The High Five process is currently being used not only by surgeons but also by clinical assistants, patient educators, and by patients who wish to perform self-assessment as part of their educational process. In the senior author's (Tebbetts) practice, many out-of-town patients who express an interest receive a special, condensed version of the High Five Clinical Evaluation Form with numbered instructions by e-mail. Interestingly, their self-assessments have been extremely accurate, and the majority of these patients fully understand the concepts of the system.

CONCLUSIONS

The refined and simplified TEPID system, evolved into a decision support process, the High Five process, defines five critical decisions in primary breast augmentation and allows surgeons and patients to quantify individual patient tissue characteristics and to base decisions about soft-tissue coverage (implant pocket location) and implant volume (size, weight, and dimensions) on objective parameters instead of subjective, arbitrary parameters. The High Five process is a comprehensive yet simple and efficient decision and management model for primary breast augmentation.

The process addresses five critical priorities and decisions in breast augmentation: optimal soft-tissue coverage, implant size (volume/weight), implant dimensions, location of the inframammary fold, and incision location. Although providing volume recommendations relative to the base width, stretch characteristics, and nipple-to-inframammary fold distance, the system also allows surgeons to add or subtract volume based on specific patient requests, considering possible long-term tissue tradeoffs and consequences.

In conjunction with staged, repetitive patient education and decision-making algorithms, the TEPID system has helped minimize reoperations for size exchange (0.4 percent versus 8.7 percent in premarket application studies) and reduce overall reoperation rates (3 percent versus 17 percent in premarket application studies).

For any process to be effective, surgeons must use it. The demands of clinical practice mandate that this process is efficient and comprehensively addresses essential clinical priorities. A comprehensive decision support process must address a wide range of implant types and prioritize the patient's tissues long term. The High Five process prioritizes five decision categories, involves only five measurements and five decisions, and requires less than 5 minutes to perform all measurements and complete clinical planning to optimize patient outcomes.

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Copyright © 2006, American Society of Plastic Surgeons. All rights reserved.

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