Predictors of postoperative aesthetics following explantation of the augmented breast.

Elective removal of breast implants has become a common operation for a variety of reasons. Although many women have their implants exchanged, a significant number of patients request removal without replacement. The purpose of this study was to identify factors that might predict the aesthetic result following elective explantation. Over the period of February 1990 to February 1996, 15 previously augmented patients had implant removal without replacement. Complete records including pre- and postoperative photos were available for study. Pre- and postoperative photos were rated by third-party observers as good = 3, acceptable = 2, and poor = 1. A deformity index was calculated for each patient by subtracting the average postoperative score from the average preoperative score. The observed deformity index was used to separate the patients into four groups. Next, each group was evaluated retrospectively by the authors for factors that may have contributed to the observed results. These included age of patient, duration of implant, rupture, contracture, ptosis, pseudoptosis, and concurrent mastopexy. Results of this study suggest that high-riding implants with ptotic breasts may predict an improved appearance following explantation. Some patients seemed to benefit from concurrent mastopexy. Advanced patient age, age of implant, rupture, and high-grade capsular contracture tended to predict a poor aesthetic result. Thin patients and patients who had unilateral explantation could be effectively predicted to have a poor outcome that could not be corrected by mastopexy. Implant replacement or flap reconstruction may best serve these patients who otherwise can expect a poor aesthetic result.