Breast Explantation With Simultaneous Mastopexy and Volume Restoration: An Analysis of Clinical Outcomes and Prospective Quality of Life

Abstract Background An increasing number of patients are undergoing explantation to alleviate symptoms attributed to the presence of a prothesis or dissatisfaction with the appearance of their breasts. Objectives The authors aim to evaluate the clinical effectiveness and quality of life (QoL) of simultaneous explantation, capsulectomy, and mastopexy for patients requesting implant removal. Methods Two hundred sixty-two simultaneous explantation, capsulectomy, and mastopexy (ECM) procedures were performed in 131 patients from 2009 to 2019. Prospective QoL assessment was administered for all patients. Inclusion criteria included a minimum postoperative follow-up of 6 months and completion of a practice-generated patient reported outcomes (PRO) questionnaire. Wilcoxon signed-rank test was performed to compare changes in QoL scores. Results Mean follow-up and BMI were 23 months (6 months to 8 years) and 24.8 kg/m2 (18–34 kg/m2), respectively. Mean age was 48.3 years (26–75 years). Autologous fat grafting was performed simultaneously in patients 47.3% (n = 62). The complication rate was 3.8% (n = 10 breasts) in 9 patients (6.9%). The overall reoperation rate was 7.3% of procedures (n = 19 breasts) and 9.2% of patients (n = 12), including secondary autologous fat grafting (11.3%, n = 7). PRO results demonstrated a significant improvement in all QoL domains, including physical well-being (P < .005), psychological well-being (P < .005), sexual well-being (P < .005), breast shape (P < .005), and breast appearance (P < .005). With respect to breast implant illness symptoms, 59 patients (88.1%) noted reduced pain, myalgias/arthralgias, and fatigue after ECM. Conclusions This study presents an effective paradigm to manage implant removal through simultaneous explantation, capsulectomy, and mastopexy with acceptable clinical outcomes and a significant improvement in QoL and breast aesthetics. Level of Evidence: 4