Techniques and Implants in Breast Augmentation after Massive Weight Loss: A Population-Based Study

Massive weight loss (MWL) after bariatric surgery is often associated with alterations in breast morphology, including ptosis, excess skin, poor tissue elasticity, and altered nipple position, which frequently motivate requests for breast surgery. However, data on implant-based augmentation after MWL are sparse and often limited to small series. In this study, the authors compare surgical techniques and implant selection among women undergoing primary augmentation who had or had not undergone bariatric surgery.

The authors conducted a national, population-based case-control study within the Breast Reconstruction After Bariatric Surgery protocol. Patients from both the Scandinavian Obesity Surgery Registry and the Swedish Breast Implant Registry were identified. A control group of women receiving breast augmentation who had not undergone bariatric surgery was created.

A total of 817 postbariatric patients (1634 breasts) and 3512 controls (7023 breasts) were analyzed. Surgery occurred a median of 3.4 years after bariatric surgery. Postbariatric patients reported greater dissatisfaction with breast volume. They more often received larger implants, round shapes, and microtextured, macrotextured, or polyurethane surfaces. Dual-plane or submuscular placement was predominant in both groups, whereas subfascial and subglandular placements were less common in postbariatric patients. Augmentation mastopexy was more frequent, whereas the use of mesh or acellular dermal matrix and lipofilling was rare. Postoperative antibiotics were prescribed more often to postbariatric patients.

Breast augmentation after MWL differs from standard practice, with larger and more textured implants and a higher frequency of mastopexies, highlighting surgical adaptation to complex anatomy.