From country to country, breast implant surgeries tend to vary widely in technique, as well as in type and size of implant, according to an international survey of surgeons.
The procedures should be standardized using best practices, the study authors argue in the Aesthetic Surgery Journal.
Breast enlargement is the most commonly performed cosmetic surgery worldwide, the authors write, with more than 1.5 million procedures done in 2015.
"Breast augmentation surgery remains one of the most frequently performed aesthetic surgical procedures, with trends increasing," said senior author Dr. Niclas Broer of Technical University Teaching Hospital in Munich, Germany.
"However, there exists a plethora of possible technical approaches, and the procedure is not very standardized," he told Reuters Health by email. "This is very interesting but also almost a little bit concerning."
Broer and colleagues analyzed responses from 628 surgeons around the world to a 38-question online survey. The surgeons were asked about current controversies, new technologies, common practices, technical considerations, and characteristics of their patients.
In most countries in Europe, Asia and Oceania, surgeons use anatomically shaped implants, whereas in the United States and Latin America, 90 percent use round implants. Surgeons ranked the higher cost and lack of proof of aesthetic superiority as the top reasons why they don't use anatomical implants more often.
"The different use of round versus shaped implants is striking," Broer said. "Is the U.S. slow to embrace the use of a new technology, or do patients in the U.S. prefer a different look?"
Worldwide, more than 80 percent of surgeons only use 100 percent silicone implants. In the U.S., just 22 percent of surgeons use them.
More than two-thirds of surgeons in the U.S. and Australia use implants larger than 300 cc, or approximately two cup sizes, and in the U.S., more than a third use implant sizes larger than 350 cc, the study also found.
Practices differ by technique and post-surgery treatment as well. Many use similar incisions to create an implant pocket, and most use antibiotics as anesthesia begins. In the U.S. and Asia, however, more than half of surgeons recommend a postoperative implant massage, while surgeons in all other countries don't.
The study authors found one worldwide agreement - the majority of surgeons said implants don't make it harder to detect abnormalities on mammograms.
"It is important for patients to have high quality information during the decision-making process to reduce the inherent risk that surgery has," said Dr. Carlos Rubi Ona of IMED Hospitals in Valencia, Spain, who wasn't involved in the study.
"Aesthetic surgery is a cosmetic procedure, but we should not forget that it carries the same risk of complications, if not even more, as many other non-aesthetic procedures," he told Reuters Health by email.
In most other surgical procedures, certain operative approaches are considered standard universally. Slight variations exist, but for the most part, a consistent standard draws from current research and accepted practice, Broer said.
"Why should breast augmentation surgery be any different?" he said. "If, for instance, it has been shown that silicone implants provide superior outcomes, why are so many women still receiving an inferior product?"
Broer and colleagues suggest creating an international task force that meets yearly to evaluate best practices and new evidence to standardize the procedure. This should include guidelines about antibiotics, incision technique and location, and implant pockets, Broer said.
"Augmentation surgery should be taken as seriously as a colon resection or gallbladder removal," he said. "If we found international practice differences for those, it would almost be a scandal."