Plastic Surgeons Generally Agree on Best Approach to Breast Augmentation

While debate continues on some topics, US plastic surgeons agree on key aspects of technique for breast augmentation surgery—including implant type and size, incision, and location of implant placement, reports a survey study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"There is a generally agreed-on approach to breast augmentation among survey respondents that encompasses many variables," write ASPS Member Surgeons Dr. David A. Hidalgo of Weil Cornell Medical College and Dr. Sammy Sinno of New York University Medical Center. But they also note that plastic surgeons have been slow to adopt some newer technologies, often because they perceived a lack of evidence on safety or effectiveness.

Plastic Surgeons Asked About Preferred Techniques for Breast Augmentation

The researchers sent an electronic questionnaire to nearly 5,000 active ASPS Member Surgeons to ask about current trends and controversies in breast augmentation. Responses from 1,067 surgeons identified general agreement in several key areas, including:

• Implant type and placement. The surgeons preferred round-shaped implants, rather than anatomically (teardrop)-shaped implants. They also favored silicone implants, with a smooth rather than a textured surface. By far, most surgeons used an incision under the breast (inframammary) and placed the implant "under the muscle" (in partial submuscular pockets).
• Implant sizing. Most surgeons still relied on "low-tech" methods— silicone implants or forms, or even "rice bags"—to assess the best implant size for individual patients. Few used recently introduced 3D imaging techniques for implant sizing. The most common implant size range was 300 to 350 cc (about 10 to 12 fluid ounces).
• Fat grafting. Most plastic surgeons did not routinely use fat grafting—transferring fat to the breasts from elsewhere in the patient's body—as either a primary or supplemental technique. While this technique has received increased attention in recent years, some surgeons expressed potential safety concerns, such as interference with breast cancer screening.
• New technologies. The low use of fat grafting and 3D imaging reflected a sense of caution about adopting newer technologies. A notable exception was a biomaterial called acellular dermal matrix, which gained high acceptance for use in revision surgery or secondary breast augmentation procedures.
• Complications. The plastic surgeons generally agreed on the management of common complications, such as contractures (scar tissue around the implant) and the need for secondary surgery.

Breast augmentation is the most frequently performed aesthetic plastic surgery procedure in the United States, with nearly 280,000 procedures performed in 2015. In recent years, several new options and techniques for breast augmentation have been introduced. The new study provides a "snapshot" of the techniques used by US plastic surgeons, as well as their views on current trends and controversies.

The results show a general consensus on many aspects of the breast augmentation, including implant selection and placement techniques. The findings also suggest that plastic surgeons tend to be conservative in adopting newer techniques—particularly if they perceive a lack of supporting evidence in terms of safety or effectiveness.

"By revealing the current practices of ASPS members, this study better informs plastic surgeons and patients on the current state-of-the art of breast augmentation," Dr. Hidalgo comments. "Breast augmentation is a still-evolving procedure, and surgeons continuously seek to use the proven techniques that will provide optimal safety and outcomes for their patients."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "Current Trends and Controversies in Breast Augmentation."

Article: "Current Trends and Controversies in Breast Augmentation." (doi: 10.1097/01.prs.0000481110.31939.e4)