Part II: Cooking up your result...Measurements don"t make a System, Ingredients don"t make a Recipe
I rapidly realized the necessity to include a third dimension€"tissue stretch€"to more accurately define the optimal volume to fill a specific patient's breast, and the TEPID System<sup>TM</sup> evolved. Optimal implant volume is determined by the width of the existing breast (measured by base width), the degree of skin stretch (measured by anterior pull skin stretch..APSS..and by nipple to inframamary fold distance€¦N:IMF). The wider the breast, and the greater the skin stretch, the more volume is required to fill the breast for an optimal result. Underfill and the result resembles a rock in a sock€"fuller at the bottom and empty at the middle and top. Overfill, and the breast resembles an excessively full, round, tight, basketball or €Baywatch€ breast€¦.and that overfill puts excessive pressure on tissues over time that cause all of the deformities and compromises listed in the previous paragraph.
The TEPID<sup>TM</sup> system is an excellent, simple system of measurements that enables surgeons who strictly followed the system to accurately size implants for optimal aesthetic results while protecting patients' tissues from uncorrectable deformities. But once again, the system's effectiveness depended on how surgeons used the measurements, and many surgeons did not use the system as designed, but instead chose to ignore or modify the described techniques to suit their own preferences. High reoperation rates and uncorrectable deformities continued.
In 2005, more than a decade after the first system was introduced, we published the High Five<sup>TM</sup> System. For the first time, a meausurement system was not simply measurements, but also included a specific, prioritized set of five decision processes to optimize use of the measurements to protect patients' tissues long-term while optimizing aesthetic results. More than a list of ingredients, High Five was a total recipe with detailed instructions on how to use the measurements and more importantly, guidelines for limiting implant choices that are likely to permanently damage patients' tissues. It's not just about patients' WISHES, it's also about their TISSUES. Suboptimal decisions of implant selection at the first operation are very likely to compromise a patient's tissues, detract from her result longer term, and may permanently damage her tissues.
Today, there are many surgeon €chefs€ in the €kitchen€. Most read the list of ingredients, or at least they are aware that a list of certain ingredients (measurements) exists, and that patients are aware that more state of the art surgery uses these scientific measurements (just as gourmet diners are aware of key ingredients that are essential for the best food). As a result, more surgeons are picking up a caliper or measuring tape as part of the patient consultation and evaluation process to make measurements. So far, so good. The ingredients are in the pan, but the dish isn't complete yet.
<em>Measurements are a start, but only a start. How those measurements are used determines patient outcomes and the risks of patients developing uncorrectable tissue compromises and deformities.</em>
With a proved recipe, what if a chef chooses to use only 3 of 6 key ingredients? What if the chef believes that salt is good, and that there really isn't a limit on how much salt a dish can tolerate? What if one customer asks the chef to quadruple the amount of an ingredient, just because the customer thinks they may like the dish cooked that way? What if the chef ignores the recommended sequence of addition of ingredients? Just because the chef can assemble a few of the ingredients (take a few measurements) certainly doesn't mean that the chef can predictably deliver the gourmet dish.
Some surgeons, aware that patients know that measurements are more accurate than guesses or opinions, are taking measurements€¦.some measurements€¦.but are not using those measurements within a proved, scientifically validated, peer reviewed and published system. Why does that matter? Because when proved measurements are used within the High Five<sup>TM</sup> system, the results have set new benchmarks for patient outcomes and reoperation rates. Specific measurements used with optimal decision systems (High Five<sup>TM</sup>) have delivered the lowest reoperation rates in the published history of breast augmentation, the first zero percent reoperation rate ever achieved in an FDA PMA study over 3 years, and a track record of zero uncorrectable deformities in the largest published series of breast augmentations in the plastic surgery literature.
The TEPID<sup>TM</sup> system is an excellent, simple system of measurements that enables surgeons who strictly followed the system to accurately size implants for optimal aesthetic results while protecting patients' tissues from uncorrectable deformities. But once again, the system's effectiveness depended on how surgeons used the measurements, and many surgeons did not use the system as designed, but instead chose to ignore or modify the described techniques to suit their own preferences. High reoperation rates and uncorrectable deformities continued.
In 2005, more than a decade after the first system was introduced, we published the High Five<sup>TM</sup> System. For the first time, a meausurement system was not simply measurements, but also included a specific, prioritized set of five decision processes to optimize use of the measurements to protect patients' tissues long-term while optimizing aesthetic results. More than a list of ingredients, High Five was a total recipe with detailed instructions on how to use the measurements and more importantly, guidelines for limiting implant choices that are likely to permanently damage patients' tissues. It's not just about patients' WISHES, it's also about their TISSUES. Suboptimal decisions of implant selection at the first operation are very likely to compromise a patient's tissues, detract from her result longer term, and may permanently damage her tissues.
Today, there are many surgeon €chefs€ in the €kitchen€. Most read the list of ingredients, or at least they are aware that a list of certain ingredients (measurements) exists, and that patients are aware that more state of the art surgery uses these scientific measurements (just as gourmet diners are aware of key ingredients that are essential for the best food). As a result, more surgeons are picking up a caliper or measuring tape as part of the patient consultation and evaluation process to make measurements. So far, so good. The ingredients are in the pan, but the dish isn't complete yet.
<em>Measurements are a start, but only a start. How those measurements are used determines patient outcomes and the risks of patients developing uncorrectable tissue compromises and deformities.</em>
With a proved recipe, what if a chef chooses to use only 3 of 6 key ingredients? What if the chef believes that salt is good, and that there really isn't a limit on how much salt a dish can tolerate? What if one customer asks the chef to quadruple the amount of an ingredient, just because the customer thinks they may like the dish cooked that way? What if the chef ignores the recommended sequence of addition of ingredients? Just because the chef can assemble a few of the ingredients (take a few measurements) certainly doesn't mean that the chef can predictably deliver the gourmet dish.
Some surgeons, aware that patients know that measurements are more accurate than guesses or opinions, are taking measurements€¦.some measurements€¦.but are not using those measurements within a proved, scientifically validated, peer reviewed and published system. Why does that matter? Because when proved measurements are used within the High Five<sup>TM</sup> system, the results have set new benchmarks for patient outcomes and reoperation rates. Specific measurements used with optimal decision systems (High Five<sup>TM</sup>) have delivered the lowest reoperation rates in the published history of breast augmentation, the first zero percent reoperation rate ever achieved in an FDA PMA study over 3 years, and a track record of zero uncorrectable deformities in the largest published series of breast augmentations in the plastic surgery literature.
Source...