title: Long-term effects of breast aging in patients undergoing explantation: analysis of breast aesthetics from before augmentation to after explantation.
abstract: OBJECTIVE
  Although most patients with implants have an uneventful course, some will require explantation. Moreover, women's breasts and their perception of their body habitus change with time. This study covering greater than a 32-year period will address the reconstruction options available after breast implant explantation.
  
  
  METHODS
  Augmentation mammoplasty was performed on 42 patients who subsequently underwent explantation. The following data were recorded: age at time of implantation and explantation, length of implant, type, reason for explantation, and decision after explantation. Recommendations were made based on patient preferences, degree of ptosis, clinical history, opinions regarding scars, and breast contour. Reconstruction options were categorized into none, mastopexy, capsulectomy and reaugmentation with saline implants, and mastopexy with immediate or delayed augmentation.
  
  
  RESULTS
  The average age of patients at implantation was 32.3 years, 46.8 years at explantation, with a length of implantation of 14.4 years. Thirty-six (86%) of 42 patients received explantation for capsular contracture, 7 (17%) for negative publicity of silicone implants, 7 (17%) for change in body habitus and perception of implants, 6 (14%) for rupture, 5 (12%) for ptosis, and 1 (2.4%) each for synmastia, breast cancer, and painful implants. Sixteen (38%) patients underwent mastopexy after explantation, 15 (36%) underwent no reconstruction after explantation, 6 (14%) with mastopexy and reaugmentation (2 immediate and 4 delayed), 4 (9.5%) with implant exchange, and 1 (2.4%) with mastectomy and reconstruction. All patients demonstrated satisfactory to excellent results.
  
  
  CONCLUSIONS
  This study provides long-term results of augmentation mammoplasty by a single surgeon (G.P.G.) evaluating available options and reasonable expectations after explantation. Although most of the augmentation patients have a good outcome, some require removal of implants for a variety of reasons and long-term satisfactory options do exist after explantation.
authors.affiliation: From the *Aesthetic and Plastic Surgery Institute, University of California, Irvine, Orange; †Division of Plastic and Reconstructive Surgery, University of California, San Francisco, San Francisco; and ‡Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, Los Angeles, CA.
authors.forename: Keyianoosh Z
authors.initials: KZ
authors.lastname: Paydar
authors.forename: Emil
authors.initials: E
authors.lastname: Kohan
authors.forename: Scott L
authors.initials: SL
authors.lastname: Hansen
authors.forename: Jason
authors.initials: J
authors.lastname: Roostaeian
authors.forename: Gilbert P
authors.initials: GP
authors.lastname: Gradinger
mesh_terms: D000328:Adult; D000375:Aging; D001940:Breast / Q000473:pathology*; D019928:Breast Implantation; D018427:Breast Implants; D020878:Device Removal; D004954:Esthetics; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult