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Re-operations five years following breast augmentation after massive weight loss: A population-based study of 1634
Emma Hansson1, Johan Ottosson2, Martin Halle3
1Department of Plastic Surgery, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Department of Plastic Surgery, Sweden.
Purpose:
Breast augmentation after massive weight loss (MWL) is surgically challenging owing to altered anatomy and tissue quality. Previous case series suggest higher revision rates, but controlled, population-based evidence is lacking. We aimed to evaluate long-term outcomes, including reoperation frequency and indications, after primary augmentation in MWL patients compared with matched controls.
Methods:
We performed a nationwide, population-based case-control study using prospectively collected registry data (SOReg and BRIMP). The cohort comprised 817 MWL patients undergoing 1634 primary augmentations and 3512 matched controls with 7023 procedures (2004-2022). Follow-up averaged 5.4 (SD 2.9) and 5.6 (SD 2.8) years, respectively. Revision procedures, indications for re-operations, and intraoperative findings were analyzed. Statistical comparisons employed the Mann-Whitney U and Fisher's exact tests with Bonferroni-Holm correction.
Results:
Reoperation was more frequent in MWL patients (9.4% vs. 7.1%, p<0.001), with shorter time to first revision (1.5 (SD 1.8) vs. 2.3 (SD 2.4) years, p<0.001). Implant malposition (20% vs. 11%, p=0.004), rotation (9.5% vs. 3.1%, p=0.002), and seroma (6.9% vs. 1.7%, p=0.002) were more common in MWL revisions. Indications were similar, most often patient-driven changes.
Conclusion:
Breast augmentation after MWL carries a higher and earlier risk of reoperation compared with the controls, though absolute complication rates remain low. These findings provide population-based evidence to guide patient counseling and surgical planning in this complex group.