Implant Replacement or Removal: What Happens after Capsular Contracture? A German Study Examining Breast Implant Revision Surgery and Patient Choices in 946 Cases

<b><i>Introduction:</i></b> Capsular contracture most often leads to implant revision surgery for aesthetic or reconstructive purposes. However, little is known about which operation is chosen when revision surgery has to be performed. We performed analysis of revision indications and performed revision surgery considering implant removal or replacement and additional surgical procedures. To our knowledge, this study presents the largest German single-center analysis regarding implant revision surgery after the onset of complications. <b><i>Methods:</i></b> Retrospective 10-year data analysis of a single-center population undergoing breast implant revision surgery. <b><i>Results:</i></b> Capsular contracture was the most frequent finding before reoperation, both removal and replacement (<i>p</i> &#x3c; 0.05). It was linked to longer duration of in situ implant placement (<i>p</i> &#x3c; 0.05) and more frequently in reconstructive patients (<i>p</i> &#x3c; 0.05). Implant replacement was performed more often before definite implant removal for reconstructive patients (<i>p</i> &#x3c; 0.05). Mean duration of in situ implant placement before definite removal was lower for reconstructive patients (<i>p</i> = 0.005). Overall reconstructive patients were older than aesthetic patients (<i>p</i> &#x3c; 0.05). After implant removal, 61.7% of aesthetic patients chose to undergo mastopexy, 54.7% of reconstructive patients opted for autologous breast reconstruction, and 25.4% did not choose an additional surgical procedure after implant removal. <b><i>Conclusion:</i></b> Significant differences are observed for reconstructive and aesthetic patients regarding indication leading to revision surgery, time of revision surgery, and the type of performed revision surgery itself. After implant removal, more than 60% of aesthetic patients undergo mastopexy, more than half of reconstructive patients choose autologous breast reconstruction, and over a quarter of patients choose no additional surgical procedures.