Breast augmentation is one of the most common aesthetic plastic surgery procedures and is in the repertoire of almost every plastic surgeon. Despite the commonality of this cosmetic breast procedure and the tremendous experience of many in performing it, it has an unappreciated (by patients) high reoperation/revision rate. While the medical literature reports reoperation rates of up to 20%, the package insert in breast implant packaging reports over a 30% revision rate in the first three years after implantation.
Amongst the many reasons for breast augmentation revisional surgery, one is unhappiness with the size of the final breast result. While some reasons for reoperation may be largely unavoidable, the choice of implant size would seem to be one that is most avoidable. Patients spend the most time before surgery thinking about the new size of their breasts and plastic surgeons have a lot of experience with implanting breast devices and have a feel for how that translates into the postoperative size change.
But the reality is that despite considerable thought on both sides of the equation (patient and plastic surgeon), there is no uniform and accurate method of choosing breast implants for any patient. Some plastic surgeons put in whatever size the patient desires and other plastic surgeons choose implants based on what they feel the tissues will tolerate and stay stable over time. (not bottom out) Neither method is right for every patient and merging these two approaches is probably best for the broadest number of patients over time.
But investigating this breast implant selection approach further, a report has appeared in the December 2012 issue of Plastic and Reconstructive Surgery to determine plastic surgeon’s preferences and how that affects patient satisfaction after surgery. Using over 600 survey question responses from board-certified plastic surgeons, breast base diameter was ranked as the most important consideration for almost half of the surgeons (47%) after understanding the patient’s aesthetic vision. When there was a conflict between what size the patient wanted and what size the plastic surgeon wanted to implant, 2/3s of surgeons (64%) choose to reeducate their patients using breast base diameter. Just ¼ (25%) of plastic surgeons proceeded with implant placement based on what the patient wanted even if they disagreed with that volume selection. Over half of the surgeons reported that their breast size change rate was 5% or less while the remaining 45% reported it was 5% or higher. Those plastic surgeons with lower reoperation rates for size change ranked breast base diameter as the most important criteria in selection. Conversely, those surgeons with reported higher breast implant size changes rated implant volume as an important selection consideration.
What this survey study shows is that reported reoperation rates for implant size change were lower when using breast base diameter as a more important consideration than implant volume. However there are numerous factors to consider when choosing breast implant size and any result can not be optimally determined by one single measurement (breast base diameter) or just volumetric estimation alone. But it does speak to the concept that each individual patient’s breast base measurement, which can quickly and reliably be done, is an important consideration that can be easily matched to that of a corresponding breast implant’s base measurement. The volume associated with that implant will go a long way to avoiding one reason for breast implant size dissatisfaction…too big of an implant.
Dr. Barry Eppley