Secondary Procedures for Complications Associated With Breast Implants in the United States, 2019-2022

Breast implantation, whether reconstructive or cosmetic, carries a known risk of postoperative complications. However, data on the subsequent management of these complications remain limited. We conducted this study to quantify the frequency and characterize the nature of secondary procedures performed in US ambulatory surgery centers to address common breast implant complications.

A retrospective cohort study was conducted using the National Ambulatory Surgery Sample to identify discharges for women aged ≥18 years who underwent surgery for implant-related complications between January 2019 and December 2022. We excluded cases involving concurrent mastectomy or planned secondary procedures. Primary outcomes included the number, type, and indication for secondary breast procedures. Secondary outcomes included cost and payer. Multivariable logistic regression was used to identify factors associated with implant removal without replacement and insurance coverage among cosmetic revision patients.

Among 74,756 discharges, reconstructive cases accounted for 55.1% and cosmetic cases for 44.9%. Reconstructive patients were older and more likely to be privately insured ( P <0.001). Reconstructive revisions more often included fat grafting, while cosmetic revisions more frequently involved capsulectomy or implant removal without replacement ( P <0.001). Implant removal without replacement was associated with multiple complications [adjusted odds ratio (AOR)=2.17, 95% CI: 1.94-2.43], insurance type, and comorbidity. In cosmetic cases, older age and autoimmune disease were associated with insurance coverage (AOR=1.22, 95% CI: 1.17-1.27).

Secondary procedures for implant complications are common and differ by surgical indication, underscoring the need for patient counseling and individualized management strategies.