COSMETIC Five Critical Decisions in Breast Augmentation Using Five Measurements in 5 Minutes: The High Five Decision Support Process

Background: Surgeons ’ decisions impact patient outcomes and implant effects on tissues over time. Tissue assessment systems that provide quantitative, ob-jective data enable objective rather than subjective decisions. First-generation dimensional systems for breast augmentation defined a desired result dimen-sionally and recommended an implant to force tissues to the desired result. A second-generation system, the TEPID system, defines measurements to match the implant to the patient’s tissue characteristics, instead of forcing tissues to a desired result. This study defines a third-generation decision support process that prioritizes five critical decisions, identifies five key measurements, and completes all preoperative assessment and operative planning decisions in breast augmentation in 5 minutes or less. Methods: Key decision parameters and data from more than 2300 primary aug-mentations planned using the TEPID system were analyzed to define the five most critical decisions that affect reoperation rates and risks of uncorrectable deformities and to define a decision support process using five critical measurements