title: Preoperative assessment preferences and reported reoperation rates for size change in primary breast augmentation: a survey of ASPS members.
abstract: BACKGROUND
  The purpose of this study was to determine the current preferences of plastic surgeons regarding preoperative assessment and their effect on clinical outcome in primary breast augmentation.
  
  
  METHODS
  An eight-question online survey was sent to members of the American Society of Plastic Surgeons. Data collected online were analyzed using Student's t test or Pearson's chi-square test. A value of p < 0.05 was considered statistically significant.
  
  
  RESULTS
  The response rate was 20.1 percent (604 respondents). Breast base diameter [n = 286 (47.4 percent)] was ranked the most important consideration vital in choosing implants. Most surgeons chose to reeducate their patients to resolve a conflict between their patient's implant size request and the surgeon's clinical judgment [n = 385 (63.7 percent)], whereas 151 (25 percent) would proceed anyway. Those surgeons who chose reeducation ranked breast base diameter as a vital consideration significantly higher than those who would accommodate their patients (2.03 ± 1.41 versus 2.31 ± 1.41; p = 0.041). Similarly, surgeons who reeducated their patients ranked implant volume as the vital consideration significantly lower than those who accommodated their patients (2.90 ± 1.67 versus 2.44 ± 1.47; p = 0.002). Regarding size change, 332 surgeons (55 percent) reported their rate was 5 percent or less, whereas 272 (45 percent) reported it was greater than 5 percent. Surgeons who reported a 5 percent or less rate ranked implant volume significantly lower than those with reoperation rates greater than 5 percent (2.93 ± 1.71 versus 2.55 ± 1.53; p = 0.004).
  
  
  CONCLUSIONS
  Breast base diameter and implant volume were the two most important considerations in choosing an implant for breast augmentation. Reported reoperation rates for size change were significantly lower for surgeons who regarded breast base diameter as more vital than those who valued implant volume more.
authors.affiliation: Minneapolis, Minn.; and Milwaukee, Wis. From the Division of Plastic Surgery, University of Minnesota, and the Department of Plastic Surgery, Medical College of Wisconsin.
authors.forename: Umar
authors.initials: U
authors.lastname: Choudry
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kim
mesh_terms: D001291:Attitude of Health Personnel; D001940:Breast / Q000033:anatomy & histology; D019928:Breast Implantation / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D018427:Breast Implants; D003661:Decision Support Techniques; D034462:Dissent and Disputes; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011300:Preoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D012955:Societies, Medical; D013518:Surgery, Plastic; D011795:Surveys and Questionnaires; D014481:United States