Breast Envelope Complications After Revision Breast Implant Surgery: A Systematic Review

Revisional surgery for cosmetic breast augmentation involves many factors like ptosis, tissue thinning, and a history of prior surgeries, which can increase the risk of reduced blood flow. There is limited research on breast vascularity in women who have undergone previous breast augmentation. This study reviews current literature on envelope-related complications in patients undergoing revisional aesthetic breast augmentation.

Between October and December 2024, a literature review was carried out in accordance with the PRISMA guidelines, using databases such as Cochrane, Google Scholar, and PubMed/Medline. For each included study, data was recorded on the study type, patient numbers, population details, imaging methods for assessing vascularity, types and numbers of complications, revision types, and outcomes. Additional information on revisional surgery was also collected: reasons for revision, implant placement, implant volume and type, and incision site.

A total of 895 publications were reviewed, with 69 selected based on the initial evaluation. After excluding studies on reconstruction, primary augmentation, and other conditions, 12 studies were chosen, including 10 retrospective case series, 1 non-randomized cohort studies, and 1 randomized trial. The studies involved 1515 patients, with 43 experiencing envelope-related complications. The overall complication rate was 2.84% and the most common issues included tissue complications, delayed wound healing, nipple problems, and necrosis.

Complications after secondary implant surgery can be challenging for both patients and surgeons, with added costs for malpractice insurers. Preoperative and intraoperative imaging appears helpful in planning successful revisions, but more studies are needed to confirm its effectiveness. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .