Modified Delphi technique to identify management of primary and secondary aesthetic breast augmentation. Will we reach a consensus?

INTRODUCTION
Breast augmentation is indeed a very common operation. While evidence has grown with experience and long term studies, variation in practice exists. Our aim was to identify the existing practices of a group of surgeons for primary and secondary aesthetic breast augmentation.


MATERIALS AND METHODS
Seventy two plastic surgeons with a specialist interest in aesthetic breast surgery were asked to participate in the survey about aesthetic breast augmentation. Once agreed, a 54 point online survey was given, covering demographics about the surgeon and their practice, implant choice and peri-operative technique, use of emerging evidence and surgical techniques, preferences about secondary surgery and opinion about topics of controversy.


RESULTS
All 72 surgeons completed the survey. Their mean age was 57.6 years, 56.9% had been in surgical practice for over 20 years and 88.9% were performing more than 50 primary breast augmentations per year. The most commonly used measurement for implant selection was breast width, implant type was silicone (81.9%) and volume range was 250-350cc (86.1%). 36.1% surgeons use anatomical implants in more than half of their cases. Opinions were divided about postoperative return to work, use of insertion funnel and acellular dermal matrix.


CONCLUSION
Multiple factors affect clinical outcome in primary and secondary aesthetic breast surgery. A few well-established techniques have gained common acceptance but the opinion is more diverse for difficult, complicated or challenging scenarios. Our survey helps understand the decision-making process of expert surgeons with an interest in aesthetic breast surgery.