Breast Explantation With Simultaneous Mastopexy and Volume Restoration: An Analysis of Clinical Outcomes and Prospective Quality of Life
Charles A. Messa, Charles A. Messa, Charles A. Messa, Charles A. Messa
Abstract
BACKGROUND: An increasing number of patients are undergoing explantation to alleviate symptoms attributed to the presence of a prothesis or dissatisfaction with the appearance of their breasts. OBJECTIVES: The authors aim to evaluate the clinical effectiveness and quality of life (QoL) of simultaneous explantation, capsulectomy, and mastopexy for patients requesting implant removal. METHODS: Two hundred sixty-two simultaneous explantation, capsulectomy, and mastopexy (ECM) procedures were performed in 131 patients from 2009 to 2019. Prospective QoL assessment was administered for all patients. Inclusion criteria included a minimum postoperative follow-up of 6 months and completion of a practice-generated patient reported outcomes (PRO) questionnaire. Wilcoxon signed-rank test was performed to compare changes in QoL scores. RESULTS: Mean follow-up and BMI were 23 months (6 months to 8 years) and 24.8 kg/m2 (18-34 kg/m2), respectively. Mean age was 48.3 years (26-75 years). Autologous fat grafting was performed simultaneously in patients 47.3% (n = 62). The complication rate was 3.8% (n = 10 breasts) in 9 patients (6.9%). The overall reoperation rate was 7.3% of procedures (n = 19 breasts) and 9.2% of patients (n = 12), including secondary autologous fat grafting (11.3%, n = 7). PRO results demonstrated a significant improvement in all QoL domains, including physical well-being (P < .005), psychological well-being (P < .005), sexual well-being (P < .005), breast shape (P < .005), and breast appearance (P < .005). With respect to breast implant illness symptoms, 59 patients (88.1%) noted reduced pain, myalgias/arthralgias, and fatigue after ECM. CONCLUSIONS: This study presents an effective paradigm to manage implant removal through simultaneous explantation, capsulectomy, and mastopexy with acceptable clinical outcomes and a significant improvement in QoL and breast aesthetics.