title: Challenging Breast Augmentations: The Influence of Preoperative Anatomical Features on the Final Result.
abstract: BACKGROUND
  Achieving satisfactory results may be difficult in augmentation mammaplasty patients in the presence of breast, chest wall, or vertebral deformities. These deformities have not been classified previously, and the impact of each deformity or combination of deformities has not been defined.
  
  
  OBJECTIVE
  The aims of this study are to determine the complicating factors in augmentation mammaplasty, to classify these factors according to their influence on surgical outcome, and to develop an identification system for simplifying the recognition of challenging cases.
  
  
  METHODS
  We retrospectively analyzed photographs and records of 100 consecutive patients who underwent augmentation mammaplasty. We observed suboptimal results in 18 cases. Preoperative deformities of the breast, chest wall, and vertebra were recorded in order to determine which factor or factors had complicated the surgeries. Eventually, the relationship between suboptimal surgical results and complicating factors was evaluated.
  
  
  RESULTS
  We observed that some deformities alone caused suboptimal results, whereas others did not. Deformities that caused suboptimal results alone were called major complicating factors, and any others were called minor complicating factors. We observed that suboptimal results were also obtained in patients who had four minor complicating factors. Patients who had suboptimal results because of major or minor complicating factors were considered challenging cases.
  
  
  CONCLUSIONS
  In this study, complicating factors for augmentation mammaplasty were defined and classified as major or minor depending on their effect on the surgical outcome. We suggest an identification system that simplifies the recognition of challenging cases in breast augmentation.
authors.affiliation: Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Bayram
authors.affiliation: Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Fatih
authors.initials: F
authors.lastname: Zor
authors.affiliation: Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Karagoz
authors.affiliation: Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Kulahci
authors.affiliation: Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Afifi
authors.affiliation: Drs Bayram and Zor are Associate Professors and Dr Ozturk is a Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Karagoz is an Associate Professor, Department of Plastic, Reconstructive, and Aesthetic Surgery; GATA Haydarpasha Training Hospital, Istanbul, Turkey. Dr Kulahci is an Associate Professor, Department of Hand Surgery, Gulhane Military Medical Academy, Ankara, Turkey. Dr Afifi is an Assistant Professor, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
authors.forename: Serdar
authors.initials: S
authors.lastname: Ozturk
mesh_terms: D000328:Adult; D001940:Breast / Q000002:abnormalities / Q000601:surgery*; D019928:Breast Implantation / Q000009:adverse effects / Q000295:instrumentation; D018427:Breast Implants; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D010781:Photography; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult