Pre-Operative Assessment and Reoperation Rates In Breast Augmentation - A Survey of ASPS Members

Purpose
To determine the current surgical preferences and practices of plastic surgeons regarding preoperative assessment and their effect on clinical outcome in breast augmentation.

Materials and Methods
An 8-question online survey was sent to 4990 members of the ASPS. Data collected online was analyzed using Student's t-test or Pearson's chi-square test. A p-value of < 0.05 was considered statistically significant.

Results
Of the 4990 surgeons polled, 604 (12%) completed the survey. Most surgeons had their personal pre-operative assessment system to choose implants (n=328; 54.3%). Breast Base Diameter (BBD) (n=286; 47.4%) was ranked the most important consideration vital in choosing implants. However, most surgeons rated “awareness of the patient's desired outcome” as the most important assessment for preoperative decision making (mean rating 4.70 ± 0.78 on a scale of 5); with BBD a close second (4.35 ±1.01). Most surgeons chose to re-educate their patients to resolve a conflict between their patient's implant size request and the surgeon's clinical judgement (n=385; 63.7%), whereas 151 (25%) would accommodate and proceed anyway. Those surgeons who chose re-education ranked BBD as a vital consideration significantly higher than those who would accommodate their patients (2.03 ± 1.41 vs 2.31 ± 1.42; p = 0.041). Similarly, surgeons who re-educated their patients ranked IV (Implant Volume) as the vital consideration significantly lower than those who accommodated their patients (2.90 ± 1.67 vs 2.44 ± 1.47; p=0.002). The median overall self-reported reoperation rate for breast augmentation was 1% - 5% (n=299; 49.5%). Capsular contracture was ranked the most common reason for reoperation (mean rank 3.30 ± 1.65). Implant size change was a close second (mean rank 3.24 ± 1.62), with 332 surgeons (55%) reporting their rate was ≤5%, while 272 (45%) reported it was >5%. Surgeons who reported a ≤5% size change rate ranked IV significantly lower than those with reoperation rates >5% (2.93 ± 1.71 vs 2.55 ± 1.53; p=0.004).

Conclusions
BBD and IV were the two most important considerations in choosing an implant for breast augmentation. Reported reoperation rates for size change were significantly lower in surgeons who regarded BBD as more vital than those who valued IV more. Further large scale prospective studies are required to further substantiate that anthropometric measurements result in better outcomes in breast augmentation.