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Howarth et al. Post-mastectomy reconstruction with larger breast implants

reconstructed breasts, and many elected to maintain a approved for use in reconstruction. Larger implants
similar breast volume following their mastectomy. Other will have their own unique risks. Known complications
factors to be considered in the decision regarding the that may be associated with breast implants include,
size of implant used in reconstruction may include but are not limited to, asymmetry, tissue atrophy/
history of radiation or other comorbid conditions such skin necrosis, extrusion, infection, hematoma, ptosis,
as current smoking status and diabetes. Native breast and pain. The specific incidence of these, and other,
shape and degree of ptosis must also be considered. complications associated with large volume implant
These are especially important when trying to achieve use will need to be determined.
symmetry in unilateral breast reconstruction. There are
many reconstructive options available to patients, thus Furthermore, patients with class II or III obesity have
surgeons must aid patients in this decision making an increased risk of surgical morbidity following
process. breast reconstruction of any modality [13] . The risks
of larger implant use in this population should be
A study by Huber et al. [10] reported that women who carefully considered. In our study, women with breast
augmented their native breast volume at the time of volumes greater than 800 g had a mean BMI of 34.0.
reconstruction were more satisfied with their overall BMIs of 30-34.99 are classified by the World Health
reconstructive outcome than those who did not, and Organization as obesity class I [14] . This patient cohort
no increase in complication rate occurred in those who is not at increased risk of surgical morbidity following
augmented their breast volume. For woman with large breast reconstruction [13] .
breasts, low patient satisfaction may be related to the
inability to match native breast volume with a similarly There may be a role for implants larger than 800
sized implant at reconstruction because of current mL for patients undergoing post-mastectomy breast
implant-volume restrictions. Patient-reported outcomes reconstruction in the United States. The FDA has
would provide more insight as to what influences recently approved ATHENA, a clinical trial that will
patients’ initial decisions, if they remain satisfied long- allow patients to select breast implants with larger
term with their choice, and if they would have chosen volumes ranging from 800 to 1445 mL for breast
differently had a larger implant been available at the reconstruction. Patient preferences and outcome goals
time of their reconstruction. will continue to guide reconstructive efforts. Future
studies on satisfaction and complication rates will
Women may have asymmetry between native breast allow us to better counsel our patients and assist them
volumes. Those who underwent unilateral mastectomy in their decision making.
with implant based reconstruction likely desired their
reconstructed breast to appear similar in size and DECLARATIONS
volume to their native breast. This would affect their
choice in implant size.
Acknowledgments
Our study is limited by the lack of patient-satisfaction The authors would like to thank Mark Todd, PA
data for our patient population. However, it was (Department of Laboratory Medicine and Pathology,
not designed to evaluate this aspect of breast Mayo Clinic AZ) and Dr. Robert Bernard (Associate
reconstruction. To investigate this further, we would Professor of Surgery at the University of Arizona
use an outcome measurement tool, such as the College of Medicine and an Adjunct Assistant
BREAST-Q questionnaire (Memorial Sloan Kettering Professor of Plastic Surgery at Mayo Clinic AZ) for
Cancer Center). Future studies could investigate the their invaluable assistance with this manuscript.
relationship between patients’ preoperative decisions
and postoperative satisfaction scores. For example, Authors’ contributions
how many patients would have selected an implant Abstract and manuscript author, data collection: A.L.
with a volume > 800 mL if they had that option Howarth
available to them at the time of their reconstruction? Substantial data collection, manuscript review: A.M.
This will be especially informative when patients have Rodriguez
the option to match their native breast volume to Abstract writing and data collection, manuscript review:
breast implant volumes as large as 1445 mL. V. Gargya
Substantial data collection, manuscript review: H.D.
In addition to satisfaction data, future studies will Lucas
investigate complication rates to ensure that larger Primary investigator, original idea, manuscript review:
implants are as safe and effective as those currently R.C. Mahabir

Plastic and Aesthetic Research ¦ Volume 4 ¦ December 29, 2017 217