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Reducing the Complications of Breast Augmentation Surgery

According to the American Society of Plastic Surgeons, more than 219,800 women had their breasts augmented in 2001 and the demand for this procedure has continued to rise. Yet, there are risks or complications associated with any surgical procedure, such as the effects of anesthesia, infection, swelling, redness, and bleeding; in addition, there are complications specific to breast implants. Breast surgeons have attempted to reduce those complications. A new methodology for breast augmentation with saline-filled breast implants has been shown to reduce local complications significantly, as well as to reduce the incidence of repeat surgeries (according to a study presented 11/03 at the ASPS/PSEF/ASMS 71st Annual Scientific Meeting in San Antonio). While previous studies have noted reoperation rates of 20 to 25%, this new study methodology (performed on 287 patients) reduced the reoperation rate significantly to 10%.

Designed by study author Leroy Young, MD, this new methodology addresses the three most common reasons for reoperation: changing the breast implant size, improving the "natural feel" of the breast, and minimizing capsular contracture. The most common reason for reoperation is to change cup size. To ensure patients chose the right breast implant size before their first surgery, women were encouraged to see how different breast sizes would look on their body type rather than simply to request the cup size the patient believed they wanted. Ironically, seven to ten women in the US wear the wrong bra size and are not aware of their current, correctly measured size. As part of this study, women were measured to determine their preoperative bra sizes. Then, using an extensive photo library, patients were asked to locate photos of women who matched their body type and assess which photograph had the breast size the patient desired. This allowed the patients to visualize how they might look physically after augmentation.

The second most common reason for breast implant reoperation is to improve the "natural feel" of the breast. To address this complaint, physicians in the study used only smooth implants. Compared to textured ones, the smooth implants wrinkle less underneath the skin, giving the breasts a more natural feel.

The third most common reason for breast implant reoperation is to treat capsular contracture, an unpredictable complication that occurs when naturally forming scar tissue around the implant tightens and squeezes it. To reduce the risk of this complication, physicians participating in the study followed a "no-touch" technique. The no-touch method included meticulously rewashing surgical gloves before handling any instrument and the implant. In addition, only the head surgeon touched the implant, using a special Teflon cutting board and immediately placing the implant underneath the muscle. All of these procedures helped ensure that no foreign materials attach themselves to the implant, which could inflame the surrounding tissue and cause complications.

Women who are considering breast augmentation surgery should discuss all of the potential risks-including the risk of reoperation-with their surgeons. In addition, women considering this procedure should ask their surgeons if they have adopted these risk reducing surgical methodologies into their practices.

Created: 2/19/2004  -  Donnica Moore, M.D.

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