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Secondary Breast Surgery after Single-stage Augmentation-mastopexy Compared to Augmentation or Mastopexy Alone: a Multi-institutional Analysis of 59,934 Patients
Anthony J. Wilson, MD, Justin P. Fox, MD, Liza C. Wu, MD.
Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

PURPOSE:
Published revision rates for simultaneous augmentation-mastopexy are as high as 20% leading to trepidation with regards to simultaneous augmentation-mastopexy. We conducted this study to evaluate the rate of secondary breast surgery after augmentation-mastopexy in a large, multi-institutional cohort of patients; compare this rate to patients undergoing augmentation or mastopexy alone; and determine if procedural volume contributes to outcomes.
METHODS:
Using ambulatory surgery center databases from 3 states we identified adult women who underwent single stage augmentation-mastopexy, breast augmentation alone, or mastopexy alone from January 2008-June 2013. Our primary outcome was secondary breast surgery, including mastopexy; implant removal/replacement, or capsulectomy, through December 2013. Multivariate cox proportional-hazards regression modeling was used to compare outcomes between groups while accounting for differences in patient characteristics and follow-up times.
RESULTS:
The final sample included 59,934 women who underwent augmentation-mastopexy (11.0%), breast augmentation alone (73.2%), or mastopexy alone (15.8%) across 754 ambulatory surgery centers. Secondary breast surgery most often occurred within 3 years and was more common among patients undergoing mastopexy-augmentation (6.0%; AOR=1.69 [1.51-1.89]) when compared to augmentation (3.7%; reference) or mastopexy (5.2%; AOR=1.29 [1.15-1.45]) alone. Specifically, subsequent mastopexy (2.7%) or capsulectomy (2.0%) was more common in the augmentation-mastopexy group compared to the augmentation (0.4%/1.7%; p <0.001) and mastopexy groups (1.9%/1.0%; p 0.05).
CONCLUSION:
Secondary breast surgery is more common after single-stage augmentation-mastopexy compared to either procedure in isolation. However, secondary breast surgery is common in all groups and the absolute difference in rates across groups is not as great as previously reported.


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