Letter to the Editor

Comments on “Breast Striae after Cosmetic Augmentation”

Aesthetic Surgery Journal 2015, Vol 35(2) NP35–NP36 © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: [email protected] DOI: 10.1093/asj/sju036 www.aestheticsurgeryjournal.com

Filipe V. Basile, MD; and Arthur Basile, MD

Table 1. Risk Factors of New-Onset Striae Found in Both Articles Basile et al N = 409

Moliver et al N = 549

19 (4.6%)

17 (3.10%)

Age (mean), y

20.91

21

Nulliparous (rate vs control)

15.94

14.38

Previous history (rate vs control)

2.66

6.11

LMP > 14 days (rate vs control)

NAb

9.24

Patients with New-Onset Striae, No. (%) Risk Factorsa

Abbreviations: NA, not available; LMP, last menstrual period. a The numbers attributed to nulliparity, previous history, and LMP indicate how many times the risk is increased if the risk factor is present. b This number was not calculated in our study.

for breast striae. In our experience, this helps to not only identify but also treat these cases. The authors also state that there was a correlation (although not statistically significant) between implant size and striae. It is important to note that in Dr Moliver’s practice, larger than average implant sizes are used, and not even these larger sizes affected the incidence of striae. To us, the impact of implant size and shape, both on the acute setting of new-onset striae and its long-term effects related to skin envelope stress, remains the most important unresolved issue on this matter.5 It is our belief that new-onset striae distensae is the result of an acute inflammatory reaction deeply connected to hormone imbalances; and, its potential connection with

Dr F. Basile is a plastic surgeon in private practice in Sao Paulo, Brazil. Dr A. Basile is a Clinical Professor, Department of Dermatology, Barão de Maua Medical School, Ribeirao Preto, Sao Paulo, Brazil. Corresponding Author: Dr Filipe V. Basile, AV Prof Joao Fiusa 2300, Ribeirao Preto-SP, Brazil. E-mail: fi[email protected]

Downloaded from http://asj.oxfordjournals.org/ by guest on October 6, 2015

We have read with great interest the recent article by Moliver and colleagues titled “Breast Striae After Cosmetic Augmentation”1 and would like to congratulate the authors for their accurate description and thorough analysis on this emerging topic. We also would like to thank the authors for referring to our 2011 original article2 as the only publication to date that has addressed the incidence and risk factors of striae after breast augmentation. The new article confirmed many of our initial findings (Table 1). Age, nulliparity, and previous positive history for striae were confirmed as the most important risk factors. More than just confirming our findings, this article brings an exciting new hypothesis: the correlation between striae distensae and the time of the last menstrual period (LMP) at the time of breast augmentation surgery. To us, this is an important finding as it contributes to the theory that a potentially significant hormonal imbalance is paramount in the development of striae distensae. Under certain conditions, hormonal receptor expression is increased, suggesting that regions undergoing greater mechanical stretching of the skin may express greater hormonal receptor activity.2,3 Alterations in hormone receptors occur within a welldefined period during the formation of striae distensae. One study showed that estrogen receptors doubled in skin with striae distensae in comparison with healthy skin.3,4 It is not clear, however, how this finding could be applied to clinical practice. Because the use of oral contraceptives showed some correlation in our study, we decided to ask a group of 204 randomly selected patients to stop taking contraceptive pills 15 days before their breast augmentation surgery. To our surprise, the incidence of new-onset striae in this group did not diminish (3.95% vs 4.06% in the original control group, P = 1.1). This finding indicates that use of a contraceptive itself may not influence new-onset striae but could change LMP, producing a bias when first analyzed. New studies should focus on these specific hormonal changes to help clarify this issue. The only small addition we would have made to the study is the use of our classification

NP36

long-term effects related to skin envelope stress will help surgeons make better clinical decisions in the future.

Disclosures The authors declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.

REFERENCES 1.

Tsai TL, Castillo AC, Moliver CL. Breast striae after cosmetic augmentation. Aesthet Surg J. 2014;34(7): 1050–1058.

Aesthetic Surgery Journal 35(2)

2. Basile FV, Basile AV, Basile AR. Striae distensae after breast augmentation. Aesthetic Plast Surg. 2012;36(4): 894-900. 3. Cordeiro RC, Zecchin KG, de Moraes AM. Expression of estrogen, androgen, and glucocorticoid receptors in recent striae distensae. Int J Dermatol. 2010;49(1): 30-32. 4. Huang GJ, York CE, Mills DC. Striae distensae as a complication of augmentation mammaplasty. Plast Reconstr Surg. 2008;122(2):90e-93e. 5. Basile FV, Basile AR, Basile A. Striae distensae after breast augmentation: expected findings versus actual findings. Aesthetic Plast Surg. 2013;37(4):849-850.

Downloaded from http://asj.oxfordjournals.org/ by guest on October 6, 2015