A Review of Psychological Outcomes and Suicide in Aesthetic Breast Augmentation

Breast Augmentation Preferences and Concerns Among Chinese Women: A Nationwide Multicenter Study of 2066 Cases

BACKGROUND

Research studies on Asian women's preferences for breast augmentation and the factors that influence decision-making are scarce or unrepresentative.

METHODS

This study was conducted from September 2016 to September 2017, a period of one year. We developed a questionnaire for Chinese female with breast augmentation intentions based on the Breast-Q questionnaire, the world's most popular breast augmentation assessment tool, and conducted questionnaire surveys in 35 hospitals located in 19 provinces in mainland China among female who came to hospitals to inquire about breast augmentation surgery.

RESULTS

A total of 2066 questionnaires were collected from female interested in breast augmentation. The age range at the time of response was 19-53 years (mean 31.2 ± 6.8 years). More than half of the respondents (58.1%) were married, and 70.4% of them had children. The respondents rated their dressed image significantly higher than their nude image. Their partners also rated their breast image poorly, with 43% rating it fair and 30.4% negatively. Internal reasons, such as improving self-confidence and creating a better body image, were the main motivators for breast augmentation. More than half of the respondents had only limited understanding of breast augmentation surgery or had heard of it but did not fully understand it (33.2% and 27.5%, respectively), and 69.4% had considered breast augmentation for less than three years. A total of 49.2% of the respondents learned about breast augmentation surgery through the Internet. A total of 43.8% of the respondents did not receive support from family members or partners. Surgical safety (20.4%), surgical effect (17.1%), and surgeon's skill (16.6%) were given the highest priority. The surgeon's professionalism, popularity, and academic background were also high on people's list of considerations.

CONCLUSIONS

The results of our breast augmentation survey provide data on many Chinese women considering breast augmentation. This will help plastic surgeons better understand the characteristics, preferences, and concerns of Chinese women undergoing breast augmentation and will be used to guide patient-doctor communication and help Chinese women make the most informed decisions.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Is it legitimate to propose surgery of the breast area before the end of puberty?]

Breast surgery is usually recommended for women who have completed puberty. Indeed, during adolescence the breast is constantly changing, the patient's weight is often unstable, the risk of inflammatory scars (hypertrophic or keloid) is higher and disturbances of areolar sensitivity can affect the patient's quality of sexual life. In addition, the risk of infection is not negligible, especially during an acne outbreak. In case of early implant placement, iterative changes should be planned. Finally, the result obtained is not always stable but above all the lack of psychological maturity and the legal need to obtain the agreement of both parents are obstacles to early surgery. However, the authors argue for the possibility of surgical correction of the breast around puberty, in particular because of the very clear positive psychological impact. Other arguments are also detailed: to ensure a breast reconstruction in successive stages started early, to limit the repercussions of hypertrophy, to correct thoracic or skin anomalies. These indications are illustrated by numerous clinical cases demonstrating the need for customized surgery on a case-by-case basis.

Body dysmorphic disorder and personality in breast augmentation: The big-five personality traits and BDD symptoms

BACKGROUND

Breast augmentation is one of the most performed cosmetic surgeries in the world. Personality traits predict the presence of psychological and social factors that may affect the patient satisfaction with a cosmetic surgical procedure and may be risk factors for body dysmorphic disorder. The aim of this study was to assess symptoms of body dysmorphic disorder in patients undergoing breast augmentation and identify their personality traits.

METHODS

Thirty-six women with hypoplasia of the breast (Sacchini index < 9 cm), a mean age of 28.1 years (SD = 6.2), body mass index ≤ 25 kg/m², and no history of breast surgery or breast-associated conditions were included in this prospective study.The Brazilian versions of the Structured Clinical Interview (SCID-I), Big Five Inventory (IGFP-5), and Body Dysmorphic Symptoms Scale (BDSS) were applied preoperatively and at 2 and 4 months after breast augmentation.

RESULTS

Personality traits were associated with symptoms of body dysmorphic disorder. A significant decrease (p< 0.001) in IGFP-5 scores on the Conscientiousness dimension, symptoms of body dysmorphic disorder (BDSS scores), and the number of patients with body dysmorphic disorder (SCID-I) were observed among different time points. In the study population, breast augmentation decreased the symptoms of body dysmorphic disorder, psychosocial impairment, and mean scores on Conscientiousness.

CONCLUSION

Personality traits varied in intensity and overlapped over time, and were associated with core symptoms of body dysmorphic disorder and the onset of body dissatisfaction.

Aesthetic Delusions: An Investigation into the Role of Rapid Visual Adaptation in Aesthetic Practice

Background

To date, the process of adaptation in the setting of aesthetic medicine has not been investigated. The combination of complex advanced feedback in the current intense social media milieu, in conjunction with easily accessible and effective aesthetic treatments, has produced pockets of overtreated patients and over-zealous practitioners. We examine whether aesthetic assessments of attractiveness and what appears natural can be distorted by the cognitive process of adaptation.

Methods

Forty-eight female participants were exposed to photographs of female faces in whom lip fullness had been strongly under- or over-exaggerated, while remaining within the bounds of natural appearing lips. Before and after evaluation of the exaggerated images, participants were asked to rate an alternative set of faces in terms of attractiveness (reflecting direct assessment of effective beauty impression) and naturalness (reflecting indirect assessment of beauty norms). The evaluation set consisted of six base faces that had been digitally altered to create a systematically varying 11 step set of lip sizes from extremely thin, to the original version, to very full.

Results

Second-order polynomial fits indicated clear shifts of the subjects’ facial aesthetic assessments towards the specific lip fullness of the adaptors. In contrast, such adaptions were not found for ratings of face naturalness. In contrast to research demonstrating mathematical foundations and unchanging rules governing perceptions of beauty, we show that simple viewing of exaggerated feature morphologies can rapidly result in recalibration of a person’s assessment of attractiveness.

Conclusion

This paper provides evidence that facial attractiveness is fluid, and that there are psychological mechanisms that cause an aesthetic bias. Over-exposure to exaggerated features can lead to significant changes to a person’s ideas of attractiveness.

Working Out the Woes: An Analysis of the Impact of Exercise on Depression

The purpose of this review is to examine existing research to determine whether exercise has a significant effect on improving emotional well-being and symptoms of depression. At any given time, it is estimated that greater than 15% of Americans are plagued by a depressive mood disorder (L. Andrew, 2014). Plastic surgical nurses will encounter individuals with symptoms of depression who seek elective plastic surgical and cosmetic procedures. With a broad spectrum of symptoms and presentations, both practitioners and those suffering may have difficulty identifying depression. Even after being identified, it can be quite challenging to effectively treat depressive mood disorders. The integration of exercise into the plan of care not only helps tackle one's mental health condition but also benefits any physical health concerns. The plastic surgical nurse can advocate for evidence-based practices and educate the plastic surgical patient on the benefits of physical exercise. Additional research is needed to determine the most effective amount and types of exercise to be used in clinical settings.

Prevalence of Depressive Symptoms in Patients Requesting Cosmetic Breast Surgery in Midwestern Brazil

Background

The prevalence of depressive symptoms (DS) before cosmetic breast surgery was analyzed in the public (PbI) and private (PrI) institutions, comparing types of surgery and patients' sociodemographic characteristics.

Methods

A cross-sectional, observational, analytical study to evaluate the prevalence of DS in 185 patients of 18-71 years of age requesting 4 different cosmetic breast surgeries (with and without implants) at public and private institutions. Patients were assessed using the Beck Depression Inventory and analyzed for statistical comparison.

Results

The most common surgical procedures were reduction mammoplasty in the PbI and augmentation mammoplasty in the PrI. The prevalence of the positive risk for depressive disorder (≥15 points in Beck Depression Inventory) in the PbI was 25.8%, whereas in the PrI: 11.4% (P = 0.012). Moderate and severe DS were, respectively, 120% and 242% higher in the PbI than in the PrI. No patients requesting mastopexy without implants had DS. The highest prevalence (51.4%) of DS occurred in patients with breast implants indications (augmentation mammoplasty and mastopexy with implants). The presence (P = 0.12) or absence (P = 0.33) of implant did not demonstrate a higher risk of DS. Among all patients, 7% answered positively to the statements on suicide ideation, with predominance within the group of implants (54.5%). There were significant differences between the PbI and PrI.

Conclusions

The prevalence of DS was high (18.9%), with the risk being 2.3 times greater in the PbI. Patients from PbI and PrI showed significant different profiles. Patients for breast implants showed a higher score for suicide ideation.

Plastic Surgery and Suicide: A Clinical Guide for Plastic Surgeons

Several studies have identified an increased risk of suicide among patient populations which a plastic surgeon may have a high risk of encountering: women undergoing breast augmentation, cosmetic surgery patients, and breast cancer patients. No formal guidelines exist to assist a plastic surgeon when faced with such a patient, and not every plastic surgery team has mental health clinicians that are readily accessible for consultation or referral. The goal of this clinical guide is to offer plastic surgeons a set of practical approaches to manage potentially suicidal patients. In addition, the authors review a screening tool, which can assist surgeons when encountering high-risk patients.

Working Out the Woes: An Analysis of the Impact of Exercise on Depression

The purpose of this review is to examine existing research to determine whether exercise has a significant effect on improving emotional well-being and symptoms of depression. At any given time, it is estimated that greater than 15% of Americans are plagued by a depressive mood disorder. Plastic surgical nurses will encounter individuals with symptoms of depression who seek elective plastic surgical and cosmetic procedures. With a broad spectrum of symptoms and presentations, both practitioners and those suffering may have difficulty identifying depression. Even after being identified, it can be quite challenging to effectively treat depressive mood disorders. The integration of exercise into the plan of care not only helps tackle one's mental health condition but also benefits any physical health concerns. The plastic surgical nurse can advocate for evidence-based practices and educate the plastic surgical patient on the benefits of physical exercise. Additional research is needed to determine the most effective amount and types of exercise to be used in clinical settings.

Allergan’s silicone gel breast implants

In the USA, women seeking breast implants for augmentation, revision or reconstruction can choose between saline-filled devices and round, silicone gel-filled devices. Form-stable, highly cohesive silicone gel-filled breast implants are marketed in other countries and are currently under review by the US FDA. Allergan has conducted clinical studies to investigate the safety and effectiveness of its round and anatomical (Style 410) devices for US marketing approval. The most frequently reported complications were reoperation, implant removal with replacement, implant malposition and capsular contracture. The FDA approved the round devices in 2006. The weight of the scientific literature suggests that silicone gel-filled breast implants do not increase a patient's risk of cancer, autoimmune disease, reproductive effects or suicide. As differently shaped, cohesive breast implants continue to be introduced, breast implant surgery will become more customized to the patient's biological conditions and desires.

Effect of nasal deviation on quality of life

BACKGROUND

Nasal deviation is a common complaint in otorhinolaryngology and plastic surgery. This condition not only causes impairment of nasal function but also affects quality of life, leading to psychological distress. The subjective assessment of quality of life, as an important aspect of outcomes research, has received increasing attention in recent decades. Quality of life is measured using standardized questionnaires that have been tested for reliability, validity, and sensitivity. The aim of this study was to evaluate health-related quality of life, self-esteem, and depression in patients with nasal deviation.

METHODS

Sixty patients were selected for the study. Patients with nasal deviation (n = 32) were assigned to the study group, and patients without nasal deviation (n = 28) were assigned to the control group. The diagnosis of nasal deviation was made by digital photogrammetry. Quality of life was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey questionnaire; the Rosenberg Self-Esteem/Federal University of São Paulo, Escola Paulista de Medicina Scale; and the 20-item Self-Report Questionnaire.

RESULTS

There were significant differences between groups in the physical functioning and general health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (p < 0.05). Depression was detected in 11 patients (34.4 percent) in the study group and in two patients in the control group, with a significant difference between groups (p < 0.05).

CONCLUSIONS

Nasal deviation is an aspect of rhinoplasty of which the surgeon should be aware so that proper psychological diagnosis can be made and suitable treatment can be planned because psychologically the patients with nasal deviation have significantly worse quality of life and are more prone to depression.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.(Figure is included in full-text article.).

Contemporary decision making and perception in patients undergoing cosmetic breast augmentation

BACKGROUND

Today's breast augmentation (BA) patient obtains information from a variety of sources that may positively or negatively influence her decision.

OBJECTIVES

The authors evaluate the decision-making process of patients undergoing BA, including how they seek information regarding the procedure, potential complications, the medical device itself, referral sources, and surgeon(s).

METHODS

A written 36-item, blinded survey developed for this study was administered to all patients who underwent aesthetic primary BA by the senior author (JW) over a 12-month period in her metropolitan private practice. Patients were included only if they had undergone surgery after Food and Drug Administration approval of silicone implants and had at least four months of follow-up. Patients were excluded if they underwent reconstruction, revision, augmentation/mastopexy, or implant exchange. Data were analyzed utilizing descriptive statistics; frequencies of responses were calculated with SPSS (version 16).

RESULTS

Of 153 mailed surveys, 100 respondents returned completed questionnaires (65%). Mean age was 30 years (range, 20-50 years). Eighty-eight patients were in the workforce, eight were students, and three were homemakers. Thirty-three percent had completed some graduate work or had a graduate degree, and 41% had a college degree. In terms of how patients began their informational searches, 41% began with Google, 18% began with a BA portal Web site, and 1% went through referral from a primary care provider (PCP)/OB-GYN. The primary influence in a patient's decision to have BA was her own desire to change her appearance (36%), and second was her plastic surgeon's Web site (16%). On a graded scale of 10 factors ranking importance (1 = not at all and 5 = extremely), 52% said that their plastic surgeon's Web site very much or extremely influenced their decision. Of respondents, 82% had silicone implants (18% saline). The most influential factor in choosing implant filler was the feel of the silicone versus saline implants (for 41%), followed by the plastic surgeon's explanation of the difference (29%) and recent FDA approval (13%). Primary sources of information for possible complications were the plastic surgeon and BA portal sites. When asked what the worst complication could be, patients reported capsular contracture (37%), implant rupture or leak (22%), and infection (20%). The most powerful influence on choice of surgeon for BA was the plastic surgeon's Web site (49%); meeting the doctor in consultation was next (14%), followed by BA portal sites (9%). Thirty-six percent of respondents consulted with a psychiatrist or psychologist at some point in their lives, with depression, anxiety, and stress management as top-ranked reasons (in that order).

CONCLUSIONS

The Internet (specifically Google, the plastic surgeon's Web site, and portal Web sites) is very important to patients ages 20 to 50 in their search for information on BA. Educational and reality TV may have less influence on this particular group than was previously thought. Patients are well educated, are part of the workforce, and seem to be independent and private thinkers when it comes to their decision making. Referral sources such as the PCP assume a much smaller role in the search for information than in days past.

A research agenda for appearance changes due to breast cancer treatment

Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor’s appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women’s perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor’s appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor’s breasts to match her preferences as much as possible.

MOC-PS(SM) CME article: breast augmentation

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Evaluate patients seeking breast augmentation using key variables to assist in selection from the choices for incision, implant type and size, and plane of dissection. 2. Minimize the need for revisionary surgery to factors beyond the surgeon's control.

SUMMARY

The purpose of this article is to provide guidelines for Maintenance of Certification continuing medical education using the breast augmentation module. It may be used as an aid in the extraction of data for 10 consecutive cases of breast augmentation and, in this regard, provides a template to facilitate the collection of pertinent information. Interspersed with the Maintenance of Certification-oriented format is continuing medical education information regarding the current state of practice concerning the multiple variables in the specific procedure of breast augmentation.