title: A 15-year experience with primary breast augmentation.
abstract: BACKGROUND
  This study evaluated patients who underwent primary breast surgery within a single group practice from 1994 to 2009. Reoperations were divided by reoperation reason into total reoperations and implant-specific reoperations. The authors hypothesized that the implant-specific reoperation rate will provide the most accurate measurement of complications caused by the breast implant device.
  
  
  METHODS
  A total of 812 patients received the same brand of breast implant for primary breast augmentation or augmentation/mastopexy. Safety and efficacy data were recorded and complication rates were calculated. Statistics were applied using Kaplan-Meier estimated cumulative incidence calculations.
  
  
  RESULTS
  This study included 482 patients with saline and 330 patients with silicone implants. The most common complications included capsular contracture, rippling, rupture, infection, and hematoma. A total of 8.2 percent of patients developed Baker grade III/IV capsular contracture by 6 years. The raw incidence of rippling was 7.1 percent, and the rate was significantly increased in underweight patients with subglandular saline implants (p = 0.045). The rate of total reoperation at 1 year was 14.2 percent. While a significantly increased rate of total reoperation was seen for silicone compared with saline implants (p < 0.01), no difference was seen in the rate of implant-specific reoperation for saline compared to silicone implants (p = 0.582).
  
  
  CONCLUSIONS
  The use of total reoperation rates as an indication of complications of breast implants can lead to both an overestimation of implant-related complications and the inaccurate conclusion that silicone implants result in higher complication rates than saline implants. The implant-specific reoperation rate may provide a more accurate incidence of implant complications than the total reoperation rate, which includes reoperations for factors unrelated to the implant.
authors.affiliation: Atlanta, Ga.; and Medellin, Colombia From the Division of Plastic and Reconstructive Surgery, Emory University; private practice; and Paces Plastic Surgery.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Codner
authors.forename: Juan D
authors.initials: JD
authors.lastname: Mejia
authors.forename: Michelle B
authors.initials: MB
authors.lastname: Locke
authors.forename: Amy
authors.initials: A
authors.lastname: Mahoney
authors.forename: Cornelius
authors.initials: C
authors.lastname: Thiels
authors.forename: Farzad R
authors.initials: FR
authors.lastname: Nahai
authors.forename: T Roderick
authors.initials: TR
authors.lastname: Hester
authors.forename: Foad
authors.initials: F
authors.lastname: Nahai
mesh_terms: D000293:Adolescent; D000328:Adult; D018427:Breast Implants; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012828:Silicones; D013997:Time Factors; D055815:Young Adult
chemical_list: D012828:Silicones