Re-operations five years following breast augmentation after massive weight loss: A population-based study of 1634 cases and 7023 controls.

Abstract

Breast augmentation after massive weight loss (MWL) is surgically challenging owing to altered anatomy and tissue quality. Previous case series suggest higher revision rates, but controlled, population-based evidence is lacking. We aimed to evaluate long-term outcomes, including reoperation frequency and indications, after primary augmentation in MWL patients compared with matched controls. We performed a nationwide, population-based case-control study using prospectively collected registry data (SOReg and BRIMP). The cohort comprised 817 MWL patients undergoing 1634 primary augmentations and 3512 matched controls with 7023 procedures (2004-2022). Follow-up averaged 5.4 (SD 2.9) and 5.6 (SD 2.8) years, respectively. Revision procedures, indications for re-operations, and intraoperative findings were analyzed. Statistical comparisons employed the Mann-Whitney U and Fisher's exact tests with Bonferroni-Holm correction. Reoperation was more frequent in MWL patients (9.4% vs. 7.1%, p<0.001), with shorter time to first revision (1.5 (SD 1.8) vs. 2.3 (SD 2.4) years, p<0.001). Implant malposition (20% vs. 11%, p=0.004), rotation (9.5% vs. 3.1%, p=0.002), and seroma (6.9% vs. 1.7%, p=0.002) were more common in MWL revisions. Indications were similar, most often patient-driven changes. Breast augmentation after MWL carries a higher and earlier risk of reoperation compared with the controls, though absolute complication rates remain low. These findings provide population-based evidence to guide patient counseling and surgical planning in this complex group.