Svahn JK, Vastine VL, Landon BN, Dobke MK.

Division of Plastic Surgery, University of California Medical Center, San Diego, USA.

A retrospective study to characterize determinants of subjective outcome Outcome of mammary following removal of silicone gel-filled mammary implants was undertaken. One hundred consecutive female patients (aged 24 to 69 years, mean 46 years) who underwent removal of implants were surveyed. Eighty-two patients had mammary implants for cosmetic indications, 17 for postmastectomy reconstruction, and 1 for correction of congenital breast absence. The survey was conducted 6 to 12 months after explantation.

Sixty-three patients (63%) returned questionnaires. Fifty-one patients were satisfied with the overall outcome of explantation (81% of respondees). Quality of life, as measured by self-assessed physical and cognitive functions, and improvement of symptoms attributed by the patients to the presence of implants, improved in 49 patients (78%), worsened in 2 patients (3%), and has not changed in 12 patients (19%). Twenty-one patients (33%) judged postexplantation and/or breast recontouring surgery aesthetic outcome as expected, 26 (41%) as an improvement better than expected, 9 (14%) judged their appearance as worse than expected, and 7 have not responded. Twenty-three patients (37%) perceived their postoperative course as "complicated" (scarring, inflammation, infection, seroma, asymmetry, distortion of breast contour, among those items listed). Five patients (8%) complained of mastalgia (not present prior to explantation). However, only 1 patient stated that the "complications" changed her opinion about "benefits" of this procedure.

Sixty respondents (95%) indicated that comprehensive informed consent prior to explantation was instrumental in their acceptance of the outcome. If convinced that implants are safe, fifteen patients (24%) would and 41 patients (65%) would not like implants "back," and 7 patients (11%) gave no answer. Analysis of the patients' perspective should help to care for patients who contemplate or have undergone surgery with mammary implants.