COMPLICATIONS LEADING TO SURGERY AFTER BREAST IMPLANTATION

Background Local complications that require additional surgical proced ures are an important problem for women with breast implants. Methods We studied 749 women who lived in Olmsted County, Minnesota, and recei ved a first breast implant at the Mayo Clinic between 1964 and 1991. W e identified complications that occurred after the initial procedure a nd after any subsequent implantation. A complication was defined as a surgical procedure performed for any of the following reasons: capsula r contracture; rupture of the implant; hematoma or bleeding; infection or seroma of the wound; chronic pain; extrusion, leakage, or sweating of the implant; necrosis of the nipple, areola, or flap; malfunction of the filler port of a tissue expander; and wound dehiscence. Results During follow-up (mean, 7.8 years; range, 0 to 25.8), 208 (27.8 perce nt) of the women underwent 450 additional implant-related surgical pro cedures. Ninety-one (20.2 percent) were anticipated, staged procedures or were done because the patient requested a size change or aesthetic improvement, and 359 procedures (79.8 percent) had at least one clini cal indication (thus constituting a complication). Complications occur red in 178 (23.8 percent) of the 749 women and involved 274 (18.8 perc ent) of the 1454 breasts with implants and 321 (18.8 percent) of the 1 703 implants. The most frequent problem was capsular contraction (131 women), followed by implant rupture (43 [5.7 percent]), hematoma (43), and wound infection (19). The rate of complications was significantly lower (P<0.001) among women with cosmetic implants (6.5 percent at on e year, 12 percent at five years) than among those who received implan ts after mastectomy for breast cancer (21.8 percent at one year, 34 pe rcent at five years) or prophylactic mastectomy (17.3 percent at one y ear, 30.4 percent at five years). Conclusions Women who have had breas t implantation frequently experience local complications during the su bsequent five years. Complications were significantly less frequent am ong patients who received implants for cosmetic reasons than among tho se who received implants after mastectomy for cancer or for cancer pro phylaxis. (C) 1997, Massachusetts Medical Society.