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Al-Halabi B, Madani A, Alabdulkarim A, Vassiliou M, Gilardino M. Defining Cognitive Competencies for Breast Augmentation Surgery. JOURNAL OF SURGICAL EDUCATION 2023; 80:873-883. [PMID: 37105861 DOI: 10.1016/j.jsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Breast augmentation is the most performed aesthetic procedure in the United States yet one that surgical trainees have limited exposure to. This creates a lack of confidence in performing this key procedure among graduates. It is imperative to develop novel curricula and objective measures to standardize acquiring competency. OBJECTIVE This qualitative study establishes various cognitive competencies and pitfalls in augmentation mammoplasty. METHODS Using a priori established task analysis, literary sources and operative observations, a total of 20 cognitive vignettes were developed to conduct cognitive task analyses (CTA) for breast augmentation through semistructured interviews of experts. Interviews were itemized, and verbal data were recorded, transcribed verbatim, and thematically analyzed by reviewers. RESULTS Eight experts were interviewed (median age 39 years, 87.5% males, with a median of 7 years in practice). A conceptual framework for breast augmentation was developed and divided into 5 operative stages containing 208 competencies and 41 pitfalls. Pitfalls were mapped to deficits in shared decision making, proper informed consent, prospective hemostasis, and awareness of anatomical landmarks and markings. CONCLUSIONS This work provided an inclusive framework of cognitive competencies in breast augmentation surgery to facilitate their assessment. This model guides the analysis of other procedures to transfer cognitive competencies to learners. In a transition toward competency-based education, this provides a primer to assessments that include all aspects of a surgeon's skill set.
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Affiliation(s)
- Becher Al-Halabi
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Amin Madani
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Abdulaziz Alabdulkarim
- Plastic Surgery, Surgery Department, College of Medicine, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Melina Vassiliou
- Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Mirko Gilardino
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada
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Content and Readability of Online Recommendations for Breast Implant Size Selection. Plast Reconstr Surg Glob Open 2023; 11:e4787. [PMID: 36699215 PMCID: PMC9872969 DOI: 10.1097/gox.0000000000004787] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/05/2022] [Indexed: 01/26/2023]
Abstract
Breast augmentation is one of the most frequently performed aesthetic procedures in the United States. Online information is often used by patients to make decisions when undergoing cosmetic procedures. It is vital that online medical information includes relevant decision-making factors and uses language that is understandable to broad patient audiences. Ideally, online resources should aid patient decisions in aesthetic surgical planning, especially implant size selection for breast augmentation. We describe patient decision-making factors and readability of breast implant size selection recommended by private practice plastic surgery webpages. Methods Using a depersonalized, anonymous query to Google search engine, the terms "breast implant size factors" and "breast implant size decision" were searched, and 52 plastic surgery private practice webpages were identified. Webpages were analyzed for reported decision-making factors of implant size selection. Readability analyses of webpages were performed with Readability Studio and Hemingway Editor. Results The two major decision-making factors for implant size selection reported by webpages were body/tissue-based measurements and surgeon input. Ten factors related to patient lifestyle, surgical goals, and procedural options were also identified. Average webpage scores for five readability measures exceeded recommended levels for medical information. Conclusions Reported decision-making factors for implant size selection emphasize a plastic surgeon's expertise but may enhance the patient's role in preoperative planning. Webpages describing breast implant size selection exceed the sixth and eighth grade reading levels recommended by the AMA and NIH, respectively. Improving the readability of webpages will refine the role of online medical information in preoperative planning of breast augmentation.
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Li B, Quan Y, He Y, He Y, Lu F, Liao Y, Cai J. A Preliminary Exploratory Study of Autologous Fat Transplantation in Breast Augmentation With Different Fat Transplantation Planes. Front Surg 2022; 9:895674. [PMID: 35756478 PMCID: PMC9226395 DOI: 10.3389/fsurg.2022.895674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Autologous fat transfer is common in breast augmentationor reconstruction. However, AFG recipient site in the breast for fat grafting has not been carefully investigated. Methods Forty female patients requiring breast augmentation with fat grafting were randomly assigned into two groups. The retromammary group received 2/3 fat into the retromammary space and the other 1/3 into the subcutaneous and retropectoral planes. The retropectoral group received 2/3 fat into the retropectoral plane and the other 1/3 into the subcutaneous and retromammary planes. The fat grafting result at 6 months was assessed by 3D laser surface scanning and then ultrasound. Any complications were recorded during follow-up. Samples from a patient who underwent fat grafting for 6 months was obtained and histological examination was conducted. Results No significant difference in the retention rate after 6 months was observed between the two groups (retromammary group: 35.9% ± 6.6; retropectoral group: 39.3% ± 5.1, p = 0.1076). The retromammary grouphad a higher incidence of oil cyst formation than the retropectoral group. Histological examination showed that there were more oil cysts and mac2 positive macrophage infiltration in the fat cells in retromammary group, while retropectoral group had more small-size adipocytes. Conclusion Although fat grafting into the retropectoral plane did not provide a superior fat graft retention rate, it did lower the incidence of complications. The retropectoral space show great potential to become a favorable recipient site.
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Breast Implant Selection: Consensus Recommendations Using a Modified Delphi Method. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2237. [PMID: 31333962 PMCID: PMC6571346 DOI: 10.1097/gox.0000000000002237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/08/2019] [Indexed: 11/25/2022]
Abstract
Background: Geographical differences in breast implant selection approaches exist, and clinical data to guide the process are limited. Developing knowledge of implant-related risk factors further complicates the process. This analysis aimed to establish expert consensus on considerations for breast implant selection in Australia and New Zealand based on practice patterns in those countries. Methods: A modified Delphi method was used to gain consensus from experts in breast augmentation surgery in Australia and New Zealand. Panelists anonymously completed an initial questionnaire on current considerations in implant selection, discussed a summary of their responses in a live meeting, and completed a final consensus survey based on their live recommendations. Results: Seven panelists completed the final consensus survey. Consensus recommendations included ensuring consideration of proper surgical technique (pocket formation, positioning of implant) and patient tissue and anatomical characteristics, weighing relative expected results of various surface textures, sizes, and degrees of cohesivity, and careful contemplation of the migration risk. Conclusions: This modified Delphi exercise provided consensus recommendations on the key factors involved in implant selection from the perspective of plastic surgeons with practices in Australia and New Zealand. A primary recommendation was that the choice of implant for each patient should be individualized to patient tissue and anatomical characteristics.
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Preoperative Implant Size Is Strongly Associated With Alternations of Implant Size During Secondary Breast Augmentation. Ann Plast Surg 2018; 81:389-392. [PMID: 29851728 DOI: 10.1097/sap.0000000000001501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast augmentation is one of the most popular cosmetic surgeries performed worldwide. In turn, there has been an increasing number of secondary breast augmentation procedures in recent years. Implant selection at secondary breast augmentation can be a challenge and is affected by a number of factors. The aim of this study was to assess the main factors affecting the decision-making process with regard to implant volume determination prior to implant exchange. METHODS Women who underwent elective breast implant exchange between 2012 and 2016 were included in this study. Medical records were used to acquire implant and patient data. The patient's desires, as well as medical considerations, were taken into account during the implant selection process. RESULTS Two hundred forty-five women with an average age of 43 years (range, 21-69 years) were included in the study. The mean time between primary augmentation and implant exchange was 10 ± 5.7 years. Overall, 192 implants (38.9%) were exchanged with larger implants, 84 implants (17%) were exchanged with smaller implants, and 218 implants (44.1%) were exchanged with implants similar to the preoperative size (±25 mL). In patients who received smaller implants, the mean reduction in implant volume was found to be 78.88 mL. Women were more likely to receive a smaller implant during implant exchange if the preoperative implant volume was larger than 367 mL (P = 0.00006). Among patients who received larger implants, no correlation was found between preoperative and postoperative implant size. A positive correlation was found between the implant age and a reduction in implant size (P = 0.036). However, no correlation was found between the patient's age and the decision to reduce or enlarge implant size upon revision. CONCLUSIONS Almost half of patients receive similarly sized implants during elective implant exchange. Among those who did decide to change their implant size, more than twice as many patients opted for a larger implant as opposed to a smaller one. Relatively large preoperative implant size and longer time since primary augmentation were associated with the selection of smaller implants during exchange. Further studies should be conducted to reinforce these results.
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Steen K, Isaac KV, Murphy BD, Beber B, Brown M. Three-Dimensional Imaging and Breast Measurements: How Predictable Are We? Aesthet Surg J 2018; 38:616-622. [PMID: 29272355 DOI: 10.1093/asj/sjx232] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Outcomes in aesthetic breast surgery are dependent on preoperative breast measurements. The accuracy of 3-dimensional (3D) imaging in measuring critical landmarks in augmentation mammaplasty surgery has not been described. OBJECTIVES We aimed to determine the predictability of 3D imaging compared to direct measurements. METHODS Two raters measured the breasts of 28 women using four anthropometric (direct) measurements: sternal notch to nipple distance (Sn-N), nipple to midline (N-M), nipple to inframammary-fold distance under maximal stretch (N-IMF), and base width (BW). Measurements (indirect) were also obtained using 3D imaging. Statistical analysis was completed with Bland-Altman plots. RESULTS Each rater collected 56 data points for each of the four measurements. This resulted in 224 data points per rater. The Sn-N measurement had a 0.05 cm (SD, 0.65) difference in the mean values obtained between direct and indirect measurements. N-M had a mean difference of 0.20 cm (SD, 0.62). The mean difference for BW was 1.26 cm (SD, 0.69 cm), and N-IMF showed a mean difference of 1.22 cm (SD, 0.74 cm). Three-dimensional imaging overestimated Sn-N, N-M, and BW, while it underestimated N-IMF. CONCLUSIONS Three-dimensional imaging has good utility and is most accurate for Sn-N and N-M measurements, which require frontal imaging of a standing patient. BW and N-IMF are less accurate due to obscured landmarks on frontal imaging. The medial and lateral aspects of the breast may be obscured when measuring BW on 3D imaging, which may explain this difference. N-IMF is a dynamic measurement, and as a result, 3D imaging has limited ability to measure this distance accurately. LEVEL OF EVIDENCE 3
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Affiliation(s)
- Kalila Steen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn V Isaac
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Blake D Murphy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brett Beber
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Brown
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Montemurro P, Cheema M, Hedén P, Agko M, Quattrini Li A, Avvedimento S. Do Not Fear an Implant's Shape: A Single Surgeon's Experience of Over 1200 Round and Shaped Textured Implants in Primary Breast Augmentation. Aesthet Surg J 2018; 38:254-261. [PMID: 29106482 DOI: 10.1093/asj/sjx145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Breast implants can be characterized by their fill material, surface texture, or shape. Whereas long-term good quality studies have provided evidence for the fill material and texture, there is still little consensus for choosing the shape of an implant. Surveys indicate that many surgeons choose only one implant shape, for reasons that may not always agree with outcomes from long-term studies. OBJECTIVES We reviewed the first author's experience over the last six years with both round and anatomical implants, compared the rate of complications with either implant shape, and discussed the importance of keeping an open mind about using both implant shapes for primary breast augmentation. METHODS A review of all consecutive primary breast augmentation patients by the first author over a six-year time period who had a minimum follow up of 6 months after surgery. RESULTS Six-hundred and forty-eight female patients had 1296 silicone breast implants inserted over the six-year period. Mean age at surgery was 30.5 years and mean BMI was 20.6 kg/m2. All implants were textured, 134 (in 67 patients, 10.3%) were round in shape with mean volume of 338 cc (range, 220-560 cc), while 1162 implants (in 581 patients, 89.7%) were anatomical shaped with a mean volume of 309 cc (range, 140-615 cc). Among these patients, 11.9% (n = 8) with round implants and 9.0% (n = 52) of those with anatomical implants developed complications postoperatively. CONCLUSIONS A single, ideal implant that is suitable for every primary breast augmentation does not exist. The optimum choice of implant shape in any given situation should take into account the patient's physical characteristics, available implant types, patient's desires, and the surgeon's experience. Together with round implants, anatomical devices ought to be considered as one of the tools in the surgeon's toolbox. By choosing to ignore them a priori means that the surgeon will only have access to half of his armamentarium and will therefore be able to offer a limited set of options to his patients. LEVEL OF EVIDENCE 4
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Affiliation(s)
| | - Mubashir Cheema
- plastic surgeon and consultant at University Hospital Birmingham, Birmingham, UK
| | - Per Hedén
- plastic surgeons in private practice in Stockholm, Sweden
| | - Mouchammed Agko
- fellows at a private plastic surgery practice in Stockholm, Sweden
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What Are the Principles That Guide Behaviors in the Operating Room?: Creating a Framework to Define and Measure Performance. Ann Surg 2017; 265:255-267. [PMID: 27611618 DOI: 10.1097/sla.0000000000001962] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To identify the core principles that guide expert intraoperative behaviors and to use these principles to develop a universal framework that defines intraoperative performance. BACKGROUND Surgical outcomes are associated with intraoperative cognitive skills. Yet, our understanding of factors that control intraoperative judgment and decision-making are limited. As a result, current methods for training and measuring performance are somewhat subjective-more task rather than procedure-oriented-and usually not standardized. They thus provide minimal insight into complex cognitive processes that are fundamental to patient safety. METHODS Cognitive task analyses for 6 diverse surgical procedures were performed using semistructured interviews and field observations to describe the thoughts, behaviors, and actions that characterize and guide expert performance. Verbal data were transcribed, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 4 independent reviewers, and synthesized into a list of items. RESULTS A conceptual framework was developed based on 42 semistructured interviews lasting 45 to 120 minutes, 5 expert panels and 51 field observations involving 35 experts, and 135 sources from the literature. Five domains of intraoperative performance were identified: psychomotor skills, declarative knowledge, advanced cognitive skills, interpersonal skills, and personal resourcefulness. Within the advanced cognitive skills domain, 21 themes were perceived to guide the behaviors of surgeons: 18 for surgical planning and error prevention, and 3 for error/injury recognition, rescue, and recovery. The application of these thought patterns was highly case-specific and variable amongst subspecialties, environments, and individuals. CONCLUSIONS This study provides a comprehensive definition of intraoperative expertise, with greater insight into the complex cognitive processes that seem to underlie optimal performance. This framework provides trainees and other nonexperts with the necessary information to use in deliberate practice and the creation of effective thought habits that characterize expert performance. It may help to identify gaps in performance, and to isolate root causes of surgical errors with the ultimate goal of improving patient safety.
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What Is the Standard Volume to Increase a Cup Size for Breast Augmentation Surgery? A Novel Three-Dimensional Computed Tomographic Approach. Plast Reconstr Surg 2017; 139:1084-1089. [DOI: 10.1097/prs.0000000000003247] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nava MB, Rocco N, Tunesi G, Catanuto G, Rancati A, Dorr J. Decisional pathways in breast augmentation: how to improve outcomes through accurate pre-operative planning. Gland Surg 2017; 6:203-209. [PMID: 28497024 DOI: 10.21037/gs.2017.03.01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast augmentation is the most commonly performed surgical procedure in aesthetic plastic surgery. Accurate pre-operative planning is crucial to obtain the best outcomes. We present our planning method deriving from a more than 30-year experience in aesthetic breast surgery, matching together patients tissues' characteristics and patients' wishes. We schematized our planning method in an easy-to-use flow diagram to help the decisional process in breast augmentation.
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Affiliation(s)
- Maurizio B Nava
- Valduce Hospital, Como, Italy.,Department of Plastic Surgery, University of Milan, Milan, Italy
| | - Nicola Rocco
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Giuseppe Catanuto
- Multidisciplinary Breast Unit, Azienda Ospedaliera Cannizzaro, Catania, Italy
| | - Alberto Rancati
- Chief Oncoplastic Surgery Instituto Henry Moore, University Of Buenos Aires, Buenos Aires, Argentina
| | - Julio Dorr
- University of Buenos Aires, Buenos Aires, Argentina
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Isaac KV, Murphy BD, Beber B, Brown M. The Reliability of Anthropometric Measurements Used Preoperatively in Aesthetic Breast Surgery. Aesthet Surg J 2016; 36:431-7. [PMID: 26647138 DOI: 10.1093/asj/sjv210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient outcomes in aesthetic breast surgery are highly dependent on breast measurements used in preoperative planning. OBJECTIVES The purpose of this study is to determine the reliability of anthropometric breast measurements. METHODS Four raters measured 28 women using 7 measurements: sternal notch to nipple distance (Sn-N), nipple to midline (N-M), nipple to inframammary-fold distance under maximal stretch (N-IMF), breast base width (BW), soft tissue pinch thickness of the upper pole (STPT:UP), STPT at the inframammary fold (STPT:IMF), and anterior pull skin stretch (APSS). Reliability was assessed using intra-class correlation coefficients (ICCs). RESULTS Inter-rater reliability was excellent for Sn-N, N-M, and BW (ICC = 0.94, 0.90, and 0.76, respectively) and was good for N-IMF (ICC = 0.70). The STPT:UP, STPT:IMF, and APSS measurements were not reliable between raters (ICC < 0.2). Intra-rater reliability was excellent for Sn-N, N-M, and BW for all raters (all ICC > 0.75). The N-IMF intra-rater reliability was excellent in senior raters (ICC > 0.75) and good in junior raters (ICC > 0.6). The STPT:UP, STPT:IMF, and APSS measurements showed fair or poor reliability for most raters (ICC < 0.6). CONCLUSIONS The Sn-N, N-M, and BW measurements are very reliable. Dynamic measurements including APSS, STPT:UP, and STUP:IMF are unreliable. N-IMF is the only reliable dynamic measurement, and its reliability improves with increasing clinical experience. The variable reliability of preoperative measurements must be considered in the planning of aesthetic breast surgery. LEVEL OF EVIDENCE 4 Diagnostic.
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Affiliation(s)
- Kathryn V Isaac
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Blake D Murphy
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Brett Beber
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell Brown
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Delphi Consensus Recommendations: Intraoperative Technique and Postoperative Management of Patients with Natrelle 410 Implants. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e557. [PMID: 26893982 PMCID: PMC4727709 DOI: 10.1097/gox.0000000000000388] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/16/2015] [Indexed: 11/26/2022]
Abstract
Background: Anatomically shaped, form-stable Natrelle 410 breast implants were approved in Europe in 1993 and in the United States in 2013. Although general guidelines for breast augmentation are available, the distinctive characteristics of Natrelle 410 warrant specific guidelines for this device. The goal of this study was to generate consensus recommendations for intraoperative technique and postoperative management with Natrelle 410 in primary breast augmentation. Methods: Surgeons were invited to participate in the study, which used a modified Delphi method. Participants completed 2 rounds of online surveys; the second survey (Recommendations Survey) was generated based on first survey results. Respondents also listed top priorities for use of Natrelle 410. Results: Participants (n = 22) reached consensus on 15 of 18 perioperative and surgical techniques; dual-plane placement, tight pockets, and limiting the boundaries of dissection were among intraoperative techniques considered most important for Natrelle 410. Consensus was reached for 18 of 32 items regarding postoperative management and 6 of 9 open-ended postoperative activity restrictions. Consensus on activity restrictions with specified time limits were similar to consensus recommendations on general restrictions. Top participant-identified intraoperative and postoperative management practices for Natrelle 410 were dual-plane placement of the implant and wearing a bra postoperatively, respectively. Conclusions: The Delphi method identified consensus recommendations on a broad range of intraoperative techniques and postoperative management practices for primary breast augmentation with Natrelle 410. These recommendations and priorities provide surgeons with a framework that, together with the surgeon’s experience, will contribute to optimal clinical outcomes with Natrelle 410.
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Hedén P, Brown MH, Luan J, Maxwell GP, Munhoz AM, Carter M. Delphi Study Consensus Recommendations: Patient Selection and Preoperative Planning Measurements for Natrelle 410. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e556. [PMID: 26893981 PMCID: PMC4727708 DOI: 10.1097/gox.0000000000000510] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 08/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is considerable variation in the planning and implementation process for breast augmentation. Although general guidelines are available, the distinctive characteristics of the Natrelle 410 breast implant warrant surgical guidelines specific to this device. This study aimed to develop consensus recommendations for patient selection and preoperative planning for Natrelle 410 in primary breast augmentation. METHODS Surgeons were invited to participate in this study, which used a modified Delphi method. Participants completed 2 rounds of online surveys, with the second round (Recommendations Survey) based on responses from the first round. Respondents also listed their top priorities for using Natrelle 410 implants. RESULTS Participants (n = 22) reached consensus on 15 of 18 criteria for patient selection; tuberous breasts, patient preference regarding upper pole shape, and asymmetry of the breasts were the top 3 patient characteristics considered appropriate for the use of Natrelle 410. Consensus was reached on 38 of 51 items related to preoperative planning, with 8 measurements and 6 markings recommended by the participants. Patient-desired outcome was considered the most essential element for Natrelle 410 implant selection; quality of skin envelope and height and width dimension of the breast were selected as the most essential elements for Natrelle 410 implant volume selection. CONCLUSIONS The modified Delphi method resulted in consensus recommendations for patient selection and preoperative planning in primary breast augmentation with the Natrelle 410 breast implant. These recommendations and priorities, used in concert with a surgeon's clinical experience, are designed to optimize surgical outcomes.
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Affiliation(s)
- Per Hedén
- From the Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif
| | - Mitchell H. Brown
- From the Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif
| | - Jie Luan
- From the Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif
| | - G. Patrick Maxwell
- From the Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif
| | - Alexandre Mendonça Munhoz
- From the Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif
| | - Mollie Carter
- From the Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif
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Holmes WJM, Timmons MJ, Kauser S. Techniques used by United Kingdom consultant plastic surgeons to select implant size for primary breast augmentation. J Plast Reconstr Aesthet Surg 2015; 68:1364-9. [PMID: 26116968 DOI: 10.1016/j.bjps.2015.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/11/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Techniques used to estimate implant size for primary breast augmentation have evolved since the 1970s. Currently no consensus exists on the optimal method to select implant size for primary breast augmentation. METHODS In 2013 we asked United Kingdom consultant plastic surgeons who were full members of BAPRAS or BAAPS what was their technique for implant size selection for primary aesthetic breast augmentation. We also asked what was the range of implant sizes they commonly used. The answers to question one were grouped into four categories: experience, measurements, pre-operative external sizers and intra-operative sizers. RESULTS The response rate was 46% (164/358). Overall, 95% (153/159) of all respondents performed some form of pre-operative assessment, the others relied on "experience" only. The most common technique for pre-operative assessment was by external sizers (74%). Measurements were used by 57% of respondents and 3% used intra-operative sizers only. A combination of measurements and sizers was used by 34% of respondents. The most common measurements were breast base (68%), breast tissue compliance (19%), breast height (15%), and chest diameter (9%). The median implant size commonly used in primary breast augmentation was 300cc. SUMMARY Pre-operative external sizers are the most common technique used by UK consultant plastic surgeons to select implant size for primary breast augmentation. We discuss the above findings in relation to the evolution of pre-operative planning techniques for breast augmentation.
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Affiliation(s)
- W J M Holmes
- Department of Plastic Surgery, Bradford Royal Infirmary, Bradford, UK.
| | - M J Timmons
- Department of Plastic Surgery, Bradford Royal Infirmary, Bradford, UK
| | - S Kauser
- Faculty of Medicine and Health, University of Leeds, Leeds, UK
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Martin del Yerro JL, Vegas MR, Sanz I, Moreno E, Fernandez V, Puga S, Vecino MG, Biggs TM. Breast augmentation with anatomic implants: a method based on the breast implantation base. Aesthetic Plast Surg 2014; 38:329-37. [PMID: 24002490 DOI: 10.1007/s00266-013-0190-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 06/22/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED Currently, aesthetic and reconstructive surgery of the breast should be considered in terms of contouring, and hence in terms of dimensions. Based on experience performing more than 5,000 breast augmentations with highly cohesive anatomic implants, the authors explore the aesthetic anatomy of the (augmented) breast and explain the importance of the breast implantation base (BIB), the aesthetic proportions of the lower breast pole, and the patient's somatotype in the implant selection for a natural-appearing breast augmentation. A method is described for transferring all these concepts and proportions to the preoperative marking of the individual patient. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jose L Martin del Yerro
- Plastic, Reconstructive and Aesthetic Surgery Service, Hospital Quirón, C/ Diego Velazquez 1, Pozuelo de Alarcon, Madrid, Spain,
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Elfakir H, Shipkov H, Mojallal A. [Optimization of primary aesthetic breast augmentation using implants: an evidence-based level approach]. ANN CHIR PLAST ESTH 2014; 59:89-96. [PMID: 24525283 DOI: 10.1016/j.anplas.2013.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/22/2013] [Indexed: 11/28/2022]
Abstract
The primary aesthetic breast augmentation has been the most performed cosmetic surgery procedure in the world for over 40 years. The current literature focuses on the new concept of "process of breast augmentation" and the importance of non-surgical part (patient selection, preoperative planning and personalized management of postoperative care) in potentiating the cosmetic results and reducing the rate of complications and reoperations. This review of literature discusses, through an analysis of scientific evidence levels, every step of the whole process of breast augmentation in order to determine the current best practices tailored to each patient to optimize satisfactory and durable cosmetic outcomes.
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Affiliation(s)
- H Elfakir
- Service de chirurgie plastique et des brûlés, centre hospitalier St-Joseph - St-Luc, 20, quai Claude-Bernard, 69395 Lyon cedex 7, France.
| | - H Shipkov
- Service de chirurgie plastique reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon, France
| | - A Mojallal
- Service de chirurgie plastique reconstructrice et esthétique, hôpital de la Croix-Rousse, hospices civils de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon, France
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Selecting the implant height in breast augmentation with anatomical prosthesis: the "number Y". Plast Reconstr Surg 2013; 131:1404-1412. [PMID: 23714801 DOI: 10.1097/prs.0b013e31828bd65b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Selecting the appropriate implant is one of the most important and demanding decisions in breast augmentation with anatomical implants, because different widths, heights, and projections can be found for a given volume. Most of the related literature and surgeons' concern have focused on width and projection. Implant height selection, however, has remained deeply overlooked, and it has been assumed that it depended on the suprasternal notch-to-nipple distance and, to a large extent, on the patient's height. METHODS With more than 5123 breast augmentations performed over the past 15 years, the authors performed an analysis of the breast and implant height with consequences in aesthetic augmentation of the breast. Two concepts--breast implantation base (or breast footprint) and somatotype--were explored. Their influence in the selection of the appropriate anatomical implant height is investigated. RESULTS Selection of implant height should follow the patient's breast implantation base, which is highly influenced by her somatotype. With this assumption, a "number Y" is proposed that correlates the suprasternal notch-to-nipple distance with the thoracic perimeter and unveils the shape of the breast implantation base in the particular patient. CONCLUSIONS Adjusting the implant shape/footprint to the breast implantation base/breast footprint gives the surgeon control over the upper pole of the breast and allows a predictable postoperative result. The number Y rationalizes the selection of the implant height in breast augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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