Henry Nader, Haddad Christian, Abi-Rafeh Jad, Meguerditchian Ari-Nareg, Vorstenbosch Joshua
Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Faculty of Medicine, McGill University, Montreal, QC, Canada.
Aesthetic Plast Surg. 2025 Feb;49(3):741-748. doi: 10.1007/s00266-024-04345-y. Epub 2024 Sep 12.
The United States Food and Drug Administration (FDA) recommends silicone breast implant rupture surveillance using MRI or ultrasound beginning at 5-6 years post-insertion and every 2-3 years thereafter. No surveillance guidelines exist in Canada or the UK. This study aims to identify surveillance practices and perceived barriers to surveillance among plastic surgeons in Canada and the UK and compare surgeon practices between public and private sectors.
All active members of the Canadian Society of Plastic Surgeons (CSPS) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) with an interest in breast surgery were surveyed. Surgeon demographics, screening practices and perceived barriers to screening were analyzed. Fisher's exact test was used to detect significant associations.
The survey response rate was 16%. Most surgeons (68%, n=58/85) were familiar with FDA guidelines; however, only 2.4% (n=2/85) followed them. Surgeons in private practice screened significantly more than surgeons in the public sector [45% (n=13/29) vs 13% (n=7/56), p<0.002]. Among surgeons, ultrasound and high-definition ultrasound were the most common screening modalities and a perceived lack of clinical necessity followed by a perceived lack of satisfactory evidence qualifying these guidelines was the most reported barrier to screening.
Despite awareness of FDA guidelines, compliance among surgeons surveyed remains low, reportedly due to a perceived lack of necessity or evidence base. Most public sector surgeons opt not to screen and do not recommend surveillance, even without barriers. While governing bodies should consider current practices to shape guidelines, increasing surgeons' awareness on their evidentiary foundation and potential consequences of silent ruptures is imperative.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
美国食品药品监督管理局（FDA）建议在硅胶乳房植入物植入后5至6年开始使用MRI或超声进行破裂监测，此后每2至3年监测一次。加拿大和英国没有相关监测指南。本研究旨在确定加拿大和英国整形外科医生的监测做法以及监测中察觉到的障碍，并比较公立和私立部门外科医生的做法。
对加拿大整形外科医生协会（CSPS）和英国整形、重建与美容外科医生协会（BAPRAS）中所有对乳房手术感兴趣的活跃成员进行了调查。分析了外科医生的人口统计学特征、筛查做法以及筛查中察觉到的障碍。采用Fisher精确检验来检测显著相关性。
调查回复率为16%。大多数外科医生（68%，n = 58/85）熟悉FDA指南；然而，只有2.4%（n = 2/85）遵循这些指南。私立执业外科医生的筛查比例显著高于公立部门的外科医生[45%（n = 13/29）对13%（n = 7/56），p<0.002]。在外科医生中，超声和高清超声是最常用的筛查方式，最常报告的筛查障碍是认为缺乏临床必要性，其次是认为缺乏符合这些指南的充分证据。
尽管了解FDA指南，但接受调查的外科医生的依从性仍然很低，据报道原因是认为缺乏必要性或证据基础。大多数公立部门的外科医生即使没有障碍也选择不进行筛查，也不建议进行监测。虽然管理机构应考虑当前做法来制定指南，但提高外科医生对其证据基础以及无症状破裂潜在后果的认识至关重要。
证据水平V：本杂志要求作者为每篇文章指定一个证据水平。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南www.springer.com/00266。
