How should plastic surgeons choose the best implant type and size for women undergoing breast augmentation surgery? Implant size selection systems based on breast tissue measurements may provide better outcomes, suggests a research review in the November issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Tissue-based planning (TBP) systems – using clinical guidelines to determine the optimal breast implant dimensions for individual patients – appear superior to approaches relying more on the patient’s or surgeon’s preference, according to the study by Drs William P. Adams, Jr, of University of Texas Southwestern Medical Center, Dallas, and Daniel McKee of McMaster University, Hamilton, Ontario, Canada. But further studies will be needed to clarify how breast implant size selection systems affect the outcomes of breast augmentation.

The researchers performed a “data-driven review” of methods used by plastic surgeons to select the appropriate implant size for breast augmentation surgery. Implant size selection systems were divided into three groups: No breast measurements; implants chosen based solely on the patient’s or surgeon’s preference; dimensional analysis systems.

Breast tissue measurements are used to set “clear and narrow boundaries” for implant selection based on clinical guidelines, with limited to no flexibility.

The review identified 33 articles on implant sizing systems. Studies evaluating TBP sizing systems were of higher quality than those in the other two categories.

“The top 10 studies based on methodological quality all used patients’ breast dimensions before selecting final implant dimensions, and this should now be considered standard of practice based on our analysis,” Drs Adams and McKee write. The TBP studies reported low rates of repeat surgery, compared to industry standards and accepted research values.

The researchers emphasise some major limitations of the available evidence on implant sizing systems. Just four out of 33 studies reported clinical outcomes that could be compared to any standard, while none of the studies compared two or more sizing systems. Overall, 60 percent of studies scored zero on the quality rating scale used – including some popular sizing systems that were “not grounded on any published data or evidence”.

The topic of implant selection can be an emotional one, with tension between the plastic surgeon’s roles as “Artist” versus “Engineer”. The researchers note that some TBP systems with the highest quality of evidence take a “middle-of-the-road” approach – based on measurements, but also considering the patient’s aesthetic desires.

Source: Prime International Journal of Aesthetic and Anti-Ageing Medicine

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