Can you tell the difference: Round vs anatomical implants – A real-time global ballot

Mohan Arvind, Marlene See, Jian Farhadi. Guys & St Thomas NHS Foundation Trust 2017 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. https://doi.org/10.1016/j.bjps.2017.11.033

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Dear Sir,

Round and anatomical implants are used throughout the world for breast augmentation. However, controversy persists as to which provides the most aesthetically pleasing results, with a paucity of evidence comparing the cosmetic outcome of the two shapes. Many argue that in the majority of patients it is impossible to tell whether augmentation has been carried out using anatomical or round implants. We performed a live global ballot at the London Breast Meeting 2016 to determine whether delegates from around the world could determine the shape of implants used to augment 50 patients. Delegates attending and viewing online at the London Breast Meeting 2016 were shown fifty consecutive photographs showing face on and lateral, pre- and post-operative images of patients having undergone breast augmentation with round and anatomical implants. All patients had a BMI of between 18 and 25, with implants between 200 and 320 ml and a starting cup size of A or B. Delegates were asked to determine what shape of implant had been used for each patient using the online voting system via the London Breast Meeting mobile app. Thirty-one patients had anatomical implants and 19 had round implants. Shape of implant was guessed correctly on average 58% of the time. Round implants were guessed correctly 63% of the time while anatomical implants were guessed correctly 54% of the time. Almost half of clinicians were unable to accurately identify implant shape. This is a finding consistent with other similar studies. At the American Society of Aesthetic Surgeons Meeting 2014, 250 Board-certified Plastic Surgeons were shown 20 sets of pre- and post-operative patient photographs and asked to vote electronically on whether implants were round or anatomical. Delegates were correct 46% of the time. Al-Ajam et al performed a blinded study asking 22 Plastic Surgeons to review pre- and post-operative photographs of 60 consecutive patients (33 round; 27 anatomical implants) that had undergone breast augmentation by a single surgeon. 63% of round and 49% of anatomical implants were correctly identified (mean 56%). Friedman et al asked eleven plastic surgeons to identify between round and anatomical implants after looking at photographs of 30 breast augmentation patients (15 round; 15 anatomical). 64% of round and 47% of anatomical implants were identified correctly (mean 55%). Although subjective in their outcome analysis, studies have shown good aesthetic results with both round and anatomical implants. Bronz compared round textured noncohesive gel filled implants with naturally shaped implants and found that on photographic examination it was nearly impossible to determine any aesthetic difference between the two. In their recent randomised controlled trial, Hidalgo and Weinstein found no observable difference in breast aesthetics between anatomical and round implants when assessed by either Plastic Surgeons or lay individuals. Our study and others demonstrate the difficulty in determining whether breast augmentations have been carried out using round or anatomical implants, even amongst experienced Plastic Surgeons. We believe that the achievement of a desirable aesthetic outcome is not dependent upon the shape of the implant used. This is supported by Hamas6 who demonstrated radiologically that both round and anatomical implants had similar shapes when standing. As many as 50 different factors influencing results in breast augmentation have been identified highlighting that careful physical examination combined with a detailed assessment of the patient’s desires are central to achieving a good result. It is clear that in the hands of experienced surgeons, the shape of implant is not the determining factor in aesthetic outcome with both round and shaped devices able to produce a natural aesthetic outcome.

Jasmine Walter

Content Editor, Mark Allen Group

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