SILICONE GEL BREAST IMPLANTS

Breast Augmentation Roundtable

Adams, William P. Jr M.D.; Teitelbaum, Steven M.D.; Bengtson, Bradley P. M.D.; Jewell, Mark L. M.D.; Tebbetts, John M.D.; Spear, Scott M.D.

Date of roundtable September 25, 2005; accepted for publication March 20, 2006.

William P. Adams, Jr., M.D.; 2801 Lemmon Avenue West, Suite 300; Dallas, Texas 75204; prs@dr-adams.com

This roundtable was conducted live at the American Society of Plastic Surgeons meeting in Chicago, Illinois, in 2005. Dr. Spear was not present for the roundtable, and his comments were formulated and added after the completion of the roundtable. For this reason, his comments have been placed in italics.

Adams: On behalf of my co-editor for this supplement, Dr. Spear, Plastic and Reconstructive Surgery, and myself, we would like to welcome each of you and thank you for your participation. All of you were selected because this is a roundtable on reoperations in breast augmentation. This is thought to be a significant problem currently in breast augmentation, and you all have experience and insight into potential solutions.

As far as the rules of this roundtable, they are written down in front of you. Basically, there is not going to be any content added post-roundtable other than grammar. There are five questions listed at the bottom. Each question will be discussed for a total of 12.5 minutes. The initial question response, which each of you will have time to respond to, will be 1.5 minutes, and the first participant to respond will be rotated. We will have an open discussion for 5 minutes or up to the 12.5-minute time limit, which Dr. Teitelbaum will facilitate. Any questions? I'd like to introduce Steve Teitelbaum, who is going to moderate this. Steve, I'll turn it over to you.

QUESTION 1

Teitelbaum: I'll start with my left and we will just go around taking the first question. We'll start with you, Brad. Are reoperations in breast augmentation a problem?

Bengtson: Nationwide and internationally, I believe that they are. A significant part of it is that each surgeon really desires to get the best result possible, to use the best implant that they deem is out and available to them, and to decrease uncorrectable deformities and problems in the future. I think they are a problem, and I think our goal should be to do everything we can to limit reoperations in the future.

Jewell: I agree. I think a reoperation problem exists. It's a quality marker, and I think we need to approach this in a fashion to help define why reoperations are occurring and what we can do to improve outcomes for patients. We need to ask and answer the question, What are we doing to prevent implants from giving us the outcome that we believe they are capable of? What decisions are we making that are wrong, that predictably produce a reoperative scenario, whether it's implant malposition, stretch deformity, things of this nature? Granted, we can't control the biologic response to an implant or the healing or scarring, but we certainly can control the decisions we make on the front end, which should lower the reoperation rate.

Tebbetts: Reoperations, in my opinion, are the number one problem for breast augmentation patients. Any reoperation subjects the patient to risks and costs that she would not have encountered had that reoperation not been necessary. A two-and-a-half decade history of 15 to 20 percent reoperation rates within just 3 years in sequential [premarket approval (PMA)] studies is difficult, to say the least, to explain to the public, especially considering that this is a totally medically unnecessary operation. This unenviable track record sends a clear public message that the processes we use for surgeon education, patient education, clinical evaluation, and decision making are flawed and ineffective.

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