title: Patient retention and replacement trends after saline breast implants: are deflations inflationary?
abstract: BACKGROUND
  This study aimed to examine serial operative trends with patients who have experienced surgical implant deflation. In addition, the economic impact of deflation on practice caseload was analyzed.
  
  
  METHODS
  A retrospective review was conducted to examine patients who experienced deflation from 2000 to 2007. Patient demographics, implant data, and the presence of secondary (performed at explantation) or tertiary (performed later) procedures were examined. Financial information was tabulated to determine the economic multiplier effect (i.e. the expected value of revenue from secondary and tertiary procedures divided by explantation cost) of taking on deflation cases in a practice.
  
  
  RESULTS
  For this study, 285 patients with an average age of 38.4 years were identified. The average time to explantation was 50 months. Slightly more than half of the patients (55%) had both implants replaced at the time of explantation, whereas 59% switched to silicone implants and 41% continued with saline implants. A larger implant was chosen by 54% of the patients (average increase, 82 ml), whereas 18% underwent secondary procedures at the time of explantation including mastopexy (n = 22), facial rejuvenation (n = 8), liposuction (n = 7), or a combination of the two (n = 8). Tertiary procedures were performed for 31% of the patients after their explantation/reimplantation (average time frame, 13 months). The tertiary procedures included replacement with silicone (33.7%), liposuction (24.7%), abdominoplasty (11.2%), facial rejuvenation (13.5%), or nonsurgical rejuvenation using Botox, Restylane, or laser procedure (33.7%). Economic multiplier analysis showed that the financial impact of revenue derived from implant deflation on downstream practice revenue is 1.02.
  
  
  CONCLUSIONS
  At the time of explantation, replacement with silicone after saline deflation is common (59% of patients). In this study, patients who chose replacement with saline had a significant tendency to replace with silicone (33%) as a tertiary procedure. Saline deflation represents a substantial opportunity for practice development. In particular, it has a positive impact on patient retention for additional aesthetic surgical or nonsurgical procedures. Economic multiplier analysis can be used to quantify the financial impact of saline deflation.
authors.affiliation: Marina Plastic Surgery Associates, Marina Del Rey, CA, 90292, USA, drstevens@hotmail.com.
authors.forename: W Grant
authors.initials: WG
authors.lastname: Stevens
authors.forename: Salvatore J
authors.initials: SJ
authors.lastname: Pacella
authors.forename: Elliot
authors.initials: E
authors.lastname: Hirsch
authors.forename: David A
authors.initials: DA
authors.lastname: Stoker