Breast SurgeryBreast augmentation is the most popular cosmetic surgical procedure in the United States; 330 631 procedures were performed in 2012.1 Any complication can be a significant disappointment for the patient and the surgeon. A known but incompletely understood complication of breast augmentation is striae distensae, also called stretch marks.Striae are linear dermal scars that form in areas of dermal damage. The histology is similar to that of scar tissue formation, but the exact origin is still unknown. Investigators have hypothesized that these scars are precipitated by an inflammatory reaction that destroys collagen and elastic fibers, with ensuing regeneration in the direction of the mechanical forces. This results in flattening and atrophy of the epidermis. Many theories have been suggested to explain the etiology of striae formation, including infection, effects of mechanical stretching, hormonal influences, genetic factors, immunosuppressed states, and chronic liver disease. Objectives: The authors investigated their own patient population to discern risk factors for new-onset striae after cosmetic breast augmentation. Methods: A retrospective chart review was performed for patients who underwent primary breast augmentation from 2005 to 2012 in a single-surgeon practice. Initial chart review revealed that only patients aged ≤25 years exhibited new striae; therefore, only patients from this age group were included. Potential risk factors examined included age, body mass index (BMI), oral contraceptive use, time of last menstrual period (LMP), parity, smoking and alcohol status, diabetes mellitus, and personal history of striae. Implant and surgical factors examined included implant material (silicone vs saline), volume, and location (submuscular vs subglandular placement) and the site of incision. Results: Of the 549 patients included in the study, 17 (3.10%) had new-onset striae, observed at a mean of 58 days postoperatively. The risk of striae was statistically significantly higher (P < .05) among patients who were younger (3.3 times), were nulliparous (14.38 times), began their LMP >14 days before surgery (9.24 times), and had a history of striae (6.11 times). There was a strong correlation between new-onset breast striae and implant size, as well as BMI (P = .07). Conclusions: There is a strong correlation between new-onset striae and hormone levels, genetic factors, and tissue stretch components in patients who undergo cosmetic breast augmentation. This information can be utilized to better educate patients about this potential complication.
Level of Evidence: 4
