Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

Abstract

<b><i>Introduction:</i></b> Capsular contracture most often leads to implant revision surgery for aesthetic or reconstructive purposes. However, little is known about which operation is chosen when revision surgery has to be performed. We performed analysis of revision indications and performed revision surgery considering implant removal or replacement and additional surgical procedures. To our knowledge, this study presents the largest German single-center analysis regarding implant revision surgery after the onset of complications. <b><i>Methods:</i></b> Retrospective 10-year data analysis of a single-center population undergoing breast implant revision surgery. <b><i>Results:</i></b> Capsular contracture was the most frequent finding before reoperation, both removal and replacement (<i>p</i> < 0.05). It was linked to longer duration of in situ implant placement (<i>p</i> < 0.05) and more frequently in reconstructive patients (<i>p</i> < 0.05). Implant replacement was performed more often before definite implant removal for reconstructive patients (<i>p</i> < 0.05). Mean duration of in situ implant placement before definite removal was lower for reconstructive patients (<i>p</i> = 0.005). Overall reconstructive patients were older than aesthetic patients (<i>p</i> < 0.05). After implant removal, 61.7% of aesthetic patients chose to undergo mastopexy, 54.7% of reconstructive patients opted for autologous breast reconstruction, and 25.4% did not choose an additional surgical procedure after implant removal. <b><i>Conclusion:</i></b> Significant differences are observed for reconstructive and aesthetic patients regarding indication leading to revision surgery, time of revision surgery, and the type of performed revision surgery itself. After implant removal, more than 60% of aesthetic patients undergo mastopexy, more than half of reconstructive patients choose autologous breast reconstruction, and over a quarter of patients choose no additional surgical procedures.

What Can We Learn from Breast Implant Explantation: a 28-Year, Multicenter Retrospective Study of 1004 Explantation Cases

“…In our study, CC accounted for a higher proportion in revision augmentation implant removed cases, the possible reason for this being that the repeated implant removal and placement affects local tissue conditions, leading to a greater susceptibility to CC (40.6% versus 16.5%). The published literature so far shows a higher incidence of CC in revision breast augmentation than in primary breast augmentation, with an incidence of 18.9% in primary augmentation and 28.9% in revision augmentation [ 26 , 30 – 33 ], which is consistent with our speculation. A comparison of primary breast augmentation versus revision augmentation on CC incidence is not achievable from our data, but it provides strong support for such conclusion.…”

Simultaneous Salvage Auto-augmentation: Contemporary Strategy for Management of the Breast Explantation Patient

“…This indicates the importance of a reconstructed breast after implant complications or implant revision surgery, as reflected by numerous studies examining positive body image and quality of life after breast reconstruction. 39–43…”

“…This indicates the importance of a reconstructed breast after implant complications or implant revision surgery, as reflected by numerous studies examining positive body image and quality of life after breast reconstruction. [39][40][41][42][43] Swanson 44 stated that a constellation of systemic symptoms known as "breast implant illness" has motivated many women to have their implants removed (this term replaces the old description "human adjuvant disease," which was similarly challenging to define). 1 The role of capsulectomy is unclear in this patient group because there is no known physical cause for this entity.…”

Conversion to Autologous Breast Reconstruction with Latissimus Dorsi and Immediate Fat Grafting in Patients with Previous Implant Failure: An Efficient, Reproducible, and Safe Technique

“…It seems paradoxical that with IBBR being the most frequent method of breast reconstruction, even more so in the context of the increasing indication of radiation therapy, there is little published evidence on this aspect of breast reconstruction. 19 Based on our own data and other published studies, it can be observed that, even today, there are patients who undergo a mastectomy without being fully informed of the pros and cons of the different reconstructive methods, especially in the cases with radiotherapy. The association between IBBR and radiotherapy has shown failure rates of close to 50%.…”

“…It seems paradoxical that with IBBR being the most frequent method of breast reconstruction, even more so in the context of the increasing indication of radiation therapy, there is little published evidence on this aspect of breast reconstruction. 19 …”