We are thankful for the opportunity to respond to Dr. Jewell. We have serious concerns that Dr. Jewel has understood the methodology and the conclusion of our study.1
All of the suggestions mentioned by Dr. Jewell are very interesting and would have probably increased the quality of our study, but infinite preoperative and postoperative patient, implant, and technique data could not have been reported. Our study is not perfect, but we have not read the perfect study yet.
One of the basic principles of the scientific method is reproducibility, and studies similar to ours have been conducted previously.2–6 In addition, our study is easy to reproduce.
Dr. Jewell also mentions “there are ample clinical outcomes” without giving any single reference. A basic concept in the scientific method is to gather data and studies to alter, refine, expand, or reject a hypothesis. This is the way we build science to discover the truth to provide our patients the best care we can provide them.
Dr. Jewell also stated “It has been my experience.” He probably did not read the discussion of our study by Dr. Lista or perhaps he did not understand the key points. We strongly recommend reading the discussion by Dr. Lista. Our study is level III, which is a higher level of evidence than level V. Our data are more likely to be close to the truth than Dr. Jewell’s opinion. The statistician W. Edwards Deming stated: “Without data, you’re just another person with an opinion.”
Recently, a level I evidence study5 has been published by Hidalgo and Weinstein showing no aesthetic superiority of anatomical over round implants. They conclude: “Given that anatomical implants have important and unique disadvantages, a lack of proven aesthetic superiority argues against their continued use in breast augmentation.” This study supports no aesthetic superiority of anatomical over round implants. Consistency is another basic concept of the scientific method; our study shows consistency with this well-designed study.
It is well known that the Plastic and Reconstructive Surgery revision process is one of the most serious and respected in our field. Our study focuses attention on a controversial aspect of breast augmentation with both clinical and economic implications. The conclusion of our study benefits patients and negatively affects the industry interests. In the future, we would like to read more data and studies and less opinions on this and other unsolved topics in plastic surgery.
The authors have no commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in this communication.
Carlos G. Rubi, M.D.IMED ValenciaBurjassot, Valencia, Spain
Jose Angel Lozano, M.D., Ph.D.Complejo Hospitalario de NavarraPamplona, Navarra, Spain
Alberto Pérez-Espadero, M.D.IMED ValenciaBurjassot, Valencia, Spain
Elena Leache, M.D.Complejo Hospitalario de NavarraPamplona, Navarra, Spain
1. Rubi CG, Lozano JA, Pérez-Espadero A, Leache ME. Comparing round and anatomically shaped implants in augmentation mammaplasty: The experts’ ability to differentiate the type of implant. Plast Reconstr Surg. 2017;139:6064.
2. Bronz G. A comparison of naturally shaped and round implants. Aesthet Surg J. 2002;22:238246.
3. Friedman T, Davidovitch N, Scheflan M. Comparative double blind clinical study on round versus shaped cohesive gel implants. Aesthet Surg J. 2006;26:530536.
4. Gahm J, Edsander-Nord A, Jurell G, Wickman M. No differences in aesthetic outcome or patient satisfaction between anatomically shaped and round expandable implants in bilateral breast reconstructions: A randomized study. Plast Reconstr Surg. 2010;126:14191427.
5. Lista F. Discussion: Comparing round and anatomically shaped implants in augmentation mammaplasty: The experts’ ability to differentiate the type of implant. Plast Reconstr Surg. 2017;139:6566.
6. Hidalgo DA, Weinstein AL. Intraoperative comparison of anatomical versus round implants in breast augmentation: A randomized controlled trial. Plast Reconstr Surg. 2017;139:587596.