Breast Striae Following Cosmetic Augmentation

Friday, April 12, 2013
Tsung-Lin Tsai, MD, Plastic Surgery, University of Texas Medical Branch, Galveston, TX and Clayton Moliver, M.D., F.A.C.S., Plastic Surgery, University of Texas Medical Branch, Webster, TX
Goals/Purpose:

Breast Augmentation is the number one cosmetic procedure performed in the United States with 301,180 performed in 2011.  As aesthetically pleasing breasts are highly sought after in society, any complications can be significantly disappointing for both the patient and the surgeon.  A known but not completely understood complication from breast augmentation is striae or stretch marks post-operatively.  To date, only one publication had described the incidence and risk factors of striae following breast augmentation; all other reports have been case studies.  We wanted to investigate our own patient population to discern if there were other risk factors for new onset striae following cosmetic breast augmentation.

Methods/Technique:

A retrospective chart review was performed for patients undergoing primary breast augmentation for cosmetic purposes from 2005 to 2012 in a single surgeon practice.  It was noticed that only patients 25 and younger were susceptible to the formation of new onset breast striae; therefore, only the population of patients 25 or younger were investigated.  Potential risk factors examined include age, body mass index (BMI), oral contraceptive use (OCP), last menstrual period (LMP), parity, smoking or alcohol status, diabetes, and history of striae.  Surgical and implant factors were also examined including silicone vs. saline, volume of implant, saline implant size and actual fill volume, incision, and pocket (subglandular vs. submuscular).

Results/Complications:

Out of a total of approximately 1500 bilateral breast augmentations, 549 patients 25 years old and younger were included in this study.  In 17 cases (3.10%), new onset striae after breast augmentation was observed.  The risk of new onset breast striae was noted to be statistically significant among the following groups of patients: patients who are younger aged, nulliparous, with history of striae, or last menstrual period (LMP) over 14 days before surgery (p < 0.05).  Although not statistically significant, there was a strong positive correlation of breast striae in patients comparing implant size vs BMI (p = 0.07)

Conclusion:

In this study, we found new onset breast striae in 3.10% of our patients aged 16 – 25 years old.  Literature has shown that striae formation may be related to estrogen levels, hormonal levels as well as other potential factors resulting in degranulation of mast cells.  Our investigation shows there is significant positive correlation with hormonal influences, especially growth hormone and estrogen levels.  We only found striae in patients aged 25 or younger, which equates with studies that have shown growth hormone levels at the highest below age 25, decreasing significantly from that age.  Most significantly, all of the patients with striae had their LMP over 14 days prior to surgery, placing their surgery dates within the second half of the menstrual period where it is known that progesterone levels are the highest.  We also found a positive correlation with nulliparous patients.  The results from this study suggest that there is a positive relationship between hormonal balance or levels and new onset breast striae formation in patients undergoing cosmetic breast augmentation.