What Is the Ideal Time Period for Preoperative Saline Deflation in Revisional Breast Surgery?

What is the Ideal Time Period for Preoperative Saline Deflation in Revisional Breast Surgery?

Goals/Purpose:

Preoperative saline deflation is a clinically useful intervention in secondary breast surgery.  It allows recovery of the stretched gland with as much shortening of the suspensory ligaments as possible prior to definitive mastopexy, allows the patient to determine whether she has enough volume to suit her desired volume without the use of an additional implant, and makes the definitive mastopexy markings easier to determine.  What is not known is the ideal time period prior to secondary surgery to perform deflation and the changes that occur in the interim.  We report our experience with preoperative deflation prior to secondary breast surgery.

Methods/Technique:

Our standard procedure is to deflate saline implants 4 weeks prior to definitive revisional breast surgery.  At 1 week prior to surgery, the patient is evaluated to determine the final operative plan including need for implants, mastopexy and adjunctive procedures such as fat grafting.  Thirty one patients underwent preoperative saline deflation prior to revisional breast surgery over a 10 year period.  A subset of these patients underwent three dimensional imaging to determine the change in volume and shape over the 3 week period of deflation. Complications including recurrent ptosis, infection, hematoma, wound healing difficulties, capsular contracture, desire for size change were recorded.

Results/Complications:

31 patients underwent 33 revisional breast surgeries: 8 patients were revised without the use of implants, with 2 undergoing concurrent mastopexy, 2 with fat grafting, 3 with mastopexy and fat grafting, and 1 had additional reduction, mastopexy, and fat grafting.  25 required the use of an additional implant: 6 had replacement with a smaller implant, 15 had augmentation mastopexy, 2 had augmentation mastopexy and fat grafting, 2 had addition/subtraction mastopexy and fat grafting (Table 1).  The subset with 3D imaging showed an average 22.9% and 17.8% increase in volume (right and left breast, respectively) over the 3 weeks of deflation (Table 2, Figure 1-3).  After an average follow up of 447 days (1.2 years), there were 2 complications.  One patient had unilateral deflation requiring replacement, another had a wound dehiscence that resolved with wound care. 

Conclusion:

Breast volume appears to increase after saline implant deflation in the interval three weeks prior to reoperation.  A possible explanation for this is recovery of the suspensory ligaments and parenchyma that have previously been stretched by the implant, with resultant expansion of the gland back to its pre-augmented volume.  This phenomenon is important to note prior to secondary breast surgery.  We find that a four week period is optimal for the gland to normalize prior to definitive correction.  Ideal candidates for this technique are patients requiring secondary mastopexy without implants and secondary augmentation mastopexy.  Preoperative saline deflation is a useful preoperative tool to facilitate planning in reoperative breast surgery.

Table 1.  Types of Revisional Breast Surgeries

Procedure	Number
Removal and mastopexy	2
Removal and fat grafting	2
Removal, mastopexy and fat grafting	3
Removal, reduction, mastopexy, fat grafting	1
Replacement with smaller implant	6
Augmentation mastopexy	15
Augmentation mastopexy and fat grafting	2
Addition/subtraction mastopexy and fat grafting	2

Table 2. Three Dimensional Imaging Volumes

Patient	Pre-Deflation (T1)		Immediately Post Deflation (T2)		1 week Preop (T3)		Percent change between T3 and T2
	Right	Left	Right	Left	Right	Left	Right	Left
1	481.7	571.4	127.2	220	141.9	208.2	11.6%	-5.3%
2	430.9	800.8	298.6	315.7	362.5	350.2	21.4%	10.9%
3	567.4	492.4	199.8	181.5	285.1	209.2	42.7%	15.2%
4	595.7	649.6	114.2	106	132.5	159.5	15.9%	50.4%
Average							22.9%	17.8%