The ABC of BBA: A Personal Perspective of a 10 Point Plan: A Critical Appraisal

The article The ABC of BBA: A Personal Perspective of a 10 Point Plan is a structured expert opinion, which focuses on the technical, aesthetic and procedural aspects of BBA. The proposed 10-point framework provides for a practical approach for the surgeon, but most of the recommendations are based on personal experience and a narrative synthesis of the authors' experience. There are also several statements-such as the preferred implant planes, the maintenance of the inframammary fold and that hybrid augmentation is better-with little evidence to support them. Moreover, patient-reported outcomes, cultural differences in aesthetic standards, and surgeon-specific learning curves are not fully discussed. More robust clinical relevance of such recommendations could be achieved by the increased integration of validated patient-centered and clinical outcome measures (BREAST-Q). The overall value of the paper lies in its didactic expert overview, but its conclusions ought to be read with caution, as no comparative research and patient-based evidence are used to validate them.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .