title: Striae distensae after breast augmentation.
abstract: BACKGROUND
  One known but not fully understood complication after breast augmentation is the new onset of stretch marks (striae distensae) on the surgically treated breast. To date, all publications on this subject have been case reports. No report has fully described the actual incidence, risk factors, or management of striae distensae after breast surgery.
  
  
  METHODS
  This study prospectively followed patients who underwent primary breast augmentation using silicone implants in a single group practice from 2007 to 2011. New-onset striae distensae were actively investigated. Time from surgery to the moment of striae onset, patient age, nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and other variables were evaluated.
  
  
  RESULTS
  A total of 409 patients were included in the study. In 19 cases (4.6%), new-onset striae distensae after breast augmentation were observed. The population with striae distensae was significantly younger than the total population (29.56 vs 20.91 years; p=0.012). Striae distensae also were more common in nulliparous than in multiparous women (8.29 vs 0.52%; p=0.006), overweight women (17.77 vs 3.02%; p=0.016), women using oral contraceptives (7.89 vs 0.55%; p=0.008), and women with a personal history of stretch marks (8.97 vs 3.36%; p=0.031). No relation was shown regarding implant pocket type, size, or profile.
  
  
  CONCLUSIONS
  Striae distensae may be a common but underreported complication after breast augmentation. In this series, striae distensae developed in 4.6% of the patients within 1 year after breast augmentation. Severity may vary from inconspicuous small marks (classifications 1 and 2) to wide red and active striae rubra (classifications 3 and 4). Nulliparity, use of oral contraceptives, overweight, personal history of stretch marks, and younger age were related to a higher incidence of striae distensae. The increased rates in these groups may be associated with their exposure to higher estrogen levels and the important role of this hormone in facilitating the formation of striae distensae. Further studies are needed to show whether changes in these risk factors (i.e., weight loss, contraceptive withdrawal) may help to decrease striae distensae rates is these populations.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
authors.affiliation: Plastic Surgery Department, Basile Medical Center, Av. Prof Joao Fiusa 2300, Ribeirao Preto, Sao Paulo, 14024-230, Brazil. fibasile@gmail.com
authors.forename: Filipe Volpe
authors.initials: FV
authors.lastname: Basile
authors.forename: Arthur Volpe
authors.initials: AV
authors.lastname: Basile
authors.forename: Antonio Roberto
authors.initials: AR
authors.lastname: Basile
mesh_terms: D000328:Adult; D000367:Age Factors; D001940:Breast / Q000473:pathology; D019928:Breast Implantation / Q000009:adverse effects*; D018427:Breast Implants / Q000009:adverse effects*; D004547:Elastic Tissue / Q000473:pathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D057896:Striae Distensae / Q000209:etiology* / Q000473:pathology; D055815:Young Adult