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Current Trends and Controversies in Breast Augmentation

Hidalgo, David A. M.D.; Sinno, Sammy M.D.

Plastic and Reconstructive Surgery: April 2016 - Volume 137 - Issue 4 - p 1142-1150
doi: 10.1097/01.prs.0000481110.31939.e4
Cosmetic: Original Articles
Video Discussion
Press Release

Background: A survey was conducted to study current attitudes and common practices in breast augmentation.

Methods: A 35-item electronic questionnaire was sent to the entire active American Society of Plastic Surgeons membership. It was divided into current controversies, new technologies, common practices, secondary procedures, and member demographics.

Results: There were 1067 respondents. Fifty percent of surgeons never use anatomically shaped implants and another 42 percent do so less than half the time. Autologous fat is used infrequently as a primary technique but more often as a supplemental technique. Approximately 7 percent report a case of anaplastic large cell lymphoma. Eighty-five percent do not use preoperative three-dimensional imaging. More than half of surgeons use acellular dermal matrix in secondary procedures. Approximately half do not use insertion funnels. Preoperative sizing with silicone implants, inframammary incisions, partial submuscular pockets, and smooth silicone implants larger than 300 cc are dominant practice preferences. Postoperative massage is still popular with over half of respondents. Just over half do not use pharmacologic agents for capsular contracture. Capsular contracture and size change were the most frequent reasons for reoperation. Capsular contracture is typically treated with anterior capsulectomy the first time, and either total capsulectomy or anterior capsulectomy with acellular dermal matrix use when recurrent. Almost half of respondents perform fewer than 50 breast augmentations yearly.

Conclusions: There is an established most common approach to breast augmentation among respondents. Most surgeons are slow to embrace controversial practices and to adopt new technologies, although acellular dermal matrix use is becoming more popular. The 7 percent incidence of anaplastic large cell lymphoma was noteworthy.

Video Discussion by Karen Horton, M.D., is Available Online for this Article.

New York, N.Y.

From the Division of Plastic Surgery, Weill Cornell Medical College; and the Department of Plastic Surgery, New York University Medical Center.

Received for publication August 29, 2015; accepted November 13, 2015.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

A Video Discussion by Karen Horton, M.D., accompanies this article. Go to and click on “Video Discussions” in the “Videos” tab to watch.

David A. Hidalgo, M.D., 655 Park Avenue, New York, N.Y. 10065,

Copyright © 2016 by the American Society of Plastic Surgeons