Objective. To assess the incidence of complications and redo surgeries depending on anatomical layer of breast implant placement in patients undergoing augmentation mammoplasty.

Material and methods. English-language manuscripts published in the PubMed/MEDLINE database for the period from January 01, 2010 to December 20, 2020 were selected. The following data were analyzed: surname of the first author, year of publication, study design, sample size, mean age and body mass index, follow-up, complications (infections, hematomas, capsular contracture, implant migration) and freedom from redo surgery. Odds ratio and 95% confidence interval were determined for each parameter. Statistical heterogeneity of publications was evaluated using χ2 and I2 criteria. Differences were significant at p-value<0.05.

Results. Data on 17644 cases of aesthetic augmentation mammoplasty were analyzed. Silicone implants were placed under pectoralis major muscle in 12989 cases. Subglandular or subfascial placement was applied in 4655 patients. Incidence of surgical site infection, hematoma and freedom from redo surgery were similar after subpectoral and prepectoral breast implant placement. Capsular contracture rate was 5.3 times higher for prepectoral implantation. Breast implant displacement was 7.2 times more common in subpectoral group.

Conclusion. Subpectoral and prepectoral implantation in breast augmentation has advantages and disadvantages regarding postoperative complications. Potential risks of complications depending on breast implant placement should be carefully explained prior to surgery.

Keywords. augmentation mammoplasty, breast replacement, complications of augmentation mammoplasty, capsular contracture, surgical site infection, implant displacement, hematoma