title: Delphi Consensus Recommendations: Intraoperative Technique and Postoperative Management of Patients with Natrelle 410 Implants.
abstract: BACKGROUND
  Anatomically shaped, form-stable Natrelle 410 breast implants were approved in Europe in 1993 and in the United States in 2013. Although general guidelines for breast augmentation are available, the distinctive characteristics of Natrelle 410 warrant specific guidelines for this device. The goal of this study was to generate consensus recommendations for intraoperative technique and postoperative management with Natrelle 410 in primary breast augmentation.
  
  
  METHODS
  Surgeons were invited to participate in the study, which used a modified Delphi method. Participants completed 2 rounds of online surveys; the second survey (Recommendations Survey) was generated based on first survey results. Respondents also listed top priorities for use of Natrelle 410.
  
  
  RESULTS
  Participants (n = 22) reached consensus on 15 of 18 perioperative and surgical techniques; dual-plane placement, tight pockets, and limiting the boundaries of dissection were among intraoperative techniques considered most important for Natrelle 410. Consensus was reached for 18 of 32 items regarding postoperative management and 6 of 9 open-ended postoperative activity restrictions. Consensus on activity restrictions with specified time limits were similar to consensus recommendations on general restrictions. Top participant-identified intraoperative and postoperative management practices for Natrelle 410 were dual-plane placement of the implant and wearing a bra postoperatively, respectively.
  
  
  CONCLUSIONS
  The Delphi method identified consensus recommendations on a broad range of intraoperative techniques and postoperative management practices for primary breast augmentation with Natrelle 410. These recommendations and priorities provide surgeons with a framework that, together with the surgeon's experience, will contribute to optimal clinical outcomes with Natrelle 410.
authors.affiliation: Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.; Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Akademikliniken, Stockholm, Sweden; Department of Breast, Plastic and Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine and Hospital Sírio-Libanês, São Paulo, Brazil; and Allergan, Inc., Irvine, Calif.
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Maxwell
authors.affiliation: Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.; Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Akademikliniken, Stockholm, Sweden; Department of Breast, Plastic and Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine and Hospital Sírio-Libanês, São Paulo, Brazil; and Allergan, Inc., Irvine, Calif.
authors.forename: Mitchell H
authors.initials: MH
authors.lastname: Brown
authors.affiliation: Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.; Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Akademikliniken, Stockholm, Sweden; Department of Breast, Plastic and Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine and Hospital Sírio-Libanês, São Paulo, Brazil; and Allergan, Inc., Irvine, Calif.
authors.forename: Per
authors.initials: P
authors.lastname: Hedén
authors.affiliation: Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.; Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Akademikliniken, Stockholm, Sweden; Department of Breast, Plastic and Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine and Hospital Sírio-Libanês, São Paulo, Brazil; and Allergan, Inc., Irvine, Calif.
authors.forename: Jie
authors.initials: J
authors.lastname: Luan
authors.affiliation: Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.; Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Akademikliniken, Stockholm, Sweden; Department of Breast, Plastic and Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine and Hospital Sírio-Libanês, São Paulo, Brazil; and Allergan, Inc., Irvine, Calif.
authors.forename: Alexandre Mendonça
authors.initials: AM
authors.lastname: Munhoz
authors.affiliation: Department of Plastic Surgery, Vanderbilt University School of Medicine, Nashville, Tenn.; Loma Linda University School of Medicine, Loma Linda, Calif.; Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada; Akademikliniken, Stockholm, Sweden; Department of Breast, Plastic and Reconstructive Surgery, Plastic Surgery Hospital of Chinese Academy of Medical Sciences, Beijing, China; Division of Plastic Surgery and Breast Surgery Group, University of São Paulo School of Medicine and Hospital Sírio-Libanês, São Paulo, Brazil; and Allergan, Inc., Irvine, Calif.
authors.forename: Mollie
authors.initials: M
authors.lastname: Carter