ABSTRACT: Prospective Evaluation of Late Cosmetic Results following
Breast Reconstruction: I. Implant Reconstruction
The long-term cosmetic outcome of breast implant reconstruction
is unknown. The morbidity and cosmetic outcome of 360 patients
who underwent immediate postmastectomy breast reconstruction
with various types of implants have been analyzed prospectively
over a 9-year period. Of these patients, 334 who completed their
reconstruction were suitable for evaluation of their cosmetic
The early complication rate (< 2 months) was 9.2
percent, with an explantation rate of 1.7 percent. The late complication
rate (> 2 months) was 23 percent, with a pathological capsular
contracture rate of 11 percent at 2 years and 15 percent at 5
years and an implant removal rate of 7 percent.
surgery rate was 30.2 percent.
The cosmetic results were assessed prospectively using an objective
five-point global scale. Every patient was scored at each visit
once surgery was completed. The overall cosmetic outcome deteriorated
in a linear fashion, from an initial acceptable result of 86
percent 2 years after patients completed their reconstruction
to only 54 percent at 5 years.
This decline in cosmetic outcome
was not associated with the type of implant used, the volume
of the implant, the age of the patient, or the type of mastectomy
Radiotherapy was not a significant factor
because only 28 patients were irradiated. Upon Cox model analysis,
pathological capsular contracture was the only factor that contributed
significantly to a poor cosmetic outcome in which p < 0.0001
(relative risk 6.3). Despite a high revisional surgery rate,
deterioration still occurred, suggesting that other unaccounted
for variables were responsible.
On photographic retrospective
review of the patients without capsular contracture who demonstrated
deterioration in their cosmetic scores, it became clear that
a possible reason for their poor results was late asymmetry produced
by the failure of both breasts to undergo symmetrical ptosis
[06/06/2001; Plastic and Reconstructive Surgery]
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