title: Delphi Study Consensus Recommendations: Patient Selection and Preoperative Planning Measurements for Natrelle 410.
abstract: BACKGROUND
  There is considerable variation in the planning and implementation process for breast augmentation. Although general guidelines are available, the distinctive characteristics of the Natrelle 410 breast implant warrant surgical guidelines specific to this device. This study aimed to develop consensus recommendations for patient selection and preoperative planning for Natrelle 410 in primary breast augmentation.
  
  
  METHODS
  Surgeons were invited to participate in this study, which used a modified Delphi method. Participants completed 2 rounds of online surveys, with the second round (Recommendations Survey) based on responses from the first round. Respondents also listed their top priorities for using Natrelle 410 implants.
  
  
  RESULTS
  Participants (n = 22) reached consensus on 15 of 18 criteria for patient selection; tuberous breasts, patient preference regarding upper pole shape, and asymmetry of the breasts were the top 3 patient characteristics considered appropriate for the use of Natrelle 410. Consensus was reached on 38 of 51 items related to preoperative planning, with 8 measurements and 6 markings recommended by the participants. Patient-desired outcome was considered the most essential element for Natrelle 410 implant selection; quality of skin envelope and height and width dimension of the breast were selected as the most essential elements for Natrelle 410 implant volume selection.
  
  
  CONCLUSIONS
  The modified Delphi method resulted in consensus recommendations for patient selection and preoperative planning in primary breast augmentation with the Natrelle 410 breast implant. These recommendations and priorities, used in concert with a surgeon's clinical experience, are designed to optimize surgical outcomes.
authors.affiliation: Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif.
authors.forename: Per
authors.initials: P
authors.lastname: Hedén
authors.affiliation: Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif.
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Brown
authors.affiliation: Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif.
authors.forename: Jie
authors.initials: J
authors.lastname: Luan
authors.affiliation: Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif.
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Maxwell
authors.affiliation: Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif.
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.affiliation: Department of Plastic Surgery, Akademikliniken, Stockholm, Sweden; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Department of Breast Plastic & Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn., and Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic Surgery, Hospital Sírio-Libanês, São Paulo, and Division of Plastic Surgery, University of São Paulo School of Medicine, São Paulo, Brazil; Global Medical Affairs Department, Allergan, Irvine, Calif.
authors.forename: Mollie
authors.initials: M
authors.lastname: Carter