Profile of breast augmentation surgery in Brazil

CHARLES-DE-SÁ, LUIZ; GONTIJO-DEAMORIM, NATALE FERREIRA; ALBELAEZ, JUAN PABLO; LEAL, PAULO ROBERTO

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Revista Brasileira de Cirurgia Plástica

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Original Article • Rev. Bras. Cir. Plást. 34 (2) • Apr-Jun 2019 • https://doi.org/10.5935/2177-1235.2019RBCP0132 copy

Profile of breast augmentation surgery in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

The latest research by the International Society of Aesthetic Plastic Surgery (ISAPS) showed that 2,524,115 plastic surgeries were performed in Brazil in 2017. Breast augmentation has been one of the most commonly-performed plastic procedures in Brazil, totaling more than 200,000 surgeries in 2016. The objective is to evaluate the current practices and trends in breast augmentation in Brazil.

Methods:

A 31-item questionnaire was constructed and sent to 6,200 active members of the Brazilian Society of Plastic Surgery (SBCP). The research addressed some current trends and controversial practices in five areas: current controversies, new technologies, breast implants, technical considerations in secondary procedures, and demographic aspects. The questionnaire was designed to profile practices, procedures, and beliefs among plastic surgeons regarding the use of breast implants in Brazil.

Results:

A total of 505 responses were collected, representing a response rate around 10%, which is well above the average response rate for Brazilian Society of Plastic Surgery (SBCP) questionnaires. The results were distributed in five tables by area of interest.

Conclusion:

In this study, the most common practices included the use of microtexture round implants and polyurethane-coated silicone as the primary procedure, a subglandular pocket, inframammary incisions, preoperative sizing with round implant samples, intravenous and oral antibiotics, double irrigation antibiotics, an implant size that was generally less than 325 cc, and without drainage. There is no consensus on breast lip balancing and the management of capsular contracture and double bubble deformity.

Keywords:
Mammoplasty; Breast; Capsular contracture in implants; Breast implants; Break

Concern with practice and expertise	Total of responses (%)
The surgeon follows his own experience	48.01
There are different approaches to the same problem.	20.72
No protocol developed by SBCP	3.57
There is some protocol by SBCP	5.78
Not informed	4.58
Use of anatomical implants
Never	46.52
Uses in <50% of cases	47.32
Uses in 50% of cases	1.79
Uses in > 50% of cases	358
Always	0.80
Concerns about anatomical implants
Aesthetic result is not superior to round implants	55.49
Rotational potential	34.93
No limitations	11.38
High cost	23.95
Larger incisions	3.99
Problems with texturing (late seroma, ALCL)	2.00
Limited incision options	1.80
Others	17.56
Use of autologous fat in the primary augmentation procedure
Never	98.92
<50% of cases	29.08
Uses in 50% of cases	1.20
> 50% of cases	0.60
Always	0.20
Concerns about use of fat grafting in the primary procedure
Limited growth potential	43.17
May require multiple procedures	43.80
Potential to interfere with imaging exams	27.31
No worries	26.91
Cost	1165
Complexity of the procedure	5.02
Others	10.04
Use of autologous fat as a supplementary technique
<50% of cases	54.91
Never	35.67
> 50% of cases	7.01
Always	2.4
Presented one case of ALCL in their practice
No	99.20
Yes	0.80
I use breast implants in your current practice
Primary breast augmentation	78.13
Mastopexy	18.29
Breast reconstruction surgery	3.58
Does not use breast implants	0.00

Use of three-dimensional technology	Total of responses (%)
No	96.41
Yes	3.59
Evaluates the role of tridimensional imageology in their practice
It has not proved that it is worth the cost and effort	61.11
It is an effective marketing tool	11.73
It made the consultation process too complex	11.73
It is an effective sizing tool	11.10
It is an effective educational tool	6.79
Other	7.90
Use of ADM in secondary cases
No	98.40
Yes	1.60
If yes, use ADM, for which purpose it is proposed
Rippling or fine tissues	24.44
Contour deformities	17.78
Capsular contracture	15.56
Post-capsulotomy	6.67
Other	48.89
Use of funnel for placement of the implant
Never	90.64
<50% of cases	5.38
Only for small incisions/large implants	1.20
50% of cases	0.40
> 50% of cases	0.80
Always	1.59
Why not use the funnel?
Not Needed	76.43
Additional cost	34.14
Adds extra time	6.17
Use of plastic adhesives to protect the skin before insertion of the implant
I don't use	90.60
Yes, over the nipple-areola complex	6.60
Yes, over the incision	1.80
Yes, on the nipple-areola complex and incision	1.00

Method for selecting the implant	Total of responses (%)
Sizing with silicone molds	47.40
Dimensioning with round silicone implants	31.80
"High-five" or other system of evaluation of the tissues	13.20
"Rice bags" or other "sizers" preoperative	4.60
Imaging technology	2.60
None	9.80
Implant Fill Type
100% Silicone	98.60
Mostly silicone/some saline solution	1.40
Equal amounts	0.00
Mostly saline solution/some silicone	0.00
100% Saline solution	0.00
Submuscular Implant Coverage
Microtexture	52.51
Polyurethane cover	26.46
Macrotexture	19.64
Foam	1.00
Smooth	0.40
Subglandular Implant Coverage
Microtexture	45.36
Polyurethane cover	23.33
Macrotexture	25.64
Foam	0.00
Smooth	0.66
Usual size of the implant
< 250 mL	3.18
250 - 300 mL	31.41
275 - 325 mL	39.17
300 - 350 mL	24.06
> 350 mL	2.19
Manufacturer of the implant
Silimed	54.69
Mentor	44.71
Allergan	31.74
PolyTech	23.95
LifeSil	11.78
Motiva	2.00
Others	20.16
Site of the incision
Infrared	89.66
Periareolar	8.75
Axillary	1.59
Periumbilical	0.00
Pocket Pocket
Subglandular	54.78
Subfascial	26.49
Partial submuscular	14.14
Complete submuscular	4.58
Antibiotic Prophylaxis
Intravenous anesthetic induction	94.22
Post-operative oral antibiotics	65.74
Double-antibiotic irrigation	38.25
Povidone-iodine Irrigation (only)	0.60
Povidone-iodine/bacitracin or neomycin	1.59
Classic Triple-Antibiotic Irrigation	3.19
Other type of irrigation	8.17
Never uses antibiotic prophylaxis	0.80
Post-operative suction drains
No	81.47
Yes	18.53
Draining periods
Less than 24 hours	31.58
1 day	30.08
2 days	18.80
3-5 days	18.05
> 5 days	1.50
Pharmacological agents for capsular contraction
Yes, prophylactically in all cases	3.79
Yes, only at the first sign of initiation	33.93
Yes, as first option in the establishment of contraction	9.38
Never	52.89
Did these agents effectively reduce capsular contraction?
Yes	10.39
Only if initiated precociously	17.39
Not sure	57.00
No	15.22
Non-surgical methods for the treatment of capsular contracture
Leukotriene inhibitors	42.07
Massage	32.77
External ultrasound	11.42
Closed capsulotomy	6.55
COX-2 inhibitors	5.92
Pulsed Electromagnetic Therapy	1.27
Papaverine	0.42
None	35.94
Other	4.65

Most common reasons for late recovery	Total % of responses
Capsular contracture	49.80
Change of size	35.14
Malposition	7.83
Rupture of the implant	1.00
SEROMA	2.81
Rippling	3.41
Surgical technique most commonly used in capsular contracture
Total capsulectomy	39.88
Capsulotomy	22.65
Anterior capsulotomy	18.64
Change of pocket	18.64
ADM	0.20
Technique for treatment of recurrent capsular contracture in subglandular implant
Change of pocket	51.56
Total Capsulectomy	29.46
Anterior Capsulectomy	8.48
No change and consider withdrawal of implants	2.68
Open capsulotomy	0.67
Capsulectomy + ADM	1.69
No surgical treatment if the contracture is bilateral and symmetrical	0.22
Technique for treatment of recurrent capsular contracture in submuscular implants
Change of pocket	47.15
Total capsulectomy	17.1
Anterior capsulectomy	15.86
Open capsulotomy	7.40
Capsulectomy + ADM	1.69
No surgical treatment if the contracture is bilateral and symmetrical	1.06
No change and consider withdrawal of implants	9.73
Most common treatment for double-bubble deformity
Change of pocket	54.04
Replacement of implant in the same existing pocket	22.13
Percutaneous suture or external support for an early appearance	16.60
Capsulorrhaphy only	5.32
Capsulorrhaphy and support with ADM	0.85
Removal of implants	1.06

Years of practice	Total of responses (%)
0-5	26.24
6-10	19.48
11-15	15.11
16-20	12.72
21-25	8.15
>25	18.29
Nature of practice
100% reconstructive	0.20
25% esthetic, 25% reconstructive	5.79
50% esthetic, 50% reconstructive	16.77
75% esthetic, 75% reconstructive	50.70
100% aesthetic	26.55
Annual number of primary breast augmentation surgeries
1 - 10	11.35
11 - 30	34.26
31 - 60	31.27
61-100	15.34
> 100	7.77

Sociedade Brasileira de Cirurgia Plástica Rua Funchal, 129 - 2º Andar / cep: 04551-060, São Paulo - SP / Brasil, Tel: +55 (11) 3044-0000 - São Paulo - SP - Brazil
E-mail: rbcp@cirurgiaplastica.org.br

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[1] *Corresponding author: Luiz Charles-de-Sá, Rua visconde Pirajá, 351, Sls 1211-1212, Ipanema, Rio de Janeiro, Brazil. CEP: 22410-003. E-mail: clinicaperforma@uol.com.br