Local Postoperative Complications common reason for breast implant revision: JAMA

In addition to local complaints, systemic health complaints in women with breast implants are receiving growing attention in the literature and especially in the lay media. A wide range of symptoms has been reported, including myalgia, chronic fatigue, and neurologic manifestations, which are collectively referred to as breast implant illness (BII). As public awareness of BII increases, a growing number of women are concerned about the safety of their implants in relation to BII and seek consultation with their plastic surgeon.

Although the impact of BII is becoming more apparent, the definition of BII, as well as its existence and prevalence remain unclear. The aim of this cohort study by Annemiek S. Lieffering et al was to investigate how often women have their breast implants explanted or replaced because of BII compared with other local complications and to examine differences in patient characteristics between women with BII and women with local complications. Furthermore, this study aimed to provide insight into the revision surgery characteristics of both complication groups.

S A legacy cohort study on breast implant revision surgery was conducted between April 1, 2015, and December 31, 2020, and a prospective cohort study on breast implantation and revision surgery was conducted between April 1, 2015, and December 31, 2019 (with follow-up until December 31, 2020). Data were obtained from the Dutch Breast Implant Registry. Data analysis was performed from September 2021 to August 2022.

All 12,882 cosmetic breast implants and 2945 reconstructive breast implants in the legacy cohort and all 47,564 cosmetic breast implants and 5928 reconstructive breast implants in the prospective cohort were included for analysis.

In the prospective cohort, 739 cosmetic breast implants (1.6%) were revised after a median (IQR) time to reoperation of 1.8 (0.9-3.1) years, and 697 reconstructive breast implants (11.8%) were revised after a median (IQR) time to reoperation of 1.1 (0.5-1.9) years.

BII was registered as the reason for revision in 35 cosmetic revisions (4.7%) and 5 reconstructive revisions (0.7%) in the prospective cohort, corresponding to 0.1% of the inserted implants. In the legacy cohort, 536 cosmetic revisions (4.2%) and 80 reconstructive breast implant revisions (2.7%) were performed because of BII.

The current study showed that 4.7% of cosmetic breast implant revisions were performed because of BII, corresponding to 0.1% of the inserted implants

In addition, the number of women with BII found according to breast implant revision surgery data are most likely an underestimation of the overall number of women with BII symptoms in study population. Revision surgery is an invasive procedure with possible postoperative complications, and, therefore, not all women with BII symptoms may find this an acceptable solution. In addition, implant removal may have negative aesthetic consequences with possible body image issues as a result and symptom relief is not guaranteed. Furthermore, the decision to undergo revision may be subject to socioeconomic status. In the Netherlands, explantation is reimbursed by health insurance companies only in cases of medical necessity, with BII rarely categorized as such. Finally, it is likely that not all women experiencing BII symptoms are aware that their health complaints might be related to their breast implants.

In this cohort study of women with silicone breast implants, despite increasing public interest in BII, it was an uncommon indication for revision compared with local complications, in both the short and long term. With this study, authors present a first estimate of the magnitude of BII as a postoperative complication of breast implant surgery. The provided preliminary associative data could ultimately be used to estimate which implant recipients are most likely to develop BII. Despite the low risk of BII, the main concern is who BII actually affects. Large cohort studies are strongly recommended to investigate the prevalence of BII symptoms before and after implantation together with risk factors related to BII.

Source: Annemiek S. Lieffering, Juliëtte E. Hommes, Lotte Ramerman; JAMA Network Open. 2022;5(10):e2236519.

doi:10.1001/jamanetworkopen.2022.36519