Breast Implants: Study Probes Reasons for Lapsed Follow-up

Reported in Journal of the American Society for Aesthetic Plastic Surgery

New York, NY (June 29, 2004) — There has been controversy about whether lack of compliance with recommended follow-up care by breast augmentation patients might reflect patient dissatisfaction with the surgery; but a groundbreaking report in the current issue of Aesthetic Surgery Journal ( ASJ ), the peer-reviewed publication of the American Society for Aesthetic Plastic Surgery (ASAPS), documents for the first time that a large number of patients who fail to seek follow-up care are not experiencing problems with their implants. The article documents the most common reasons for lapsed follow-up and suggests what surgeons can do to encourage compliance.

"We undertook this study because of concerns expressed by the Food and Drug Administration and shared by plastic surgeons,” says the study's lead author, Leroy Young, MD, a St. Louis , MO plastic surgeon. “This study is the first to examine the issue of patient compliance with follow-up care after cosmetic surgery and specifically breast augmentation. The findings clearly contradict the assertion made by some that augmentation patients who don't return to their surgeons are unhappy with their breast implants and may have had them removed by someone else," he says.

To probe the reasons why implant patients may not adhere to guidelines for follow-up care, Dr. Young's study utilized a 56-item questionnaire posted on an independent Web site, www.implantinfo.com , which is popular among women who have undergone breast augmentation or are seeking information about the procedure. The data, which have a confidence interval of 95 percent, were collected from 1350 survey respondents from April 8 through June 30, 2003 .

Eighty percent of survey respondents said that in the first year following augmentation they followed their surgeon's recommendations for follow-up visits. However, compliance declined over time; 33 percent of those who had implants for longer than 2 years said they had missed a follow-up visit. Among women who did not schedule or keep routine follow-up appointments, nearly half (45 percent) indicated the reason was that they had no problems with their implants. Reasons cited less frequently included lack of time to keep appointments and undergoing routine examination by a primary care physician or mammographic screening. Nearly all respondents (90 percent) said they would see their original plastic surgeon if a problem developed.

Significantly, the survey found that only seven percent of respondents did not keep follow-up appointments because they were unhappy with their implants, and two percent because their implants had been removed but not replaced.

"Breast augmentation is one of the few aesthetic procedures that involves implantation of a device that must be checked regularly," says Dr. Young. "Women with breast implants ideally should undergo an annual examination by a plastic surgeon."

Based on the survey results, the study's authors offer several recommendations for plastic surgeons to improve follow-up compliance among breast augmentation patients:

  • Emphasize to all breast augmentation patients the need for follow-up examinations at least annually after the first postoperative year
     
  • Provide patients with a clear explanation of why routine follow-up visits are important
     
  • Send reminders about follow-up appointments
     
  • Tell patients if there is no charge for follow-up visits
     
  • Encourage patients who have moved, or who live a distance away, to find a local plastic surgeon for follow-up


"In breast augmentation and other cosmetic surgery, the responsibility for patient follow-up falls on both the physician and patient," says ASAPS President Peter Fodor, MD, of Los Angeles . "It is the physician's job to make sure patients receive appropriate care that is delivered according to the highest standards of practice. It is the patient's responsibility to follow guidelines for postoperative follow-up that are designed to help ensure optimum results over the long-term."

Dr. Fodor also notes that patients must carefully select their surgeon, checking credentials and establishing rapport, prior to undergoing any type of cosmetic surgery. A highly positive finding of the survey was that 85 percent of respondents knew that their surgeon was board-certified in plastic surgery.

Preliminary data from this and another online survey developed by Dr. Young were reported, prior to publication in ASJ , at the October 2003 FDA advisory panel hearings on silicone-gel breast implants. Information included patient satisfaction following breast augmentation, patient informed consent, reoperation rates, health insurance and other key issues. Highlights of the data can be found in the Press Center of the ASAPS web site, www.surgery.org/press . According to Dr. Young, further analysis of data collected from the two surveys is ongoing, and additional reports will be compiled as more information becomes available.

About ASAPS
The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world’s leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body.  ASAPS is comprised of over 2,600 Plastic Surgeons; active members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and non-surgical aesthetic procedures. International active members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.

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