AESTHETIC OUTCOME OF BREAST IMPLANT REMOVAL IN 85 CONSECUTIVE PATIENTS

As we began to see increasing numbers of women concerned about their g el-filled breast implants, we became aware that we could not advise th em with any degree of confidence what they might expect in terms of ae sthetic result after implant removal. We decided to review the records and outcomes over a 2-year period of a number of patients who underwe nt implant removal. Eight-five consecutive patients were reviewed, 69 of whom had undergone cosmetic augmentation and 16 of whom had breast reconstruction with silicone gel implant(s). Thirty-nine of the 69 cos metic augmentation patients had removal of implants alone, and 27 had removal accompanied by mastopexy. Three had reaugmentation with saline -filled implants; one had replacement with saline-filled implants. Fif teen of the 16 reconstruction patients underwent autogenous tissue tra nsfer. Preoperative and postoperative photographs of all patients were mixed randomly and rated by two independent raters in four aesthetic categories on a five-point scoring system. Repeatability was measured several weeks later, when each rater scored randomly selected photogra phs from this patient pool. The patients also performed their own outc ome evaluations by means of questionnaire. We discovered that cosmetic augmentation patients who undergo implant removal only often suffer a dverse aesthetic results. The postremoval appearance of many cosmetic augmentation patients actually will be improved over their preoperativ e appearance when mastopexy is performed in conjunction with implant r emoval. the study demonstrated that patients with certain body types c ould expect a particular outcome; i.e., women with asthenic builds and older patients with lax, striated breast skin generally had unsatisfa ctory aesthetic outcomes with implant removal only. Patients selected for autogenous breast reconstruction had favorable results, with exten ded latissimus dorsi and TRAM flaps yielding equally good outcomes. Th e study allows us to offer patients an optimistic view of postoperativ e results following breast implant removal. We have begun to advise se lected patients that implant removal accompanied by mastopexy provides a more pleasing aesthetic outcome than implant removal alone.