Newswise — November 30, 2023 – Continuing quality improvement data submitted by board-certified plastic surgeons highlights current trends in surgical technique in aesthetic breast augmentation using implants, reports a study in the December issue of Plastic and Reconstructive Surgery®, its official medical journal American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.
“The findings show the evolving trends in breast augmentation over the past 16 years, including factors such as incision location and the type and location of implants,” comments lead author Michael J. Stein, MD, MAS, FRCSC, FACS of Lenox Hill. Hospital, New York, NY “The data reflect current best practice among board-certified plastic surgeons, with attention to safety issues and the latest research evidence.”
Trends in breast augmentation technique from 2005 to 2020
Breast enlargement is the most frequently performed aesthetic plastic surgery procedure. In 2022, ASPS member surgeons performed nearly 300,000 breast augmentation procedures, according to ASPS statistics. To assess practice patterns and surgical techniques over time, Dr. Stein and colleagues analyzed data from the American Board of Plastic Surgery (ABPS) continuing certification process.
In this process, plastic surgeons submit information about frequently performed “tracking procedures” as evidence of continued improvement in clinical practice. The study included data on 31,700 breast augmentation cases performed by 1,082 surgeons between 2005 and 2020. Cases were divided into early (2005-14) and recent (2015-20) cohorts to assess trends in surgical technique over time. .
Patients in the more recent cohort were less likely to smoke, 12% versus 8%. and less likely to have preoperative mammograms, 29% vs. 24%. Women in the recent cohort were more likely to have drooping breasts: 23% versus 20%.
The data showed changing patterns of practice in several key areas from the early to the late period:
- The use of submammary incisions (below the breast fold) increased from 68% to 80%. Meanwhile, the use of peri-areolar incisions (around the nipple area) decreased from 24% to 14%.
- Submuscular implant placement (under the pectoralis major muscle) increased significantly: from 22% to 56%. At the same time, the use of subglandular implant placement (“over the muscle” – below the breast gland tissue) decreased from 19% to 7%.
- The use of textured implants increased from 2% in 2011 to 16% in 2016 – reflecting the belief that textured implants could reduce problems with scar tissue (contraction) around the implants. However, the use of textured implants has plummeted since 2019 and has since stopped entirely. Textured implants were used in 0% of cases from 2020 onwards.
“Focus on evidence-based practices to maximize patient safety and patient satisfaction”
The discontinuation of textured implants reflected FDA warnings about a rare form of cancer associated with this type of implant (breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL). Other trends in surgical technique – including increased use of the submammary incision and “under the muscle” implant placement – were consistent with new evidence-based studies.
Although not without limitations, the use of ABPS continuous certification data provides an “excellent resource” for assessing trends in plastic surgery over time, according to the authors. Dr. Stein comments, “Our findings inform the continued evolution of surgical technique in breast augmentation by board-certified plastic surgeons, with an emphasis on evidence-based practice to maximize patient safety and patient satisfaction.”
Senior author Arun K. Gosain, MD, of Lurie Children’s Hospital, Chicago, has initiated similar evaluations using ABPS continuous certification data for a variety of tracer procedures, focusing on craniofacial surgery, hand surgery, and cosmetic surgery. Dr. Gosain comments, “The current review highlights the value of Continuing Certification for plastic surgeons by allowing them to assess their practice patterns against those of their colleagues and assess how those practice patterns have evolved over time. .”
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About Plastic and Reconstructive Surgery
For more than 75 years, Plastic and Reconstructive Surgery® (http://www.prsjournal.com/) has been the one consistently excellent reference for any specialist using plastic surgery techniques or working in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-date reports on the latest techniques and follow-up on all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn reconstruction and cosmetic surgery, as well as medical news .
About ASPS
The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 7,000 physician members, the company is recognized as a leading authority and source of information on cosmetic and reconstructive plastic surgery. The ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the company represents physicians certified by the American Board of Plastic Surgery or the Royal College of Physicians and Surgeons of Canada.
About Wolters Kluwer
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