Five things plastic surgeons should avoid – American Society of Plastic Surgeons

1) Avoid performing routine mammograms before breast surgery.

Mammograms should be ordered based on existing clinical practice guideline recommendations, for patients undergoing breast surgery, including non-complicated breast augmentation, mastopexy, and breast reduction. Existing clinical practice guidelines recommend annual screening mammograms for patients of specific age groups. There are no recommendations for patients undergoing elective breast surgery to undergo additional screening unless there are concerning aspects of the patient’s history or findings during a physical exam which would suggest the need for further investigation.

Avoid using drains in breast reduction mammaplasty.

Although wound drains can minimize the amount of fluid at the surgical site, there is no evidence to support the use of drains. Evidence also indicates that the use of drains neither increases nor decreases postoperative complications, causes greater patient discomfort and possibly increases the length of the hospital stay. In patients that have liposuction as an adjunctive technique to the breast reduction, the decision to use drains is left to the surgeon’s discretion.

Avoid performing routine and follow-up mammograms of reconstructed breasts after mastectomies.

Evidence indicates that clinical examination is sufficient to det ect local cancer recurrence in patients undergoing breast recon struction after complete mastectomy. Current clinical practice guidelines recommend regular clinical exams for detection of breast cancer and imaging studies are not recommended as a part of routine surveillance . However, diagnostic imaging is indicated if there are clinical findings and/or clinical concern for recurrence. In cases of breast reconstruction after partial mastectomy or lumpectomy, mammography is still recommended. It is also important to continue mammography of the opposite breast i n women who had a unilateral mastectomy.

Avoid performing plain X-rays in instances of facial trauma.

Evidence currently indicates that maxillofacial computed tomogr aphy (CT) is available in most trauma centers and is the most s ensitive method for detecting fractures, in instances of facial trauma. Evidenc e also indicates that the use of plain X-rays does not improve quality of care, causes unnecessary radiation exposure and leads to substantial increase in costs.

Use of plain X-rays for diagnosis and treatment is helpful in instances of de ntal and/or isolated mandibular injury or trauma.

Avoid continuing prophylactic antibiotics for greater than 24 hours after a surgical procedure.

Current evidence suggests that discontinuing antibiotic prophyl axis within 24 hours or less after surgery is sufficient in preventing surgical site infection compared to continuing antibiotic prophylaxis beyond 24 hours after surgery. Prolonged use of antibiotics may increase the occurrence of antibiotic resistant bacteria and increase the risk of other infections. This recommendation is also supported by the Surgical Care Improvement Project, which is a national quality partnership of organizatio ns interested in improving surgical care by significantly improv ing surgical complications. In cases where a surgical drain is placed next to a prosthetic device (breast implant or tissue expander), there is not enough evidence to recommend discontinuing antibiotics and therefore t he decision is left to the surgeon ’s discretion.

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