Letter to the Editor
Response to “Misconceptions of Capsular
Contracture, Operative Times, and
Complications in the Transaxillary Breast
Augmentation Literature”
Aesthetic Surgery Journal
2016, Vol 36(5) NP193–NP194
© 2016 The American Society for
Aesthetic Plastic Surgery, Inc.
Reprints and permission:
[email protected]
DOI: 10.1093/asj/sjv269
www.aestheticsurgeryjournal.com
Scott L. Spear, MD, FACS
Accepted for publication December 21, 2015.
I would like to thank the editor for the privilege of writing a
brief response to the Letter to the Editor by Benjamin
Gelfant1 regarding “Utility of Video-Assisted Endoscopy in
Transaxillary Breast Augmentation” by Roxo et al2 Dr
Gelfant’s letter also references my earlier paper published
in this journal in 2012.3
Let me begin by complimenting Dr Gelfant on his enviable results and experience with what I presume to be his
personal technique of video-assisted endoscopy transaxillary breast augmentation with smooth, silicone gel-filled
breast implants.
I would also add that I personally like this operation and
certainly never intended to give it a “black eye”; far from it.
However, I believe that Dr Gelfant’s letter illustrates a
number of important concepts that deserve elucidation.
(1) If you do the same procedure frequently, you and your
team usually get faster and more efficient at doing it.
(2) Retrospective anecdotal recollections of one’s personal
experiences and successes using imprecise data which
include language such as “routinely takes between 35
and 40 minutes,” “in over 2,500 cases,” and “contracture rates are very low, in the range of 1% long term,”
although often very well intended, inevitably underestimate the actual risks, complications, and outcomes.
For example, there are some unanswered questions in
Dr Gelfant’s claims. What were the time points that
they used in their measurement for time of surgery?
What were the actual follow-up data at 1, 3, and
5 years? How do they define capsular contracture?
What is their protocol regarding various things such as
lowering the inframammary fold, compression garments, and postoperative exercises?
(3) The truth or the most reliable answers in medical and
scientific investigations are rarely elucidated by a
single study or investigation. Rather it is the weight of
the evidence or the repeatability of the experience by
others that ultimately leads to the truth. I previously
wrote an editorial entitled “The Nature of Scientific
Evidence” on this subject in 20074 where I cited much
from the book Science on Trial written by Marcia
Angell,5 a distinguished previous editor of the New
England Journal of Medicine. In it she mentions that
“Scientists usually find answers in the slow accumulation of evidence from many sources.”5
(4) When data are reported from a specific unique source,
they should not be applied universally and accepted
as an absolute fact. At best, what any single report says
is that at a specified place and time, in the hands of
certain named surgeons, using their described technique that their outcomes are as reported. It should not
mean or imply that it necessarily will be or can be
duplicated by anyone else.
Dr Spear is a Clinical Professor of Plastic Surgery and Founding
Chairman, Department of Plastic Surgery, Georgetown University
Hospital, Washington, DC.
Corresponding Author:
Dr Scott L Spear, 5454 Wisconsin Avenue, Suite #1210, Chevy Chase,
MD 20815, USA
E-mail: [email protected]
Aesthetic Surgery Journal 36(5)
NP194
So, my take on the above letter and the cited articles
is the following: Dr Gelfant likes and is an expert at
video-assisted endoscopic transaxillary breast augmentation. Dr Roxo and her colleagues believe that they are
just as effective and faster at doing transaxillary breast
augmentation without endoscopic assist as compared to
the same with the endoscope. And I personally have
found that my revision rate for capsular contaacture after
breast augmentation is low with all techniques but is
highest for whatever reason when using the transaxillary
approach.
The reader is entitled and encouraged to draw his or her
own conclusions.
Disclosures
Dr Spear is a consultant and speaker for Allergan, Inc (Irvine,
CA) and LifeCell Corporation (Branchburg, NJ).
Funding
The author received no financial support for the research,
authorship, or publication of this article.
References
1. Gelfant BM. Misconceptions of Capsular Contracture, Operative Times, and Complications in the Transaxillary Breast Augmentation Literature. Aesthet Surg J. 2016;36(5):NP190.
2. Roxo AC, Marques RG, De Castro CC, Aboudib JH. Utility
of video-assisted endoscopy in transaxillary breast augmentation. Aesthet Surg J. 2015;35(3):265-272.
3. Jacobson JM, Gatti ME, Schaffner AD, Hill LM, Spear SL.
Effect of incision choice on outcomes in primary breast
augmentation. Aesthet Surg J. 2012;32(4):456-462.
4. Spear SL. The nature of scientific evidence. Plast Reconstr
Surg. 2007;119(7):2310-2311.
5. Angell M. Science on Trial. London/New York: W.W.
Norton & Co.; 1996.