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Evidence-Based Medicine

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Evidence-Based Cosmetic Breast Surgery

Abstract

Cosmetic breast surgery is popularly perceived as artistic. Unfortunately, this notion has allowed nonscientific concepts to persist, without proper scrutiny to establish validity. Without measurements, there is no means to test the effectiveness of surgical methods.

Existing level of evidence scales benefit from modification to include important methodological considerations. Randomization is impractical for elective surgery. However, well-done observational studies can be just as useful. Consecutive patients are needed to avoid selection bias. Prospective studies are initiated before the data are collected, not after. A prospective study among consecutive patients meeting eligibility criteria, with a reported inclusion rate, the use of contemporaneous controls when indicated, and consideration of confounders, is a realistic goal. Such measures are likely to improve study quality. Commercial bias is an endemic problem in medicine. A plastic surgeon may function as a highly paid consultant or as an impartial investigator, but not both.

Patient-reported outcomes are essential in plastic surgery because patient satisfaction is the most important determinant of surgical success. Unfortunately, plastic surgeons are not in the habit of soliciting their patients’ opinion regarding the result. A proprietary psychometric test, known as the BREAST-Q, has limited clinical usefulness. Ad hoc surveys provide useful clinical information that can be used to compare operations. There is no better education than performing outcome studies on one’s patients.

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    Eric Swanson MD

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Swanson, E. (2017). Evidence-Based Medicine. In: Evidence-Based Cosmetic Breast Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-53958-4_1

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