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Luong KP, Ter Stege MHP, Hummelink S, Zaal L, Slijper HP, Ulrich DJO. High Quality of Care Delivery Improves Patient Satisfaction and Quality of Life Outcomes After Breast Augmentation. Aesthet Surg J 2024; 44:NP686-NP694. [PMID: 38874090 PMCID: PMC11403808 DOI: 10.1093/asj/sjae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/16/2024] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Breast augmentation is one of the most common aesthetic procedures worldwide. Most studies have focused on evaluating the outcome with validated patient-reported outcome measures (PROMs) and factors that may influence them. However, the influence of care delivery, which can be measured with patient-reported experience measures (PREMs), is rarely considered in studies of breast augmentation patients. OBJECTIVES In this study we aimed to evaluate the associations between PREMs and PROMs in patients who underwent breast augmentation. METHODS A multicenter cohort study was conducted in breast augmentation patients. Patients completed PREMs, including items such as communication between physician and patient, expectation management, welcome, and hygiene, and the BREAST-Q PROM (satisfaction with breasts and psychosocial, physical, and sexual well-being) preoperatively and 6 months postoperatively. Regression analyses were performed to investigate the associations between PREMs and PROMs. RESULTS Overall, 329 patients were included between 2018 and 2022. Univariate regression analysis showed a positive association between PREM and PROM scales. The feeling of being heard (B = -38.39 and B = -18.90), the opportunity to ask questions (B = -9.21), and trust in their physician (B = -39.08) had the highest association with change in the 4 BREAST-Q scales. The multivariable regression analysis showed that the variance in PROMs related to changes in PREMs (19%) was little influenced by patient characteristics (1%). CONCLUSIONS Patient outcomes are more positive after breast augmentation when patients feel they are being heard, have the opportunity to ask questions, and have trust in their physician. Future studies should be targeted at optimizing patient-reported experience to investigate whether this improves patient-reported outcomes. LEVEL OF EVIDENCE: 3
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Luong KP, Peters M, Slijper HP, Hummelink S, Ulrich DJO. Patient-Reported Satisfaction and Health-Related Quality of Life in Patients with Breast Augmentation: A Follow-Up of 6 Months. Plast Reconstr Surg 2024; 154:299-309. [PMID: 37647502 DOI: 10.1097/prs.0000000000011029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND To evaluate the success of a breast augmentation, it is essential to measure outcomes from the patient perspective, because a successful aesthetic result is, in particular, determined by the patient. This study aimed to evaluate patient-reported satisfaction with their breasts, and psychosocial, physical, and sexual well-being in patients undergoing breast augmentation using validated questionnaires. METHODS This is a multicenter cohort study based on ongoing routinely collected data. Patient-reported satisfaction and health-related quality of life were assessed with the BREAST-Q augmentation module at intake and 6 months postoperatively. RESULTS A total of 1405 patients were included. Large changes in BREAST-Q scores (range, 0 to 100) between intake and 6 months postoperatively were seen in satisfaction with breasts (mean, effect size: +57, 3.8), psychosocial well-being (mean, effect size: +38, 2.1), physical well-being (mean, effect size: -14, -1.2), and sexual well-being (mean, effect size: +44, 2.4). Moreover, improvements in all four scales were not dependent on their intake scores, and all postoperative scores reached similar levels. A decreased physical well-being of the chest was measured after surgery. The satisfaction with breasts scale correlated moderately to strongly with the psychosocial and sexual well-being scale 6 months after surgery. Subgroup analysis based on patient characteristics found no differences in outcomes, except for body mass index. CONCLUSIONS Significant improvement in patient-reported satisfaction with breasts, psychosocial well-being, and sexual well-being can be seen 6 months after breast augmentation, despite a decline in physical well-being after treatment. Postoperative satisfaction levels did not depend on preoperative scores. These insights can contribute to improving preoperative communication between surgeon and patient regarding the expected outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Kim Phi Luong
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences
- Research Center, Velthuis Kliniek
| | - Magdalena Peters
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences
| | - Harm P Slijper
- Research Center, Velthuis Kliniek
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam
| | - Stefan Hummelink
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences
| | - Dietmar J O Ulrich
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences
- Research Center, Velthuis Kliniek
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Knoedler S, Knoedler L, Kauke-Navarro M, Alfertshofer M, Obed D, Broer N, Kim BS, Könneker S, Panayi AC, Hundeshagen G, Kneser U, Pomahac B, Haug V. Quality of life and satisfaction after breast augmentation: A systematic review and meta-analysis of Breast-Q patient-reported outcomes. J Plast Reconstr Aesthet Surg 2024; 95:300-318. [PMID: 38945110 DOI: 10.1016/j.bjps.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/03/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Breast augmentation ranks among the most popular plastic surgery procedures. Yet, reports on post-operative patient-reported quality of life (QoL) and satisfaction remain conflicting. METHODS A systematic review was conducted following the PRISMA guidelines. Three databases were searched for eligible studies that reported pre-and/or post-operative Breast-Q™ augmentation scores for patient QoL (psychosocial, sexual, and physical well-being) and/or satisfaction. RESULTS A total of 39 studies (53 patient cohorts and 18,322 patients) were included in the quantitative synthesis. The pairwise meta-analysis revealed significant improvements in patient-reported psychosocial (MD: +38.10) and sexual well-being (MD: +40.20) as well as satisfaction with breast (MD: +47.88) (all p < 0.00001). Physical well-being improved slightly after breast augmentation (MD: +6.97; p = 0.42). The single-arm meta-analysis yielded comparable results, with Breast-Q™ scores in psychosocial and sexual well-being as well as satisfaction with breast increasing from 37.2, 31.1, and 26.3 to 75.0, 70.6, and 72.7, respectively (all p < 0.00001). Physical well-being improved by 8.1 (75.8 pre-operatively to 83.9 post-operatively; p = 0.17). Subgroup analyses highlighted higher QoL and satisfaction following breast augmentation for purely esthetic purposes and alloplastic mammaplasty. Although patient-reported physical and sexual well-being increased in the long term, psychosocial well-being was the highest in the short term. CONCLUSION Patient satisfaction with breast, psychosocial, and sexual well-being increased significantly after breast augmentation. In contrast, patient-reported physical well-being yielded ambivalent results, varying by mammaplasty technique and post-operative follow-up time. Plastic surgeons should be sensitized about our findings to refine eligibility criteria and gain a deeper understanding of the patients' perceived surgical experience. PROSPERO TRIAL REGISTRATION NO CRD42023409605.
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Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonard Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michael Alfertshofer
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Doha Obed
- Department of Plastic, Aesthetic, Hand and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital Munich, Munich, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Sören Könneker
- Department of Plastic Surgery and Hand Surgery, University Hospital Zürich, Zurich, Switzerland
| | - Adriana C Panayi
- Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Gabriel Hundeshagen
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Valentin Haug
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany.
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Zucal I, Tremp M, Duscher D, Wenny R, Zaussinger M, Kutz A, Pagani A, Huemer GM. Augmentation-Mastopexy: Analysis of 95 Consecutive Patients and Critical Appraisal of the Procedure. J Clin Med 2023; 12:jcm12093213. [PMID: 37176652 PMCID: PMC10179061 DOI: 10.3390/jcm12093213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Single-stage mastopexy-augmentation has been demonstrated to be a safe procedure. However, revisions may still be necessary. We evaluate 95 consecutive patients undergoing mastopexy-augmentation and introduce a new surgical technique for the procedure: the modified dual plane technique. In this retrospective study, 95 patients (mean age 34 ± 11 years) underwent mastopexy-augmentation between 2009 and 2019. The procedures were classified as subglandular, dual plane, or modified dual plane technique. The outcome measures included major and minor complications. A total of 19 patients underwent a subglandular procedure, 32 patients a dual plane procedure, and 44 patients a modified dual plane procedure. We observed a high overall complication rate in the subglandular group (n = 12, 63%), dual plane group (n = 15, 47%), and modified dual plane group (n = 10, 23%). Complications leading to implant loss/change occurred in seven patients in the subglandular group (37%), six patients in the dual plane group (19%), and no patient in the modified dual plane group. While we observed a high complication rate in patients undergoing mastopexy-augmentations, the modified dual plane technique was associated with a lower complication rate.
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Affiliation(s)
- Isabel Zucal
- Department of General Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland
| | - Dominik Duscher
- TF Plastic Surgery and Longevity Center, Herzogstrasse 67, 80803 Munich, Germany
- TF Plastic Surgery and Longevity Center, Dorotheergasse 12, 1010 Vienna, Austria
- Department of Plastic, Reconstructive, Hand and Burn Surgery, BG-Trauma Center, Eberhard Karls University Tübingen, 72076 Tübingen, Germany
| | - Raphael Wenny
- Section of Plastic, Aesthetic and Reconstructive Surgery, Medcampus III, Kepler University Hospital, 4020 Linz, Austria
| | - Maximilian Zaussinger
- Section of Plastic, Aesthetic and Reconstructive Surgery, Medcampus III, Kepler University Hospital, 4020 Linz, Austria
| | - Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine Cantonal Hospital Aarau, 5001 Aarau, Switzerland
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Andrea Pagani
- Department of Orthopedics, Traumatology and Hand Surgery, Hospital of Bolzano-SABES, 39100 Bolzano, Italy
| | - Georg M Huemer
- Section of Plastic, Aesthetic and Reconstructive Surgery, Medcampus III, Kepler University Hospital, 4020 Linz, Austria
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Wei C, Yang M, Chu K, Huo J, Chen X, Li H. Does drainage affect development of heterotopic ossification after total hip arthroplasty? J Int Med Res 2022; 50:3000605221129562. [PMID: 36214112 PMCID: PMC9551349 DOI: 10.1177/03000605221129562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To investigate the effect of drainage on heterotopic ossification (HO) after total hip arthroplasty (THA) and to evaluate other postoperative complications and joint dysfunction between patients with and without drainage. METHODS In this retrospective cohort study, the medical records of patients who underwent THA from 2017 to 2019 were reviewed. The patients were divided into a drainage group and non-drainage group. Standard preoperative anteroposterior and lateral radiographs were assessed by senior radiologists for HO analysis. Clinical indicators included the hemoglobin concentration, superficial infection, blood transfusion, hematoma formation, hip range of motion (ROM), erythrocyte sedimentation rate, C-reactive protein concentration, dressing changes, visual analogue scale score, and Harris Hip Score (HHS). RESULTS The incidence of HO was significantly higher in the drainage than non-drainage group (32.0% vs. 16.3%). The presence of severe HO (Brooker grade III or IV) was also different between the groups. Patients in the non-drainage group had smaller ROM early after surgery, but the final ROM and HHS did not differ significantly between the groups. CONCLUSIONS The rate and degree of HO after THA were significantly different between patients with and without drainage. There is no added advantage of closed suction drainage over no drainage in primary THA.
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Affiliation(s)
- Congcong Wei
- Department of Joint Surgery, No. 215 Hospital of Shaanxi Nuclear
Industry, Xianyang, Shaanxi, P.R. China
| | - Meng Yang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Kun Chu
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Jia Huo
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Xiao Chen
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Huijie Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital
of Hebei Medical University, Shijiazhuang, Hebei, P.R. China,Huijie Li, Department of Osteonecrosis and
Hip Surgery, the Third Hospital of Hebei Medical University, No. 139 Ziqiang
Road, Shijiazhuang, Hebei Province 050051, P.R. China.
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A Shakespearean Dilemma in Breast Augmentation: to Use Drains or not? a Systematic Review : Drains in Breast Augmentation. Aesthetic Plast Surg 2022; 46:1553-1566. [PMID: 35048149 DOI: 10.1007/s00266-021-02693-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast augmentation is one of the most commonly requested and performed plastic surgery procedures. In order to prevent early postoperative complications such as seroma or hematoma, surgical drains could be useful. The aim is to perform a systematic review of the literature on the use of surgical drains in primary breast augmentation. METHODS This review was performed following the PRISMA guidelines. PubMed, SCOPUS, Web of Science and Cochrane Library databases were queried in search of clinical studies describing the use of surgical drains in women undergoing primary breast augmentation with implants and documenting seroma and/or hematoma formation rate and/or infection rate. RESULTS Initial search identified 2596 studies, and 162 were found relevant. Full-text review and application of our inclusion criteria to all retrieved papers produced 38 articles that met inclusion criteria. Among the included studies, 16 papers reported the use of surgical drains in breast augmentation, while in the remaining 22 articles drains were not used. Only 5 studies specifically investigated the role and effectiveness of surgical drains in augmentation mammaplasty and its possible relationship with complication rate such as seroma, hematoma or infection. CONCLUSIONS Despite similar complication rates emerged from the analyzed articles, because of the heterogeneity of the studies, we were not able to demonstrate specifically whether drain use affects the rate of early postoperative complications such as seroma, hematoma and infection. Additional randomized controlled trials are strongly advocated in order to provide the necessary scientific evidence. LEVEL OF EVIDENCE III 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 .
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Zhang Y, Cai H. Modified Dual-Plane Technique Coverage Using the Pectoralis Major Fascia. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03204-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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