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AesthPlastSurg
https://doi.org/10.1007/s00266-019-01429-y
EDITOR’SINVITEDCOMMENTARY
InvitedResponseon:‘‘DoesStandardizedPracticeReduce
ComplicationsinBreastAugmentationComparedwithNonstandardizedOne?’’
StefanoAvvedimento1 • AdrianoSantorelli1 • BarbaraCagli2
Received:5June2019/Accepted:15June2019
SpringerScience+BusinessMedia,LLC,partofSpringerNatureandInternationalSocietyofAestheticPlasticSurgery2019
LevelofEvidenceV Thisjournalrequiresthatauthors assignalevelofevidencetoeacharticle.Forafull descriptionoftheseEvidence-BasedMedicineratings, pleaserefertotheTableofContentsortheonline InstructionstoAuthors www.springer.com/00266.
Dearauthors,
Thankyouforyourinterestandvaluablecommentson ourrecentpublicationthathighlightsomeofthelimitations ofourstudy[1].
Whileweagreethatamulticenterprospectivestudyhas theadvantageofimprovingthereproducibilityandconsistencyoftheresults,weareawareofthecriticalissuesin designingandconductingthistypeofstudyinaesthetic surgery.Firstly,recruitingcentersandtrainingco-investigatorsarecostlyandtime-demandingactivitieswhich dependheavilyontheavailabilityoffunding.
Secondly,wethinkthatourstudydesignhaspartially addressedsomepotentialbiasrelatedtostudiescarriedout inmulticentersettings.Oneoftheadvantagesofreviews basedonasingle-surgeonexperienceisthattheassessment oftheefficacyandreproducibilityofthepresentedmethod arenotconfoundedbydiscrepanciesinpreoperativeconsultation,surgicaltechnique,andpostoperativecarethat couldbepresentwhenmorethanonesurgeonisinvolved [2].Inotherwords,thefactthatthesamesurgeonusesboth methodswithinthesamecohortofpatientsminimizesthe chancesofbiasrelatedtostudymanagement.Thirdly,we
& AdrianoSantorelli
1 Naples,Italy
2 DepartmentofPlastic,ReconstructiveandAestheticSurgery, ‘‘CampusBio-Medico’’UniversityofRome,Naples,Italy
areawarethatmeasurementbiasinaestheticsurgeryis problematicbecausethecriteriatoestablishwhetherthe treatmenthasresultedinthedesiredoutcomesarehighly subjective,andwethinkthatthesingle-surgeonexperience minimizesthechancesforthistypeoferror[3].
Werecognizethattheincidenceofwounddehiscencein thetwogroupsissurprisinglyhigh.Webelievethatthe highreportedfrequencyisessentiallyduetotheinclusion intheanalysisofallthedelayedwoundhealings,minor suturereactions,sutureabscess,orepidermolysisphenotypesthatareusuallynotreportedascomplications.Asa result,evenslightdistressatthejunctionoftheinvertedT wasreportedas‘‘wounddehiscence.’’
Althoughformallythehighrateofwounddehiscence couldbeattributedmoretothelearningcurveofthesingle surgeonratherthantheclosuretechnique,wealsobelieve thatthemainadvantageofathree-layerclosurecompared tothetwolayersisamoreconsistentreconstructionofthe fold.Wheneverthefoldisdisrupted,therepairshouldbe doneinamultilayeredfashion(thoracicfascia,superficial fascia,dermis)torecreatethethree-dimensionalconfiguration[4].
Wearealsoawarethatdefinitiveconclusionsonthe capsularcontractureratescouldnotbedrawnsince15and 32monthsareundoubtedlyashorttimeintervalforthe developmentofthelong-termcomplications.Alonger follow-upwouldallowabettercomparisonbetweenthe twogroupsandwithpreviousstudies.
Finally,weindeedtakeintoconsiderationtheirsuggestiontousetheBREAST-Qforamorecomprehensive evaluation.Ourassessment(scale1–10)couldnotbe consideredasastandardizedandvalidatedmethod.However,thismethodhasbeenaddedtoourpracticeforthe simplicityandeaseofuse.Evaluationofpatient-reported