Techniques and implants in breast augmentation after massive weight loss - A population-based study including 817 cases and 7023 controls

PURPOSE: Massive weight loss after bariatric surgery is often associated with alterations in breast morphology, including ptosis, excess skin, poor tissue elasticity, and altered nipple position, which frequently motivate requests for breast surgery. However, data on implant-based augmentation after massive weight loss are sparse and often limited to small series. This study aimed to compare surgical techniques and implant selection in post-bariatric patients versus non-bariatric women undergoing primary augmentation. METHODS: We conducted a national, population-based case-control study within the Breast Reconstruction After Bariatric Surgery protocol (NCT07059104). Patients occurring in both the Scandinavian Obesity Surgery Registry and the Swedish Breast Implant Registry were identified. A non-bariatric control group having breast augmentation was created. RESULTS: A total of 817 post-bariatric patients (1634 breasts) and 3512 controls (7023 breasts) were analysed. Surgery occurred a median of 3.4 years after bariatric surgery. Post-bariatric patients reported greater dissatisfaction with breast volume. They more often received larger implants, round shapes, and micro- or macro-textured or polyurethane surfaces. Dual-plane or submuscular placement was predominant in both groups, whereas subfascial and subglandular placements were less common in post-bariatric patients. Augmentation mastopexy was more frequent, while the use of mesh/ADM and lipofilling remained rare. Postoperative antibiotics were prescribed more often to post-bariatric patients. CONCLUSION: Breast augmentation after massive weight loss differs from standard practice, with larger and more textured implants and a higher frequency of mastopexies, highlighting surgical adaptation to complex anatomy.