Breast augmentation with silicone implants performed without drainage – retrospective analysis of 726 cases

Nenad Stepić; Jovana D Končar; Milica Rajović; Marijan Novaković

doi:10.2298/VSP151115171S

Nenad Stepić Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
Jovana D Končar Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
Milica Rajović Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia
Marijan Novaković Clinic for Plastic Surgery and Burns, Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP151115171S

Keywords: mammoplasty, breast implants, drainage, postoperative complications,

Abstract

Background/Aim. Breast augmentation has been one of the most popular aesthetic procedures. Early complications, like infection, seroma, hematoma and capsular contracture like ones of the most frequent long term complications, might be related to wound drainage. The aim of the study was to investigate the rate of the complications of breast augmentation procedure performed without drainage. Methods. Retrospective analysis of all patients who had underwent breast augmentation in the period of 2003–2013 was performed. From the medical history of the patients, data related to their demographic characteristics, surgical technique and the rate of complications were collected. Wound drainage had not been used in any of the patients. The patients were followed at the discharge, after 7 days, three months and yearly thereafter. Wound seroma, wound hemathoma, wound infection and capsular contracture were followed. Results. There were 726 patients with the average age of 28.5 (22–48) years. Breast augmentation using silicone implants was performed with inframammary approach using subglandular and submuscular technique. The average implant size was 339 (200–520) cc. Subglandular augmentation had 545 (75%) of the patients while 181 (25%) received an implant in submuscular plane: completely submuscularly in 95/726 (13%) and by dual plane technique in 86/726 (12%) of the patients. In early postoperative period, there were no infection, five (0.7%) seromas and eight (1.1%) hematoma (five of them required surgical evacuation). There was no statistically significant difference between the two surgical techniques in terms of complication rate. During follow-up, there were three (0.4%) capsular contractures. Conclusion. The incidence of complications in our group of patients after breast augmentation is low even though no drainage was used. Still, further randomized trials are needed to prove the role of drainage in prevention of complications after breast augmentation.

References

Czerny V. Plastic replacement of the breast with a lipoma. Chir Kong Verhandl 1895; 2: 216. (German)

Institute of Medicine. Safety of Silicone Breast Implants. Washington, DC: National Academy Press; 1999.

Cronin TD, Gerow FJ. Augmentation mammaplasty: a new “natural feel” prosthesis. In: Broadbent TR, American Association of Plastic Surgeons, American Society of Plastic and Reconstructive Surgeons, International Confederation for Plastic Surgery, editors. Transactions of the Third International Congress of Plastic Surgery; 1963 October 13−18, Washington, DC, U.S.A. Amsterdam: Excerpta Medica Foundation; 1963. p. 41−9.

Biggs T, Yarish RS. Augmentation mammaplasty: a comparative analysis. Plast Reconstr Surg 1990; 85(3): 368−72.

Gutowski KA, Mesna GT, Cunningham BL. Saline-filled breast implants: a plastic surgery educational foundation multicenter outcomes study. Plast Reconstr Surg 1997; 100(4): 1019−27.

Burkhardt BR, Dempsey PD, Schnur PL, Tofield JJ. Capsular Contracture: a prospective study of the effect of local antibacterial agents. Plast Reconstr Surg 1986; 77(6): 919−32.

Gherardini G, Zaccheddu R, Milner SM, El-Shazlyl M, Liapakis I. Breast augmentation with silicone implants: the role of surgical drainage—report on 502 consecutive patients. Eur J Plast Surg 2006; 29(1): 9–12

Araco A, Gravante G, Araco F, Delogu D, Cervelli V, Walgenbach K. Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients. Aesthetic Plast Surg 2007; 31(4): 325−9.

Stojkovic CA, Smeulders MJ, Van der Horst CM, Khan SM. Wound drainage after plastic and reconstructive surgery of the breast. Cochrane Database Syst Rev 2013; 3: CD007258.

Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 2001; 107(5): 1255−72.

Hedén P, Jernbeck J, Hober M. Breast augmentation with anatomical cohesive gel implants. The world’s largest current experience. Clin Plast Surg 2001; 28(3): 531−52.

Elizabeth J. Hall-Findlay. Breast Implant Complication Review: Double Capsules and Late Seromas. Plast Reconstr Surg 2011; 127(1): 56−66.

Handel N, Jensen JA, Black Q, Waisman JR, Silverstain MJ. The fate of breast implants: a critical analysis of complications and outcomes. Plast Reconstr Surg 1995; 96(7):1521−33.

Brickman M, Parsa NN, Parsa FD. Late hematoma after breast implantation. Aesthetic Plast Surg 2004; 28(2): 80−2.

Araco A, Gravante G, Araco F, Delogu D, Cervelli V, Walgenbach K. Infections of breast implants in aesthetic breast augmentations: a single-center review of 3,002 patients. Aesthetic Plast Surg 2007; 31(4): 325−9.

Adams WP Jr, Rios JL, Smith SJ. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 2006;117(1): 30−6.

Chang L, Caldwell E, Reading G, Wray RC Jr. A comparison of conventional and low-bleed implants in augmentation mammaplasty. Plast Reconstr Surg 1992; 89(1): 79−82.

Bengtson BP, Van Natta BW, Murphy DK, Slicton A, Maxwell GP; Style 410 U.S. Core clinical Study Group. Style 410 highly cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg 2007; 120(7 Suppl 1): 40S−8S.