Algorithm for secondary aesthetic breast surgery

Breast augmentation is the most popularly carried out procedure in aesthetic sur- gery worldwide. Approximately 80,000 operations are carried out in the US alone on a yearly basis. Whilst both implant manufacturing and the process of breast aug- mentation have vastly improved over the past six decades, complication rates remain high. The reasons for complications are multifactorial: they include iatrogenic causes such as poor implant selection, poor surgical technique, and poor process including neglected post-operative care. Other causes are related to the implants themselves and their inherent deficiencies. Patient anatomy whether it be in primary or secondary situations also plays an important part in determining outcome and potential complications. The most comprehensive overview of implant performance and complication rates has been derived from the core studies with Allergan and Mentor implants [1]. There are numerous other studies looking at complications and outcomes from single surgeon or single centre units defining key determinants relat- ing to poor outcome [2–5].