The exposed implant in breast reconstructive surgery: a strategy for salvage using acellular dermal matrix and platelet-rich plasma

The use of breast implants in breast reconstructive surgery is currently the most popular choice among surgeons. Following the introduction of acellular dermal matrices in breast reconstruction, some surgeons proposed their use also in complication repair surgery. In this work, we present our method of treatment of the exposed breast implant using an acellular dermal matrix (Strattice) combined with a series of mesotherapy with platelet-rich plasma (PRP). A group of five women, all treated with radiotherapy, who had a breast implant exposure following post-oncological reconstructive surgery were treated in our unit in the period from March 2011 to November 2012. Only those patients who presented an extrusion area less than 3–3.5 cm, without evident signs of implant infection, were included in this study. After perilesional tissue excision and pocket lavage, the acellular dermal matrix was fixed in the pocket and a new implant was positioned. After the surgery, patients underwent a four-session cycle of mesotherapy with autologous PRP. In four patients, the implant exposure was successfully resolved using the acellular dermal matrix without postoperative complications. One patient developed a prosthesis infection which required its explant and subsequent reconstruction with latissimus dorsi flap. The surgical technique that we describe is proposed, in selected cases, as an alternative to the classical procedures for those patients who are undecided about undergoing further surgery, with long time and demanding demolition. Further studies involving larger case series are necessary. Level of Evidence: Level V, therapeutic study.     

Characteristics of women with cosmetic breast implants compared with women with other types of cosmetic surgery and population-based controls in Denmark

Herein the authors describe characteristics of women with breast implants compared with women with other types of cosmetic surgery as well as population controls. All women who acquired breast implants from 1977 to 1997 were identified from the files of two private plastic surgery clinics in Denmark. Patient characteristics were obtained through a self-administered questionnaire. The magnitude of differences between patient and control groups was estimated using odds ratios and 95% confidence intervals. Women with breast implants had a significantly lower body mass index and reported a two-fold greater incidence of current smoking compared with women from the general population and compared with women with other cosmetic surgery. Women with implants reported a greater number of full-term pregnancies and were less likely than controls to have had their first birth at age 30 years or older. Women with implants were not more likely than women in either control group to report a history of diseases, including connective tissue diseases, cancer, or depression before their implant surgery. Women with cosmetic breast implants differ from women with other forms of cosmetic surgery and from general population controls with respect to characteristics that may importantly influence health outcomes and that need to be addressed in future breast implant studies.     

影响聚丙烯酰胺水凝胶取出的因素及术后乳房整形策略探讨

目的 探讨聚丙烯酰胺水凝胶取出与乳房整形策略的关系. 方法 2003年2月至2009年8月,共收治聚丙烯酰胺水凝胶注射隆乳术后患者130例,于术前常规行乳腺B超或MRI检查,明确注射物的分布层次和周围组织浸润等情况,并在注射物取出术后根据是否植入假体或何时植入假体,将患者分为一期植入假体、二期植入假体和不植入假体3种情况,分别给予相应治疗. 结果 本组患者随访最长时间3个月,满意、基本满意和不满意率分别为83例(63.84%)、41例(31.53%)、6例(4.63%).基本满意组中5例6只乳房出现轻度包膜挛缩(Baker Ⅰ级);3例患者注射物残留过多,但仍执意要求植入假体,2例术后假体出现不平,但患者可以接受.不满意组皆为患者自行选择乳房假体,术后感到乳房外形与年龄不符,再次行假体取出术.除上述并发症外,无假体疝出、感染、切口裂开及双侧乳房不对称等畸形. 结论 根据聚丙烯酰胺水凝胶取出术后乳房畸形特点及乳房修复条件,选择恰当的再隆乳策略,既可改善胸部外观,又可缓解心理压力.     

植物油乳房假体隆乳术后相关变化观察

目的：观察并总结植物油乳房假体置入体内后临床表现变化、假体变化以及假体包膜的组织病理变化。方法：对植物油假体隆乳术后的患者进行临床体检而后实施假体取出或更换，肉眼观察假体变化并对假体包膜进行组织学观察。结果：共16例(32只假体)，假体置入术后1～6年，1例单例出现红肿疼痛炎性表现，Baker’s包膜挛缩分级5例Ⅳ级，9例Ⅲ级，2例Ⅱ级，肉眼见包膜明显增厚，包膜腔有明显渗出液伴难闻气味，假体随置入时间延长出现明显皱缩变形，内容物稠厚有腐败气味，对4例包膜进行组织病理检查显示胶原纤维明显增多，包膜增厚。结论：植物油假体在置入人体后随时间延长会出现明显内容物外渗、内容物变质、假体变形、包膜增厚，可引起感染，影响术后美容效果并明显危及患者人身安全，应尽早取出。     

The exposed breast prosthesis at the infra-mammary region: treatment by local flaps

Exposure of a breast implant is a matter of grave concern for every plastic surgeon. Basic surgical principles mandate removal of exposed foreign material. Nevertheless, removal of a breast prosthesis involves a huge psychological distress for the patient. In addition, it often requires subsequent reconstructive interventions, and the final cosmetic result may be compromised. In the literature, only a few strategies, concerning management of an exposed prosthesis, have been reported. We present two cases where a successful salvage procedure was achieved by providing tissue support in the critical area by using local flaps. Between July and August 2009, two patients presented with implant exposure at the infra-mammary scar. There were no signs of systemic or local infection. One patient had previously undergone cosmetic breast augmentation; the other patient suffered implant exposure after breast reconstruction following mastectomy. Both patients refused to have their implants removed. After the patients were thoroughly informed about the options and possible risks, they were prepared for an implant salvage procedure. After rinsing both the pocket and implant, an infra-mammary tissue support was provided by means of a local flap. Three procedures were performed in these two patients. Three different flaps were used: an external oblique muscle flap, an adipofascial flap and a posterior capsular flap. In both patients, we were able to salvage the original implant. During a follow-up period of more than 18 months, both patients remained without recurrence, and no capsular contracture occurred. In case of implant exposure in the infra-mammary region and the absence of severe infection, salvage surgery procedures should be considered and form part of the plastic surgeon's armamentarium.     

Mastectomy with breast reconstruction in previously augmented patients: indications for implant removal

Surgeons performing breast reconstruction in previously augmented patients can either leave the preexisting implant in place and incorporate the implant into the reconstruction, or remove the implant, usually performing an implant exchange. The focus of this study is to identify indications for implant removal in previously augmented patients undergoing mastectomy with breast reconstruction. We performed a retrospective chart review of patients who underwent breast reconstruction from 1997-2007 at University of Alabama, Birmingham Medical Center. Of these patients, 54 had previous augmentation with silicone or saline implants. Twenty-two of these underwent bilateral breast reconstruction, making a total of 76 reconstructed breasts. Patients were followed for a mean of 2.1 years (range 0.1-5.1 years). The mean body mass index was 23.0 (range 18-30). Implants were explanted in all but one patient. Reasons for implant removal or exchange included subglandular position (n = 39), aged silicone implant (n = 50), rupture or leak (n = 24), implant exposure (n = 1), and infection (n = 1). Some patients had more than one reason for explantation. We recommend removal of preexisting implants for patients who have implants in a subglandular position, ruptures or leaks, site infections, implant exposures, capsular contractures, pain, indolent seromas, aged silicone implants, poor cosmesis, plans for or history of radiotherapy, and close proximity of tumor to implant. We also remove implants to respect patient preferences and to achieve symmetry in our reconstruction. Consequently, we find in our practice that most of previously augmented patients who undergo breast reconstruction will also undergo implant removal.     

Primary breast lymphoma in a patient with silicone breast implants: a case report and review of the literature.

Primary breast lymphoma is a rare disease. Estimated incidence is 72 to 910 cases per year. We report a patient who developed anaplastic large cell lymphoma in her breast adjacent to a silicone breast implant 14 years after elective breast augmentation. Metastatic work up revealed no other focus of disease. She was treated with systemic chemotherapy. Review of the literature revealed five cases of primary breast lymphoma associated with a breast implant. Patients presented with either a mass or a periprosthetic fluid collection an average of eight years after either silicone gel-filled or saline-filled breast implant placement. Diagnosis was obtained with either biopsy or aspiration. All patients had the same histological subtype, anaplastic large cell lymphoma. It is unlikely that any cause-effect relationship exists between breast implants and primary breast lymphoma since chance alone could easily account for the low incidence of primary breast lymphoma in patients with breast implants. However, a fluid collection around a breast implant may be a unique presentation for this population of patients. Clinicians should include malignancy in the differential diagnosis of periprosthetic fluid collections and periprosthetic masses. Useful diagnostic tests may include MRI, aspiration with cytology, and percutaneous or open biopsy.     

Poland’s Syndrome: Different Clinical Presentations and Surgical Reconstructions in 18 Cases

Background The literature reports many variations of Poland’s syndrome. This article describes 18 cases of Poland’s syndrome in different stages of treatment, with variable clinical presentations and reconstructive techniques. Methods This study evaluated 15 females and 3 males, ages 2 to 43 years, for breast deformity, nipple–areolar complex position, pectoralis muscle malformation, thoracic deformities, and the presence of brachysyndactyly. Surgical treatment was performed for 14 patients, individualized for each case. Results For the women, the hypoplastic breast was treated with a latissimus dorsi muscular flap associated with silicone gel implant in five cases. Two other patients still are receiving tissue expansion for a future muscular and prosthetic reconstruction. Prosthetic implants alone were used on the affected side in four cases. The nipple–areolar complex was reconstructed for two patients. Seven women underwent contralateral breast surgery: reduction mammoplasty in three cases, mastopexy in two cases, and prosthetic implants in two cases. The only man who underwent surgery was treated with endoscopic rotation of the latissimus dorsi muscle flap. Conclusions This study demonstrated several breast reconstruction options for patients with Poland’s syndrome, reinforcing the importance of an individualized treatment to achieve complete and adequate rehabilitation.     

Findings in the removal of silicone gel breast implants: a correlation between time of implantation and rupture

Thirty-eight patients underwent surgical removal of their smooth silicone gel breast implants. In 22 cases the implants had been inserted for aesthetic augmentation, and in 16 for reconstruction. Twelve of the reconstructed patients had a simple mastectomy, four had a modified radical mastectomy with latissimus dorsi flap reconstruction. The time between implantation and removal was from three months to 18 years, with a mean of 8.75. Sixty-two implants were removed of which 33 were intact, 17 leaking, and 12 ruptured. Fifteen intact implants were removed in the first five years and 18 from five to ten years; no implant had been in place for more than ten years. In those implants where there was leakage (n=17), two were removed in the first five years, four from five to ten years, and 11 after ten years. None of the implants removed during the first five years of implantation were ruptured. Nevertheless, rupture was detected in three implants removed from five to ten years, and in nine removed after ten years. Thus, the 20 implants removed after 10 or more years of implantation showed some form of damage to their outer shell. These findings suggest that a thorough follow-up is mandatory in patients having silicone gel breast implants for more than five years.     

Breast Implant and Anaplastic Large Cell Lymphoma Meta-Analysis

Recent studies have shown a relationship between lymphoma and breast implants. We performed a meta-analysis about this problem. We found 80 cases, 50 of which were reported in the United States (62.5%). The average age was 52 years. The average time between breast implant surgery and lymphoma was 11 years. Forty-one percent of the breast implants were silicone, 42.19% were saline and 15.8% were unknown. The coverage of the breast implants was texturized in 21.3% and unknown in 78%. The most common brands were McGhan and Mentor. In 72.6% of the cases, the brand was unknown. The clinical findings were seroma (67.33%), nodes (13.8%), mass (22.1%), other (11.7%) and unknown (32%). The most common surgical treatment was capsulectomy and breast implant removal. In 97% of the cases, ALK was negative and 3% were positive. The most common marker was CD30. The most common chemotherapy regimen was CHOP. Three patients died. Two of the patients had extracapsular extension of the disease and breast cancer history. Lymphoma related with the breast implant was a different type of lymphoma, and in most cases, it was less aggressive. The disease was confined to the capsule. Few patients developed aggressive disease, were extracapsular and showed bad prognosis.     

Anatomic and Physiologic Advantages of Totally Subfacial Breast Implants

For the past 4 years, whenever it was possible to choose between the subglandular or the submuscular location for the implant pocket (in cases with no precise indication for the submuscular location), the authors have opted for the totally subfascial plane (subaponeurotic) to avoid the disadvantages of the other locations and to obtain additional benefits. The subfascial plane lies below the deep thoracic fascia, or deep aponeurosis, which is not only that of the pectoralis (the muscle connecting with the breast in its upper two-thirds only). The implant is placed completely beneath this fascia, which covers, in addition to the pectoralis major muscle, the serratus, the lateral oblique, and the rectus anterior muscles. This study included 100 women who had breast implanted in the subfascial (subaponeurotic) plane. Of these women, 63 were thin patients with little fatty tissue. Textured surface implants were used McGhan style 120 and 110. All procedures were approached through an inferior periareolar incision. Excellent coverage of the implant as well as natural shape and mobility was achieved for all patients. No rippling in the upper half was observed. Two patients had Baker grade 2 capsular contracture (2%). No seromas or infections were seen, and only once was a surgical exploration necessary for excess drainage volume (1%). In the immediate postoperative period, less edema was recorded and recovery was faster than with the other two procedures: submuscular and subglandular. When circumstances indicate a subglandular pocket, the subfascial plane would seem to be the logical place for mammary implants.     

Long-lasting complications with the use of polyurethane-covered breast implants

Polyurethane-covered breast implants have been recommended by some authors for aesthetic and reconstructive procedures, since with these implants the incidence of capsular contracture is insignificant and risks of implant displacement or exposure are reduced. Reports on the use of these implants focus merely on aesthetic aspects, and risks associated with disintegration and incorporation of the polyurethane-coating are often overlooked. The authors have observed several complications associated with the use of these prostheses; two cases of long-lasting complication are described, which are ascribed to difficult removal of infected fragments of the coat and to delayed foreign body reaction to polyurethane. The authors believe that the hazards associated with these implants outweigh their advantages for primary use, but suggest their use for secondary procedures in patients who have had recurrent problems with smooth implants.     

Use of Porous High-Density Polyethylene in Revision Rhinoplasty and in the Platyrrhine Nose

Nasal reconstruction presents a significant challenge to the facial plastic surgeon. Reestablishment of the desired aesthetic nasal contour and restoration of respiratory function are the dual goals of this endeavor. While autologous cartilage or bone is considered optimal grafting material, the supply is often limited and harvesting entails additional morbidity. Many synthetic materials have been introduced for use in nasal reconstruction, but high infection and extrusion rates have left most surgeons dissatisfied with conventional implants. Porous polyethylene (Medpor) implants were used for nasal reconstruction in 187 patients; 66 (35.3%) patients underwent primary rhinoplasty, while revision surgery was performed in 121 (64.7%) patients. Most patients required multiple implants, including columella struts, plumper grafts, dorsal tip implants, and nasal valve battens. Postoperative follow-up ranged from 6 months to 3.5 years. Complications occurred in five (2.6%) patients. Three early and two delayed infections necessitated implant removal in five patients, all of whom had compromised skin–soft tissue envelopes secondary to heavy smoking, cocaine abuse, or prior surgery. One case of an overly augmented nasal dorsum and tip required implant removal, reduction, and reinsertion. All implants were easily removed. No other complications including implant extrusion or skin erosion have been noted. Porous polyethylene (Medpor) implants allow for fibrovascular ingrowth, which lends stability to the implant. Porous polyethylene implants are well tolerated and provide an ideal material for nasal reconstruction.     

Anaplastic large cell lymphoma associated with breast implants: a report of 13 cases

We report 13 cases of anaplastic large cell lymphoma (ALCL) associated with breast implants. Patient age ranged from 39 to 68 years, and the interval from implant to ALCL was 4 to 29 years. All tumors were composed of large, pleomorphic cells that were CD30 and ALK1, and all 7 cases assessed had monoclonal T-cell receptor γ-chain rearrangements. Two patient subgroups were identified. Ten patients presented with effusion surrounded by fibrous capsule without a grossly identifiable tumor mass. Nine patients had stage I and 1 had stage II disease. Eight patients underwent implant removal and capsulectomy. Four patients received chemotherapy and 4 radiation therapy. All patients were alive without disease at last follow-up. A second subgroup of 3 patients had effusion and a distinct mass adjacent to the implant. One patient had stage I and 2 stage II disease. One patient had a 3-year history of lymphomatoid papulosis, and 1 patient had a 1-year history of CD30 T-cell lymphoma adjacent to the breast before the diagnosis of ALCL associated with breast implant. Two patients received chemotherapy and 1 radiation therapy. Two patients died 2 and 12 years after diagnosis, respectively. We conclude that the clinical behavior of ALCL associated with breast implants is heterogeneous. Patients who present with effusion without a distinct mass have an indolent disease course, similar to CD30 lymphoproliferative disorder of skin. In contrast, patients who present with a distinct mass may have advanced stage or possibly systemic disease and have a poorer prognosis.     

Incidence of silicone breast implant rupture

HYPOTHESIS: The incidence of silicone breast implant rupture varies with implantation time and type of implant. OBJECTIVE: To measure the incidence of implant rupture by repeated magnetic resonance imaging (MRI) among women with silicone breast implants. DESIGN, SETTING, AND PARTICIPANTS: In 1999, 271 women who had received breast implants at least 3 years before, and who were randomly chosen from a larger cohort of women with cosmetic breast implants, underwent a baseline MRI. A second MRI was performed in 2001; 317 silicone implants (in 186 women) that were intact at the baseline MRI (n = 280) or were intact at baseline but removed before the second MRI (n = 37) were included in the rupture incidence analyses. MAIN OUTCOME MEASURES: Implants were diagnosed with definite or possible rupture. Crude and implant age-adjusted incidence rates were calculated, and implant survival was estimated based on the observed rupture rates. RESULTS: We found 33 definite ruptures (10%) and 23 possible ruptures (7%) during the 2-year period. The overall rupture incidence rate for definite ruptures was 5.3 ruptures/100 implants per year (95% confidence interval, 4.0-7.0). The rupture rate increased significantly with increasing implant age. Double-lumen implants were associated with substantially lower rupture risk than single-lumen implants. For modern implants intact 3 years after implantation, we estimated rupture-free survival of 98% at 5 years and 83% to 85% at 10 years. CONCLUSIONS: The risk of implant rupture increases with implant age. A minimum of 15% of modern implants can be expected to rupture between the third and tenth year after implantation.     

Silicon assays in women with and without silicone gel breast implants--a review.

During the past 5 years, as the failure properties of silicone gel breast implants have emerged, there has been considerable interest in measuring the levels of silicone and silicon in blood, serum, breast milk, and body tissues. Assays have been done in control patients without implant exposure, and in patients with silicone gel implants in an attempt to predict implant failure. Nuclear magnetic resonance measurements of silicone compounds have not been helpful because of their low sensitivity of detection. However, all compounds containing the element silicon, which includes silicone, have been measured accurately. Modern techniques, such as electrothermal atomic absorption spectrometry, direct-current plasma emission spectrometry, and inductively coupled plasma emission spectroscopy have allowed precise measurement of silicon in body fluids and tissues. Using these techniques, recent studies have demonstrated consistent levels of silicon in the blood and plasma of control women without exposure to implants. In one study, plasma silicon was shown to be 140 +/- 10 ng per milliliter. In four other studies, serum silicon levels in control patients were the following: mean, 130 +/- 70 ng per milliliter; mean, 170 +/- 100 ng per milliliter; median, 100 ng per milliliter (range, 30-209 ng per milliliter); and 10 to 250 ng per milliliter. Three independent studies have shown that women with silicone gel implants have higher blood and serum silicon levels than control subjects, but their values were still within the range of control subjects. One study has shown that the mean silicon level in breast milk was not significantly different between 15 implant patients and 34 control patients. The measurement of silicon in control breast tissue has shown consistent results in three different studies, with most tests varying from <0.2 to 2.2 microg per gram dry weight. Three studies have shown that capsules from women with silicone gel breast implants had markedly elevated silicon levels compared with control breast tissue. Median silicon levels varied from 9,980 to 14,390 microg per gram dry weight. There was no significant difference in capsule silicon level between intact and ruptured implants or associated with implant duration in situ or year of implantation. Four studies have shown that capsules from saline implants had elevated levels of silicon compared with control tissue, but their silicon levels were much lower than those of gel implants. The median levels of silicon in the capsules of these studies were as follows: 7.7, 71.5, 198, and 1,100 microg per gram dry weight. Based on current knowledge, because of the large variability among patients, the use of silicon measurements in blood, serum, breast milk, or implant capsule tissue has no clinical role for the effective monitoring of implant leakage in women with silicone gel breast implants.     

Capsular contracture after cosmetic breast implant surgery in Denmark

The authors investigated the association between the occurrence of capsular contracture and implant and patient characteristics. All women with breast implants from 1977 to 1997 were identified from the files of two private plastic surgery clinics in Denmark. Information on implant and patient characteristics, surgical procedure, and complications was obtained through medical records and self-administered questionnaires. Of 754 women (1,572 implants), average age at implantation was 32 years. Implant types were silicone double lumen, textured, 31.2%; silicone single lumen, textured, 27.8%; silicone single lumen, smooth, 24.5%; silicone double lumen, smooth, 0.8%; and other or missing, 15.7%. Placement was submuscular for more than 90% of implants. Capsular contracture occurred in 7.9% of implanted breasts, on an average of 621 days postoperatively, with 51.6% being bilateral. Overall, 66.1% of capsular contractures were recorded within the first 12 months postoperatively, and 79.0% were recorded within 24 months. Double-lumen implants were associated with a significantly (p < 0.01) reduced occurrence of capsular contracture. In summary, capsular contracture typically occurs within the first 2 years of implantation. Host factors may be important because more than half the capsular contractures in the current study were bilateral. Occurrence of capsular contracture did not appear to be associated with implant surface or placement, occurrence of local complications, or patient characteristics, although these findings should be interpreted cautiously.     

Two-year outcomes with a novel, double-lumen, saline-filled breast implant

Background: A double-lumen, saline-filled breast implant with a baffle structure (IDEAL IMPLANT Saline-Filled Breast Implant; Ideal Implant Incorporated, Irving, Texas) was developed to overcome the limitations of single-lumen saline implants by controlling saline movement and providing internal support to the implant edge and upper pole. Objectives: The authors report 2-year data from a 10-year US clinical trial evaluating the safety and effectiveness of this investigational implant. Methods: Women seeking primary breast augmentation or replacement of existing augmentation implants were enrolled between February 2009 and February 2010 at 35 private practice sites, where the women underwent surgery to receive the new technology implant. Data collection included incidence and grade of capsular contracture (CC) and wrinkling as well as patient- and surgeon-reported satisfaction measures. All clinical data were reported as Kaplan-Meier risk rates of first occurrence, per patient, in each cohort. Results: Two-year follow-up visits were completed by 472 of 502 enrolled women (94.0%), 378 of whom had undergone primary breast augmentation and 94 of whom had received replacement augmentation. Patient-reported satisfaction with the outcome was 94.3% for primary augmentations and 92.3% for replacement augmentations; surgeon-reported satisfaction was also high (96.5% and 93.4%, respectively). Baker Grade III and IV CC rates were 3.8% (primary) and 8.2% (replacement), whereas moderate-to-severe wrinkling was 3.8% (primary) and 12.0% (replacement). Deflations occurred in 4.8% of primary augmentations and 3.3% of replacement augmentations. No deflations were caused by a shell fold flaw. Conclusions: Two-year data from 472 women indicate that this double-lumen saline implant containing a baffle structure has a low rate of wrinkling and a lower rate of CC at 2 years than was reported for current single-lumen saline implants at 1 year. Level of Evidence: 2.     

Surgical intervention and capsular contracture after breast augmentation: a prospective study of risk factors

Epidemiologic data on local complications after breast augmentation are scarce. In particular, few prospectively collected data are available on modern breast implants on this issue. Using data from the Danish Registry for Plastic Surgery of the Breast, the authors examined determinants of surgery-requiring complications and capsular contracture grades III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003. During an average follow-up period of 1.6 years after implantation, 4.3% of these women (3% of implants) required secondary surgery as a result of short-term complications. The most frequent clinical indications for surgery were displacement of the implant (38%), capsular contracture grades III to IV (16%), ptosis (13%), and hematoma (11%). Overall, the authors found that inframammary incision and subglandular placement were associated with decreased risks of developing complications requiring surgical intervention, whereas implants larger than 350 mL increased the risk of such complications (relative risk [RR], 2.3; 95% confidence interval [CI], 1.3-4.0). Thirty-nine Baker III to IV capsular contractures were identified, of which 22 were treated surgically within the study period. Submuscular placement of the implant decreased the risk of capsular contracture grades III to IV (RR, 0.3; 95% CI, 0.2-0.8), whereas surgical routes other than inframammary and drainage of implant cavity were associated with increased risk of capsular contracture. Current surgical practices and modern implants used for breast augmentation produce fewer short-term complications than procedures and devices of the past. This prospective study indicates that surgical procedures are more important predictors for local (short-term) complications than implant or patient characteristics.