revision n (%)
Dog ear bilateral 2 (16.7)
Dog ear unilateral 2 (16.7) Figure 4: (a-c) A patient presenting with bilateral Grade IV capsular
Areolar scar revision 2 (16.7) contracture following augmentation mammoplasty; (d) explanted implant
Periareolar to vertical scar conversion 2 (16.7) showing bilateral fold flaw failure; (e-g) three months postoperative
pictures following bilateral capsulectomy and change of prosthesis using
Nipple level asymmetry 1 (8.3) 460 mL textured round cohesive gel silicone implants
Capsular contracture 1 (8.3)
Vertical scar revision 1 (8.3) neo-NAC positioning, either too low or too high, also may
Bottoming out 1 (8.3) result in persistent ptosis or bottoming out. In authors
[21]
experience, use of periareolar markings should ideally be
mastopexies were performed using vertical scar with
superomedial flaps. There was a revision rate of 20.5%, limited for unilateral mastopexy with asymmetrical nipple
after augmentation mastopexy, 10.7% in augmentation, and areolar level and with a difference of not more than 2 cm
[19]
24.6% in mastopexy alone. Again the results support the or patients presenting with early ptosis with an NAC at
argument for a combine procedure than to stage the inframammary crease level. A breast with skin excess in
procedure without an added risk of higher complication. horizontal excess, a breast with a wide base, or a breast with
When the procedure is staged, the second operation lower pole skin excess, periareolar skin excision from above
rate is 100%, with two visits to hospital, two costs of the nipple does not address the tissue excess and result
individual procedures, and two lots of recovery time from in less than optimal outcome. Bottoming out following
each procedure. mastopexy using vertical scars in patients presenting more
than 9 cm distance from nipple to inframammary crease is
Late complications following simultaneous mastopexy a common observation. Nipple elevation to another few
with augmentation mammoplasty and augmentation centimeters results in increased and above average nipple
mammoplasty are mostly implant-related and include to inframammary crease length leading to bottoming
capsular contracture, rippling, and device failure. The out. Vertical scar markings selection for all mastopexies
complications related to implants are not unique to each or augmentation mastopexies as all-season markings is
individual procedure and are shared between the two. The a novel idea but should be used with caution. Lower pole
revision for capsular contracture being the most common redundancy or persistent ptosis has been reported in 28%
reason for reoperation in both these groups [Figure 4]. In of all the mastopexies when vertical scar mastopexy alone
[19]
general, capsular contracture and device failures are time was used for all types of mastopexies. Other published
dependent and longer the follow-up, higher the incidence studies also have shown that use of periareolar mastopexy
resulting in revision surgery. or vertical scars markings was one of the leading cause for
revision surgery in this group of patients. [22,23]
Rippling in the lower pole is almost unavoidable and largely
depends on the type of implant and existing breast envelope The current article did not include authors own mastopexy
thickness. Breast augmentation in subglandular pocket, alone revision rate and results. Therefore, based on the study
regardless of the preoperative tissue thickness, tends to have design, our conclusion has limitation. However, previously
a higher revision rate for rippling due to the ever-changing published data of mastopexy alone has been used, and our
breast envelope thickness. One very important tissue- data correlate with what has been published. Furthermore,
[20]
related and avoidable complication following augmentation there was no patient satisfaction survey included that
mastopexy is the siting of nipple and the choice of the would have indeed added strength to the outcome analysis.
markings. Choice of marking can vary from 65% areolar to
100% vertical scar markings. [18,21] Inappropriate marking for In conclusion, there was a statistically and clinically
Plast Aesthet Res || Vol 3 || Issue 1 || Jan 15, 2016 29