AESTHETIC MANAGEMENT OF THE BREAST FOLLOWING EXPLANTATION - EVALUATION AND MASTOPEXY OPTIONS

This retrospective study reviews 720 patients referred for evaluation of their silicone gel-filled breast implants from December of 1992 to January of 1996. Of the 720 patients evaluated, 282 (39.2 percent) sub sequently underwent explantation, and 59 of these patients (20.9 perce nt) had a breast contouring procedure per-formed at the time of explan tation. Our definition of explantation is the operative removal of the implant as well as the implant capsule. The overall complication rate for explantation was 5 out of 282 patients (1.8 percent), whereas the rate of complication among the patients who underwent simultaneous br east contouring was 2 out of 59 patients (3.4 percent). This article p resents the management of the breast following explantation, implant r emoval, and capsulectomy. We review both the preoperative assessment o f patients seeking explantation and our technique of explantation. Add itionally, we address the importance of preoperative breast ptosis in technique selection and have developed a practical clinical algorithm for guiding simultaneous explantation and breast contouring. We also i dentify those patients who should undergo delayed breast contouring du e to associated risk factors (smoking, need for >4 cm of nipple moveme nt, and paucity of breast parenchyma.