Use of a system designed to aid breast implant selection can help to optimize patient satisfaction after augmentation mammaplasty and reduce the rate of reoperation for size change, according to Dennis C. Hammond, M.D., who spoke at the 2010 meeting of the Canadian Society of Aesthetic Plastic Surgery in Toronto.
Dr. Hammond originated the idea, and he developed the system in collaboration with Mentor consultants. After they established the basics, a working group of high-volume breast augmentation surgeons was organized to help finalize the system, which was introduced in 2008 and is being used by surgeons worldwide.STUDYING SATISFACTION According to Dr. Hammond, a survey of patients who used the system to guide implant selection before their operations indicate it is fulfilling its design objectives. In a cohort of 30 women whose implants were selected with use of the kit, 96 percent indicated they were satisfied with their size and agreed with the surgeon that the desired result had been obtained, says Dr. Hammond, a board-certified plastic surgeon practicing in Grand Rapids, Mich.
"Available data on breast augmentation indicate a surprisingly high rate of reoperation for size change. This problem reflects in part the pitfalls of trying to use cup size for determining the outcome. Many women presenting for breast augmentation have a certain cup size in mind, but cup size is variable and an inaccurate representation of breast size," Dr. Hammond says. "Therefore, even when the surgeon has completed a technically perfect breast operation, if implant selection was based on cup size, the woman can be very dissatisfied because she may not be the full C she hoped for."
"The implant selection system is designed to help the surgeon better understand how the patient hopes to look after augmentation and to pick the implant in a more accurate way to match that goal," he says.
COMPLEMENTARY TOOL The implant selection system is intended to be an adjunctive tool that still allows for surgical judgment and experience. Using supplied skin-fold calipers and a slide rule-type instrument, the surgeon determines breast base diameter, breast height, skin thickness of the medial and lateral skin folds and the upper pole and the position of the nipple and areola. The data are recorded on a worksheet that also captures assessment of the skin envelope, inframammary fold position and patient input on the desired outcome.
For the latter, patients are asked to choose one of four outcomes depicted pictorially as representing the following: a modest, natural result; a breast that looks as full as possible but still appears natural; a full breast that looks somewhat artificial; or an out-of-proportion breast that is as big as possible.
"Most patients select the second option. However, the system also features an educational component that reflects its purpose to increase the likelihood of picking an implant to match the patient's desired result 'within reason,'" Dr. Hammond says.
"The outcome some women have in mind is not safe to create. To help prevent problems before they occur, the system includes an element of preoperative evaluation to help identify this situation, so the patient can be advised that what she is seeking is not a good idea," he says.
Using the data in hand, the surgeon refers to the implant selection booklet that will identify a range of devices varying in terms of implant volume, projection and base diameter but that would be appropriate to provide the desired result.
The breast implant selection kit is available without charge to any surgeon who requests it from their Mentor sales representatives, the company says. It includes an instructional CD that Dr. Hammond developed to outline its use. A chapter about the selection system is also found in Dr. Hammond's book, Atlas of Aesthetic Breast Surgery, Elsevier, 2009.