Misconceptions of Capsular Contracture, Operative Times, and Complications in the Transaxillary Breast Augmentation Literature
Bibliographic record
Abstract
Another article appears, this time with “level 3” evidence, again professing endoscopic-assisted transaxillary breast augmentation isn't a good procedure. 1 In this study it is purported to have increased operating time, on average, by nearly an hour per procedure. The authors appear to have limited experience with the procedure (17 cases between June 2011 and March 2013, or less than one per month). As a surgeon with more than 18 years of experience with this operation, I would ask, “What were they doing?” Similarly, a study we have seen and heard quoted with some frequency (level 4 evidence) concludes “The risk of CC [capsular contracture] is significantly higher with transaxillary incisions than with periareolar or inframammary incisions.” 2 The transaxillary approach again gets a “black eye” from authors who have what appears to be little experience (47 breasts over six years). In our personal experience, without any hint of rushing, the operation routinely takes between 35 and 40 minutes, from skin to skin (and not occasionally, less). With smooth-shelled, gel-filled implants, this is facilitated with an insertion funnel. (We have no experience with placement of textured devices via the transaxillary approach.) The operation is gentle, nearly bloodless, and complications are rare; in over 2500 cases since 1997 there have been seven hematomas and only one peri-prosthetic infection requiring explantation (16 years ago). Contracture rates are also very low, in the range of 1% long term. The power of statistics today is such that a higher level of evidence will accord a paper longevity, citations, and eventually canonization. The adage “Lies, damned lies, and statistics” 3 can be negated in this environment by evidence-based medicine. But clinical experience will hopefully allow us to see the flaws and for reason to prevail. The author holds shares in Ideal Implant, Inc. (Dallas, TX) and Johnson and Johnson, Inc. (New Brunswick, NJ). The author received no financial support for the research, authorship, and publication of this article.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.090 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.002 | 0.005 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".