Part I: Cooking up your result...Measurements don"t make a System, Ingredients don"t make a Recipe
Sixteen years ago, I introduced the first measuring system to help surgeons and patients make better, more logical decisions about implant size and selection. A quick look at two decades of previous data, with more than 20% of augmentation patients having additional operations within 3 years made several things obvious to me:
1) Something is terribly wrong when 20% of patients having an operation that was medically unnecessary in the first place then have additional, related operations within just 3 years.
2) Either surgeons were not doing an optimal job, the implant was not doing an optimal job, or both.
3) Implant selection was not being based on science (numbers that could be measured and used in a scientific system to select breast implants based on tissue types and patient wishes). Absent science or quantifiable numbers, decisions were being made based entirely on opinions or desires, not facts.
4) Breast size and implant selection were (and in many cases, still are) based on cup size, a parameter that neither surgeons nor patients have ever been able to define--<em>decisions based on a criteria that is not and cannot be defined, even today.</em>
5) More reoperations have always been caused by surgeon and patient decision related issues--not by implant failures. That fact suggests that the information and methods that surgeons and patients are using to select implants are clearly suboptimal and flawed.
6) Given the facts listed previously, it seemed obvious that a more objective, scientific approach to decisions and implant selection was sorely needed to improve outcomes for patients and reduce reoperations.
Without boring readers with the history and evolution of breast measurement systems, it is important to list the shortcomings of each system that evolved in order to appreciate what is available today.
The first dimensional system allowed patients and surgeons to define a size breast that the patient desired, a specific width of the gap between the breast (cleavage) that the patient desired , and then use the measurements to select an implant that would produce the desired result. This system <em>did not include any measurement of tissue stretch, hence it was a two dimensional system (width and height) that was inherently inaccurate by omitting the third dimension--stretch. </em>More importantly, the first system<em> FORCED TISSUES TO A DESIRED RESULT, REGARDLESS OF THE PATIENT'S TISSUE CHARACTERISTICS.</em>
Patients frequently got what they wanted (ordered), but many had no idea of what they would get later--the consequences to their tissues of forcing tissues to a desired result, often using breast implants that were too large or too projecting for the dimensions and characteristics of their breast envelope. Many of these patients subsequently developed uncorrectable tissue compromises and deformities that include loss of breast tissue and ability to nurse (parenchymal atrophy), skin thinning and stretch, visible rippling, implant edge visibility, and even depression deformities of the chest wall--all the result of poor decisions. The concept of measurements was good. Failure to limit how surgeons and patients would use those measurements was suboptimal. The concept of a recipe for cooking is sound. Failure to properly use the recipe can wreck the dish.
1) Something is terribly wrong when 20% of patients having an operation that was medically unnecessary in the first place then have additional, related operations within just 3 years.
2) Either surgeons were not doing an optimal job, the implant was not doing an optimal job, or both.
3) Implant selection was not being based on science (numbers that could be measured and used in a scientific system to select breast implants based on tissue types and patient wishes). Absent science or quantifiable numbers, decisions were being made based entirely on opinions or desires, not facts.
4) Breast size and implant selection were (and in many cases, still are) based on cup size, a parameter that neither surgeons nor patients have ever been able to define--<em>decisions based on a criteria that is not and cannot be defined, even today.</em>
5) More reoperations have always been caused by surgeon and patient decision related issues--not by implant failures. That fact suggests that the information and methods that surgeons and patients are using to select implants are clearly suboptimal and flawed.
6) Given the facts listed previously, it seemed obvious that a more objective, scientific approach to decisions and implant selection was sorely needed to improve outcomes for patients and reduce reoperations.
Without boring readers with the history and evolution of breast measurement systems, it is important to list the shortcomings of each system that evolved in order to appreciate what is available today.
The first dimensional system allowed patients and surgeons to define a size breast that the patient desired, a specific width of the gap between the breast (cleavage) that the patient desired , and then use the measurements to select an implant that would produce the desired result. This system <em>did not include any measurement of tissue stretch, hence it was a two dimensional system (width and height) that was inherently inaccurate by omitting the third dimension--stretch. </em>More importantly, the first system<em> FORCED TISSUES TO A DESIRED RESULT, REGARDLESS OF THE PATIENT'S TISSUE CHARACTERISTICS.</em>
Patients frequently got what they wanted (ordered), but many had no idea of what they would get later--the consequences to their tissues of forcing tissues to a desired result, often using breast implants that were too large or too projecting for the dimensions and characteristics of their breast envelope. Many of these patients subsequently developed uncorrectable tissue compromises and deformities that include loss of breast tissue and ability to nurse (parenchymal atrophy), skin thinning and stretch, visible rippling, implant edge visibility, and even depression deformities of the chest wall--all the result of poor decisions. The concept of measurements was good. Failure to limit how surgeons and patients would use those measurements was suboptimal. The concept of a recipe for cooking is sound. Failure to properly use the recipe can wreck the dish.
Source...