The Influence of BIA-ALCL on the Use of Textured Breast Implant and its Placement:A Survey of Dutch Plastic Surgeons

BACKGROUND: Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and its association with macrotextured breast implants may have induced plastic surgeons to change their breast augmentation and breast reconstruction practice.OBJECTIVES: The aim of this study was to survey Dutch plastic surgeons about the effects of BIA-ALCL on their choice of breast implant texture and placement technique.METHODS: An online questionnaire was distributed to all members of the Dutch Association of Plastic Surgeons. Descriptive data were presented as frequencies and percentages. Technique alterations were analyzed by the marginal homogeneity test for paired nominal data.RESULTS: A total of 63 plastic surgeons completed the questionnaire. The majority of respondents altered their use of textured implants due to BIA-ALCL concerns for both breast augmentation and reconstruction (75.4% and 69.8%, respectively; both being statistically significant, P &lt; .001). Microtextured and smooth/nanotextured breast implants are now most frequently used. BIA-ALCL did not influence the placement technique in breast augmentation and reconstruction (87.7% and 94.3%, respectively). Dual-plane breast implant placement is still the most favored technique for breast augmentation, and submuscular placement is still most favored for breast reconstruction.CONCLUSIONS: BIA-ALCL has had a significant impact on the use of macrotextured breast implants by Dutch plastic surgeons in both aesthetic and reconstructive breast surgery. Breast implant placement technique has not been affected.</p

Readability of Dutch online patient-directed health information on breast reconstruction

Background The Netherlands and Belgium are among the top five worldwide of highest incidence in breast cancer, leading to an increase in post-mastectomy reconstruction interest. This study aims to analyze readability of Dutch-written online patient-directed information on breast reconstruction. Methods An online patient query for the term borstreconstructie was simulated using the largest search engine, Google. Content from the 10 most popular web sites from the Netherlands and Belgium was collected and formatted into plain text. Readability level assessment was performed using four available tools for the Dutch language: Accesibility.nl, Klinkende Taal, Texamen, and WizeNote, which measure readability according to the Common European Framework of Reference for Languages (CEFR). Results Of the 20 websites (10 Dutch and Belgian), breast reconstruction content was mainly written in B2/C1 and exceeded the recommended B1 level. The readability tool "Klinkende Taal" was found to have the lowest average CEFR level at B2 (average 4.01, 2.40-5.00), WizeNote (average 4.57, 3.00-5.00), and Accesibility.nl (average 4.58, 3.40-5.50). Both had a CEFR level B2/C1, while Texamen scored the highest average at C1 (average 4.77, 3.60-5.25). Kiesbeter.nl, a Dutch government web site, was found to comply with the recommended B1 level on their breast reconstruction information. Conclusions Readability of online health information on breast reconstruction was generally found to be too advanced for the lay population. Therefore, it may hold benefit for patient-directed health information to be analyzed and revised in order to tailor the information to the targeted population

Building Bridges for Bridges: Towards a Participatory Approach for Tackling Large-Scale Societal Assignments in Project-Based Polycentric Systems: The Case of the Large-Scale Rehabilitation Assignment of Civil Engineering Structures in the Netherlands

The Dutch civil engineering sector is facing a large-scale rehabilitation assignment of their civilengineering structures, that consists of complex projects that lead to cost overruns and time delays. As a consequencethereof, the sector as a whole must realise a productivity growth to match the required capacity and complexity.Criteria such as innovation, knowledge dissemination and digitisation have a positive effect on productivity growth.However, barriers such as current rules &amp; regulation, individual interests and short-term competition result incollective action problems. Furthermore, the sector is characterised as a polycentric system that consists of multipleautonomous yet interdependent public and private actors with diverging interest. These aspects the challenges of therehabilitation assignment. Therefore, there is a need for governance and coordination that is able to facilitatecollective action. This article presents a novel conceptual framework of governance and coordination is that is ableto address the challenges of the rehabilitation assignment. More specifically, the framework combines programmemanagement, process management, polycentric systems, hybrid organisational structures and participatory systemsto facilitate collective action.Complex Systems Engineering and Management (CoSEM

Evaluation of anatomical and round breast implant aesthetics and preferences in Dutch young lay and plastic surgeon cohort

Background: Literature remains inconclusive on the attractiveness and natural aspect of anatomical breast implants, and thus far, studies have failed to demonstrate the visible difference in implants that are in practice compared to those that are round. This study was undertaken to evaluate (1) whether lay and professional participants can distinguish between breasts augmented with either round or anatomical breast implants and (2) their opinion with regard to naturalness and attractiveness of these augmented breasts. Methods: Twenty breast augmentations (10 anatomical and 10 round implants), each depicted by two postoperative pictures, were scored by 100 lay participants and 15 plastic surgeons. Implant volume ranged from 275 to 400g. Ptotic or malformed breasts were excluded. Finally, they had to score the most natural, unnatural, attractive, and unattractive breast shapes on a schematic depiction of breast types with varying upper poles. Results: The rate of correct implant identifications was 74.0% (1480/2000 observations, p <0.001) in the lay and 67.3% (202/300 observations, p <0.001) in the surgeon cohort. Breasts with anatomical implants were rated as significantly more natural (3.3 +/- 1.0 vs. 2.6 +/- 1.0, p Conclusion: Participants were able to distinguish between the results achieved with either anatomical or round textured Allergan breast implants and found augmented breasts with the anatomical implants more natural and attractive. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved