In most medical specialties, many of the decisions doctors make are driven by guidelines or recommendations that are based on the published literature. Thus making it possible for physicians to practice what is known as “evidence-based medicine.” The most important aspect of this type of practice being the quality of the studies upon which the guidelines are being based. For example, if a set of guidelines for treating a particular disease were based on two or three papers that reported findings in small series of patients, these would not be nearly as useful as ones which were based on several, well-controlled trials that included large samples of subjects. Therefore, guidelines are only as good as the levels of evidence upon which they are based.
In the field of plastic surgery, it is difficult to generate high levels of evidence. Therefore, it is also difficult to develop guidelines for specific problems. Given this limitation, we would like to commend the American Society of Plastic Surgeons (ASPS) for publishing a small library of very informative and comprehensive guidelines. One, in particular, which we would like to highlight is on the topic of breast reconstruction with expanders and implants. This document, last updated in March of 2013, presents a very useful summary of the studies that have been done on certain issues pertaining to the use of expanders and implants in reconstruction and extrapolates the findings from these studies to make recommendations for their use. The guidelines for expanders and implants can be found here.
For most people, this type of medical literature can be a bit technical and difficult to follow. But I still encourage everyone to look at these types of documents and to absorb what they can. There is a very good summary table of all the recommendations at the end of the document. One might even consider starting with this summary table.
The internet can be packed with advice, experiences, and opinions. Documents like the one highlighted here, however, try to outline what we know based on the currently body of peer-reviewed literature and present an objective summary. Feel free to email us with questions: [email protected].
credit to: Dr. Ergun Kocak, M.D.