Philadelphia, Pa. (February 28, 2013) –For women undergoing breast reconstruction using implants, most patient-reported outcomes are similar with two different shapes of silicone gel-filled implants, reports a study in the March issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Assessment of key areas of quality of life after breast reconstruction shows few significant differences with conventional round implants versus newer “shaped” implants, according to the new research, led by Dr. Sheina A. Macadam of University of British Columbia, Vancouver. 

Does Implant Shape Affect Breast Reconstruction Outcomes?

The researchers evaluated patient-reported outcomes in women who underwent breast reconstruction with implants after mastectomy for breast cancer. Reconstructions were done using two different types of silicone gel-filled implants:  conventional round implants and anatomical “shaped” implants. The study included 65 women receiving round implants and 63 receiving shaped implants; the round implants all had a smooth surface, while the shaped implants had a textured surface

The patients completed the BREAST-Q© questionnaire, which evaluated changes in several areas of health-related quality of life, including satisfaction with breasts and with overall outcome, psychosocial, sexual, and physical well-being, and satisfaction with care. Quality of life is increasingly regarded as an important factor in evaluating the benefits of various types of medical or surgical treatments.

Data on patient-reported outcomes was collected one to four years after breast reconstruction. About 80 percent of women in both groups had reconstruction immediately after mastectomy.

The BREAST-Q data showed good overall outcomes with both types of implants. Average scores for satisfaction with the overall reconstruction (on a 100-point scale) were approximately 77 for women receiving shaped implants and 75 for those with round implants. Scores for satisfaction with the breasts were about 64 in both groups.

Scores in other areas—including psychological and sexual well-being—were also similar for the two groups. Just one area differed significantly between groups: women with shaped implants rated their breasts as firmer than women with round implants.

Findings May Help to Guide Women’s Choice of Implants

In a finding important to plastic surgeons, there was no difference in implant “rippling” between groups. Rippling, or wrinkling, had been a drawback of the first generation of shaped implants. Newer shaped silicone implants are not yet approved in the United States; clinical trials are underway.

New implants are introduced to the breast reconstruction market with limited data on the outcomes important to patients—especially in terms of how the reconstruction affects key areas of quality of life.  “Patient-reported outcomes data is required to provide guidance based on previous patients’ experience and satisfaction profiles,” Dr. Macadam and colleagues write.

The new study finds few differences in patient-reported outcomes after breast reconstruction with round versus shaped implants.  “[T]hese two types of silicone implants are equivalent in terms of satisfaction with outcome,” according to the authors.

Dr. Macadam and colleagues point out the increased firmness of shaped implants as “the one notable difference” between the two types. They believe their findings will help surgeons inform patients about the expected outcomes of reconstruction using round versus shaped implants, and may help to guide introduction of the shaped implants for widespread use.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & WilkinsLippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes.

LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2012 annual revenues of €3.6 billion ($4.6 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com

Because of their role in dealing with aesthetic problems after massive weight loss, plastic surgeons must understand the principles and expected benefits of bariatric surgery procedures—as well as the characteristics and potential medical risks of patients undergoing these procedures, according to the new review by Drs. Bruce Wolfe and Erin Gilbert of Oregon Health and Science University, Portland.

Rising Rates of Obesity Lead to Increases in Bariatric Surgery…

The authors reviewed and summarized the latest data on the use and outcomes of bariatric surgery for the management of morbid obesity.  The rise of bariatric surgery parallels the rising rates of obesity in the United States.  Drs. Wolfe and Gilbert point out, “In 1990, not one state had a prevalence of obesity greater than 15 percent, whereas in 2009, only Colorado and the District of Columbia had prevalence less than 20 percent.”

Obesity increases the risk of a wide range of chronic health problems—highlighted by the recent surge in diabetes among overweight and obese children and adolescents.  ”Not only is obesity a significant risk factor for many [diseases], but it also is associated with an overall increase in mortality and a reduction in life span of 10 years,” the authors write.  Currently, bariatric surgery is considered for patients who are unable to achieve a five percent decrease in weight with diet and lifestyle modifications.

Drs. Wolfe and Gilbert review the three main options for bariatric surgery:  adjustable gastric banding, sleeve gastrectomy, and “Roux-en-Y” gastric bypass.  The expected percentage of excess weight loss is about 48 percent after adjustable gastric banding and 61 percent after sleeve gastrectomy and gastric bypass.

Gastric bypass is the most popular procedure because it results in greater weight loss and less weight regain.  It also performs best in terms of resolving obesity-related diseases, such as diabetes, high cholesterol and high blood pressure.  However, gastric banding is a reversible procedure that causes fewer long-term metabolic problems.

…And Rising Demand for Body Contouring

It’s especially important for plastic surgeons to understand the concepts and outcomes of bariatric surgery procedures, as there is a fast-growing population of patients seeking body contouring surgery.  Body contouring refers to several different types of plastic surgery procedures done to remove excess fat and skin in patients after massive weight loss.  ASPS statistics show sharp increases in the demand for body-contouring procedures—such as lower body lift, upper arm lift, and abdominoplasty (“tummy tuck”) over the past decade.

In general, body contouring should be delayed until weight has stabilized for at least three months—which may take a year or longer after surgery, according to Drs. Wolfe and Gilbert.  They emphasize the need to carefully screen patients for ongoing medical issues such as diabetes, heart disease or obstructive sleep apnea.  Nutritional deficiencies are also common after bariatric surgery, including protein malnutrition and deficient levels of nutrients such as vitamin B12, vitamin D, iron, calcium and folate.  All of these conditions should be identified and corrected before body contouring is performed.

“Given the increasing incidence of morbid obesity and the effectiveness of bariatric surgery in treating this disease, it will likely continue to increase in popularity,” Drs. Wolfe and Gilbert conclude.  They believe that the growth of bariatric surgery may increase even further as the overall safety profile continues to improve.  In addition, the number of adolescent patients undergoing surgical treatment for obesity is likely to increase as future studies verify the safety of bariatric surgery in this age group.

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About Plastic and Reconstructive Surgery

For more than 60 years, Plastic and Reconstructive Surgery® (http://journals.lww.com/plasreconsurg/) has been the one consistently excellent reference for every specialist who uses plastic surgery techniques or works in conjunction with a plastic surgeon. The official journal of the American Society of Plastic Surgeons, Plastic and Reconstructive Surgery® brings subscribers up-to-the-minute reports on the latest techniques and follow-up for all areas of plastic and reconstructive surgery, including breast reconstruction, experimental studies, maxillofacial reconstruction, hand and microsurgery, burn repair, and cosmetic surgery, as well as news on medico-legal issues.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world’s largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. You can learn more and visit the American Society of Plastic Surgeons at www.plasticsurgery.org or www.facebook.com/PlasticSurgeryASPS and www.twitter.com/ASPS_news.

About Lippincott Williams & Wilkins

Lippincott Williams & Wilkins (LWW) is a leading international publisher of trusted content delivered in innovative ways to practitioners, professionals and students to learn new skills, stay current on their practice, and make important decisions to improve patient care and clinical outcomes. LWW is part of Wolters Kluwer Health, a leading global provider of information, business intelligence and point-of-care solutions for the healthcare industry. Wolters Kluwer Health is part of Wolters Kluwer, a market-leading global information services company with 2011 annual revenues of €3.4 billion ($4.7 billion).

Contacts:

Robert Dekker
Director of Communications
Wolters Kluwer Health
+1 (215) 521-8928
Robert.Dekker@wolterskluwer.com

Connie Hughes
Director, Marketing Communications
Wolters Kluwer Health Medical Research
+1 (646) 674-6348
Connie.Hughes@wolterskluwer.com