Breast augmentation remains
one of the most common invasive procedures that plastic
surgeons perform, and it has increased in popularity over
the last several years. Saline-filled breast implants were
approved by the U.S. Food and Drug Administration in 2000
and remain on the U.S. market for both cosmetic and
reconstructive purposes. Since January of 1992, in the
United States, only women with Food and Drug
Administration-defined criteria have been eligible to
receive silicone gel breast implants. Thus, silicone
implants have been used primarily for reconstruction after
mastectomy or for other compelling reasons. In the meantime,
various clinical trials have been underway and reported to
the Food and Drug Administration, most notably at panel
meetings in October of 2003 and April of 2005.
This extraordinary scrutiny
regarding breast implants in general and silicone gel
implants in particular has crystallized several issues:
1. There is a significant and
consistent rate of problems after breast augmentation,
including capsular contracture, malposition, and,
eventually, rupture.
2. The reoperation rate for
these problems and others is significant, even in 3-year
trials.
3. It is in the best interest
of plastic surgeons and patients alike to decrease the
frequency of these problems.
4. It is quite likely that
such a decrease can occur if appropriate attention is paid
to the entire surgical process.
Unfortunately, as with many
other procedures in plastic surgery, along with the increase
in popularity of breast augmentation has come a deluge of
marketing, hype, and spin primarily designed to attract
customers rather than educate patients. In contrast, this
supplement is intended to provide surgeons with recent
information, techniques, and data so that they can better
perform breast augmentation and take care of patients.
Over the last decade, we have
come to realize more than ever that the reality surrounding
breast augmentation should be based solely on data,
evidence, and science, and not on marketing, opinion, and
conjecture. Thus, we have attempted to collect and
synthesize a few major scientific contributions in this
supplement as a reliable reference to any surgeon who wishes
to expand his or her knowledge in this field. These articles
represent some of the more significant recent advances in
the past 10 years and ultimately should serve to benefit the
patient as well as the surgeon.
The future of breast
augmentation is bright. The key to this is the critical
shift from viewing breast augmentation as an isolated
surgical procedure without consequences to seeing it as a
true long-term process involving four key subprocesses:
patient education/informed consent, meticulous preoperative
planning, refined surgical technique, and defined
postoperative care. This general approach in various forms
has produced improved outcomes in multiple independent
studies. Despite the momentary uncertainty regarding the
status of silicone gel implants, it is likely that our
patients will have an increased choice of implants in the
very near future; however, the tenets of these basic best
practice techniques remain applicable, regardless of the
device.
Both guest editors are
familiar with the personal sacrifice required to produce
scientific data, and we commend the authors of this
supplement for their dedication to the science of breast
augmentation. It is our hope that surgeons will be able to
have this quick comprehensive reference readily available as
needed. Modern physicians are increasingly pulled in many
directions, and once-simple acts, such as reading a journal,
are increasingly sacrificed. Thus, this publication was
designed as a com-pendium of many of the important and
valuable contributions to this discipline as a service to
those in our field.
We hope you find that this
compilation makes your breast augmentation practice better
for both you and your patients.
