Augmentation/Mastopexy after Massive Weight Loss: A Temporal Outcomes Analysis
Massive weight loss (MWL) patients lacking autologous tissues often utilize implant augmentation for breast enlargement. Anecdotally, many surgeons report problems with implant malposition in this population due to poor skin quality and a weak inframammary fold. Several prior studies have few MWL patients in their cohort, or fail to differentiate them from an entire cohort. Our aim is to report on temporal relationships of outcomes, including implant malposition and recurrent ptosis, in the largest series to date of MWL patients undergoing augmentation/mastopexy.
Methods/Technique:
A retrospective review from 2003-2011 was performed to record age, BMI indices, operative details, implant characteristics, implant malposition, and recurrent ptosis of the MWL population undergoing augmentation/mastopexy.
Results/Complications:
30 MWL patients were reviewed. Mean age of the patients was 44.8±8.5 years; mean Current BMI was 26.1±3.9 kg/m2; mean follow-up time was 243.6 days. Preoperatively, MWL patients presented with 3% Grade 0 ptosis, 23.3% Grade 1, 10.0% Grade 2, and 63.3% Grade 3 ptosis. Five (16.7%) MWL patients developed recurrent ptosis within the first 3 months after surgery, with no increase in cases after this time frame. Implant malposition, however, increased as time went on, with 13 (43.3%) eventually experiencing implant malposition within 12 months. Significant differences existed when comparing incidence of implant malposition at each time interval to one another (<3 month vs. 3-6 month vs. 6-12 month intervals). Implant malposition was found to be significantly associated with a higher Current BMI (27.7±4.1 vs. 24.8±3.4; p = 0.047) and had a trend of increased occurrence with higher age; recurrent ptosis was found to be significantly associated with a higher age (46.6±7.5 vs. 35.8±8.6; p = 0.039) and had a trend of increased occurrence with higher Current BMIs.
Conclusion:
Massive weight loss patients are at a high risk for recurrent ptosis or implant malposition. The incidence of implant malposition increases with time, thus reinforcing the need for appropriate preoperative counseling in this population. Further research to improve outcomes of augmentation/mastopexy in this population is warranted.