Nomogram Risk Prediction Model for Reoperation/Revision in the First 5 Years After Primary Breast Augmentation Following Massive Weight Loss: A Clinical Tool.

[BACKGROUND] Previous studies suggest higher revision rates after primary breast augmentation after massive weight loss (MWL); yet, specific risk factors remain unclear. Robust predictive models are lacking.

[OBJECTIVES] The study aimed to create a nomogram to predict 5-year revision risk after primary breast augmentation in women with massive weight loss, providing a clinical tool to guide surgical decision-making.

[METHODS] A nationwide, population-based study was conducted within the Breast Reconstruction After Bariatric Surgery project (ClinicalTrials.gov NCT07059104). Data from the Scandinavian Obesity Surgery Registry and the Swedish Breast Implant Registry (2008-2022) were linked with national healthcare and prescription databases. Univariable logistic regression and group LASSO with 1000 bootstrap iterations were applied to identify predictors of revision within 5 years. A final multivariable model informed the development of a clinical nomogram.

[RESULTS] Among 810 women undergoing 1604 primary breast augmentations after massive weight loss, 84 (10%) required revision during a median follow-up of 5.5 years. Revisions were associated with smaller implant volumes (P = .032) and shorter intervals between bariatric surgery and augmentation (P = .042). In bootstrap analyses, implant volume (92% selection), surgical timing, and medications impairing wound healing were consistently retained. The final model included these three predictors, forming the basis of the nomogram.

[CONCLUSIONS] Implant volume, timing of augmentation, and relevant medications were independent predictors for revision. The nomogram provides a tool to support surgical planning and patient counselling in this high-risk population.