Clinical Practice Patterns and Evidence-Based Medicine in Primary Augmentation Mammoplasty: A 16-Year Review of Continuous Certification Tracer Data from the American Board of Plastic Surgery.

INTRODUCTION: As part of the Continuous Certification process, The American Board of Plastic Surgery, Inc. collects case data for specific tracer procedures in aesthetic surgery for purpose of assessing practice improvement by the Diplomates. This case-based data provides valuable information on national trends in clinical practice. The present study analyzes practice patterns in aesthetic primary breast augmentation.

METHODS: Breast augmentation tracer data was reviewed from 2005 to 2021 and grouped into an "early cohort" (EC) from 2005-2014 and a "recent cohort" (RC) from 2015-2021. Fisher's exact tests and two-sample t-tests compared patient demographics, surgical techniques, and complication rates.

RESULTS: Patients in the RC were slightly older (34 vs. 35 years, p<0.001), more likely to have ptosis > 22 cm (20% vs. 23%, p<0.0001), less likely to smoke (12% vs 8%, p<0.0001) and less likely to undergo a preoperative mammogram (29% vs 24%, p<0.0001). From a technical standpoint, inframammary incisions have become more common (68% vs. 80%,p<0.0001), whereas peri-areolar incision use has decreased (24% vs. 14%, p<0.0001). Submuscular plane placement has increased (22% vs. 56%, p<0.0001) while subglandular decreased (19% vs. 7%, p<0.0001). Silicone implants are most popular (58% vs. 82%, p<0.0001). Textured implant use increased from 2011 (2%) to 2016 (16%), followed by a sharp decline to 0% by 2021. Trends follow FDA approvals and warnings.

CONCLUSIONS: The present study highlights evolving trends in aesthetic breast augmentation over the last 16 years. Today, the most common technique remains a smooth, silicone prosthesis placed in the subpectoral plane through an inframammary incision.