The High Five Process: tissue-based planning for breast augmentation.

Despite popularity, breast augmentation has not advanced significantly in 20 years. The re-operation data for breast augmentation has been excessive at 15% to 20% in every Federal Drug Administration pre-market approval study for the past 15 years. Recently, a more scientific approach to breast augmentation has described a true process approach to this procedure. One element, tissue-based pre-operative planning, has been shown to reduce re-operation rate to less than 3% in published peer-reviewed studies. The High Five process was published in 2005 and codifies the 5 most important pre-operative decisions made during a breast augmentation procedure. Application into clinical practice of this planning system is discussed.