CLINICAL EXPERIENCE

The senior author's (Tebbetts) clinical experience with the TEPID system includes more than 2000 primary breast augmentation cases. In three series reported in this Journal, with up to 7 years of follow-up of 1664 reported cases, the overall reoperation rate was 3 percent, and the reoperation rate for implant size exchange was 0.2 percent. The junior author's (Adams) clinical experience includes more than 300 augmentations with up to 6 years of follow-up using this system, with an overall reoperation rate of 2.8 percent.6 Although these rates are from a single surgeon's experience, these data provide an interesting comparison with the overall reoperation rates of 17 percent and rates for size exchange or adjustment rates of 8.7 percent from the averaged data of Mentor andAllergan/Inamed/McGhansubmitted for their saline premarket approval studies in 2000.

Additional experience by the authors and input from other colleagues and residents further codified and refined the TEPID system to a comprehensive decision support process that specifically addresses five critical decisions in breast augmentation.

For efficiency, the High Five process does not include any parameters that are not essential to one of these decisions, and the process enables surgeons to perform all measurements and make all implant selection and operative planning decisions in 5 minutes or less.

MEASUREMENTS, IMPLANT SELECTION, AND OPERATIVE PLANNING

With the patient sitting and the High Five Clinical Evaluation and Operative Planning resting in the patient's lap, the surgeon performs five measurements, records the measurements, and makes five prioritized decisions within 5 minutes or less. During the process, the surgeon can discuss the measurements, decisions, implications, and tradeoffs with the patient.

A copy of the High Five Clinical Evaluation and Operative Planning Form is downloadable from the Journal's Web site at www.plasreconsurg.org , along with a video file including measurement techniques and the entire decision-making process. Details and illustrations of the required measurements and estimates are included in the previous system1 and are abbreviated in this report.

Soft-Tissue Coverage and Pocket Selection

The surgeon performs the first two measurements and records the measurements on the evaluation sheet

STPTUP: soft-tissue pinch thickness of the upper pole (skin and subcutaneous tissue superior to the breast parenchyma (below)

Measure soft-tissue pinch thickness of the upper pole by isolating skin and subcutaneous tissue superior to the breast parenchyma, pinching firmly, and measuring the thickness with a caliper. Measure soft-tissue pinch thickness at the inframammary fold by isolating skin and subcutaneous tissue at the inframammary fold, pinching firmly, and measuring the thickness with a caliper.

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