Users’ guide to the surgical literature: how to assess an article about harm in surgery

Users’ guide to the surgical literature: how to assess an article about harm in surgery

Can J Surg 2016;59(5):351-57 | PDF

Achilleas Thoma, MD, MSc; Manraj Nirmal Kaur, MSc, PhD (candidate); Forough Farrokhyar, PhD; Daniel Waltho, MD; Carolyn Levis, MD, MSc; Peter Lovrics, MD; Charlie H. Goldsmith, PhD

Clinical scenario

You are a new plastic surgeon in the community and you are referred a patient interested in breast reconstruction. The patient is a 35-year-old female school teacher who had a bilateral prophylactic mastectomy 2 years earlier, as she was a BRCA gene carrier. Since she is of a petite build with very little subcutaneous tissue or extra skin in the lower abdomen, you decide that she is not a suitable candidate for an abdomen-based autologous tissue reconstruction. You recommend the technique of tissue expansion and silicone gel implants. She is concerned, however, about the possibility of anaplastic large cell lymphoma (ALCL) developing in her breasts. She read in a magazine recently that ALCL, an unusual form of breast cancer, has been occurring in patients who have breast implants. She is very concerned that she might be at risk and asks for your opinion as to whether she should proceed with the procedure or not.


Accepted Jan. 18, 2016

Affiliations: From the Division of Plastic Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont. (Thoma, Levis); the Surgical Outcomes Research Center, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont. (Thoma, Kaur, Levis, Lovrics, Goldsmith, Farrokhyar); the Department of Clinical Epidemiology and Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ont. (Thoma, Farrokhyar, Goldsmith); the School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ont. (Kaur); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Waltho); the Division of General Surgery, Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, Ont. (Lovrics); the Faculty of Health Sciences, Simon Fraser University, Vancouver, BC (Goldsmith).

Funding: M. Kaur is funded by the Canadian Institute of Health Research Doctoral Award (2015-18).

Competing interests: None declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.015115

Correspondence to: A. Thoma, 206 James St. South, Hamilton ON L8P 3A9; athoma@mcmaster.ca