A decision-making method for breast augmentation based on 25 years of practice

 

 Permissions and Reprints

Introduction

Breast augmentation is the most commonly performed procedure in the field of aesthetic plastic surgery [1] [2]. Women considering breast enhancement are mostly interested in shape improvement: 29% wish to improve the size or volume of their breasts, 15% wish to improve the general shape, 29% wish to return to a previous shape (pre-breastfeeding), 32% would like to address sagging of their breasts, and 8% wish to improve symmetry.

Accurate preoperative planning is crucial for obtaining the best outcomes and for reducing the re-intervention rate. The entire decisionmaking process in breast augmentation was initially determined exclusively by the patient’s wishes and the surgeon’s preferences, making the choice of implant size, type of implant, implant position, and type of incision an arbitrary decision. This led to high re-intervention rates due to patients’ dissatisfaction with the implant size and other postoperative complications [3] [4] [5].

Many techniques aiming to refine the preoperative decision-making process for breast augmentation have been developed in the last 10 years, leading to a significant reduction of the re-operation rates [6] [7] [8]. Lower re-intervention rates are associated with the application of tissue-based planning methods and decision-making systems matching implants to patients’ tissues and breast dimensions [9] [10] [11] [12]. Herein, we present our planning method, which is derived from more than 25 years of experience in aesthetic breast surgery and involves matching the characteristics of patients’ tissues with their wishes. We schematized our planning method in an easy-to-use flow diagram to help the decision-making process in breast augmentation.

This invited manuscript is based on the topic of Maurizio Bruno Nava’s presentation at the PRS Korea 2016 meeting (November 19, 2016) in Seoul, Korea.

Publication History

Received: 11 March 2017

Accepted: 26 September 2017

Article published online:
22 May 2022

© 2018. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• References

• 1 American Society of Plastic Surgery. 2015 Cosmetic plastic surgery statistics. Arlington Heights: American Society of Plastic Surgeons; 2017. [cited 2016 Dec 31]. Available from: http://www.plasticsurgery.org/Documents/news-resources/statistics/2015-statistics
  Google Scholar
• 2 International Society of Aesthetic Plastic Surgery. 2015 Cosmetic Plastic Surgery Italian Statistics International Society of Aesthetic Plastic Surgery [cited 2016 Dec 31]. Available from: Hanover c2006-2015 http://www.isaps.org/Media/Default/global-statistics/2016%20ISAPS%20Results.pdf
• 3 Adams Jr WP, Teitelbaum S, Bengtson BP. et al. Breast augmentation roundtable. Plast Reconstr Surg 2006; 118 7 Suppl 175S-187S
  CrossrefPubMedGoogle Scholar
• 4 Bengtson BP. Complications, reoperations, and revisions in breast augmentation. Clin Plast Surg 2009; 36: 139-56
  CrossrefPubMedGoogle Scholar
• 5 Jewell ML, Jewell JL. A comparison of outcomes involving highly cohesive, form-stable breast implants from two manufacturers in patients undergoing primary breast augmentation. Aesthet Surg J 2010; 30: 51-65
  CrossrefPubMedGoogle Scholar
• 6 Bengtson BP, Van Natta BW, Murphy DK. et al. Style 410 highly cohesive silicone breast implant core study results at 3 years. Plast Reconstr Surg 2007; 120 7 Suppl 1 40S-48S
  CrossrefPubMedGoogle Scholar
• 7 Maxwell GP, Van Natta BW, Murphy DK. et al. Natrelle style 410 form-stable silicone breast implants: core study results at 6 years. Aesthet Surg J 2012; 32: 709-17
  CrossrefPubMedGoogle Scholar
• 8 Maxwell GP, Van Natta BW, Bengtson BP. et al. Ten-year results from the Natrelle 410 anatomical form-stable silicone breast implant core study. Aesthet Surg J 2015; 35: 145-55
  CrossrefPubMedGoogle Scholar
• 9 Tebbetts JB, Adams WP. Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg 2005; 116: 2005-16
  PubMedGoogle Scholar
• 10 Tebbetts JB. Achieving a zero percent reoperation rate at 3 years in a 50-consecutive-case augmentation mammaplasty premarket approval study. Plast Reconstr Surg 2006; 118: 1453-7
  CrossrefPubMedGoogle Scholar
• 11 Adams WP. The high five process: tissue-based planning for breast augmentation. Plast Surg Nurs 2007; 27: 197-201
  CrossrefPubMedGoogle Scholar
• 12 Adams Jr WP. The process of breast augmentation: four sequential steps for optimizing outcomes for patients. Plast Reconstr Surg 2008; 122: 1892-900
  CrossrefPubMedGoogle Scholar
• 13 Tebbetts JB. Dimensional augmentation mammaplasty using the biodimensional system. Santa Barbara: McGhan Medical Corporation; 1994
  Google Scholar
• 14 Tebbetts JB. A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg 2002; 109: 1396-409
  CrossrefPubMedGoogle Scholar
• 15 Largent JA, Reisman NR, Kaplan HM. et al. Clinical trial outcomes of high- and extra high-profile breast implants. Aesthet Surg J 2013; 33: 529-39
  CrossrefPubMedGoogle Scholar
• 16 Tebbetts JB, Teitelbaum S. High- and extra-high-projection breast implants: potential consequences for patients. Plast Reconstr Surg 2010; 126: 2150-9
  CrossrefPubMedGoogle Scholar
• 17 Tebbetts JB. Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types. Plast Reconstr Surg 2006; 118 7 Suppl 81S-98S
  CrossrefPubMedGoogle Scholar
• 18 Mallucci P, Branford OA. Design for natural breast augmentation: the ICE principle. Plast Reconstr Surg 2016; 137: 1728-37
  CrossrefPubMedGoogle Scholar
• 19 Deva AK, Adams Jr WP, Vickery K. The role of bacterial biofilms in device-associated infection. Plast Reconstr Surg 2013; 132: 1319-28
  CrossrefPubMedGoogle Scholar
• 20 Adams Jr WP, Rios JL, Smith SJ. Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study. Plast Reconstr Surg 2006; 118 7 Suppl 46S-52S
  PubMedGoogle Scholar
• 21 Giordano S, Peltoniemi H, Lilius P. et al. Povidone-iodine combined with antibiotic topical irrigation to reduce capsular contracture in cosmetic breast augmentation: a comparative study. Aesthet Surg J 2013; 33: 675-80
  CrossrefPubMedGoogle Scholar
• 22 Craft RO, Damjanovic B, Colwell AS. Evidence-based protocol for infection control in immediate implant-based breast reconstruction. Ann Plast Surg 2012; 69: 446-50
  CrossrefPubMedGoogle Scholar
• 23 Adams Jr WP, Small KH. The process of breast augmentation with special focus on patient education, patient selection and implant selection. Clin Plast Surg 2015; 42: 413-26
  CrossrefPubMedGoogle Scholar
• 24 Cooter RD, Barker S, Carroll SM. et al. International importance of robust breast device registries. Plast Reconstr Surg 2015; 135: 330-6
  CrossrefPubMedGoogle Scholar
• 25 Nahabedian MY. Discussion: international importance of robust breast device registries. Plast Reconstr Surg 2015; 135: 337-8
  CrossrefPubMedGoogle Scholar