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Lei C, Xu L, Xu F, Li J, Jiang H, Guan S, Wang X, Wen B, Li J, Li X, Geng C, Yin J. Patient satisfaction in one-stage immediate breast reconstruction after mastectomy: A multi-center comparative patient evaluation of prosthesis, LDMF, and TRAM techniques. Medicine (Baltimore) 2020; 99:e19991. [PMID: 32481367 DOI: 10.1097/md.0000000000019991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To analyze patient satisfaction and the predictive factors characterizing three types of one-stage immediate breast reconstruction (IBR) after mastectomy, including prosthesis, latissimus dorsi myocutaneous flap (LDMF), transverse rectus abdominis myocutaneous (TRAM) flap techniques.Data were collected via face-to-face or telephone interviews from eight breast centers in China from January 2012 to December 2016. A standardized questionnaire that evaluated the general satisfaction and aesthetic satisfaction was sent to patients who had undergone IBR. Logistic regression analysis was performed to identify risk factors associated with patient satisfaction among the three types of breast reconstruction.A total of 412 questionnaires were sent out, and 309 copies were collected including 226 prosthesis, 46 LDMF, and 37 pedicle TRAM reconstruction. Logistic regression analysis showed that general satisfaction and aesthetic satisfaction were significantly correlated with radiotherapy (P < .001, P = .018), respectively. Besides, the aesthetic satisfaction was also associated with nipple-areola complex (NAC) preservation (P < .001).Our multi-center study identified factors of higher patient satisfaction, like NAC preservation and absence of radiotherapy, in order to help breast surgeons make better decisions about individualized reconstruction plan.
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Affiliation(s)
| | - Lijie Xu
- Department of General Surgery, Beijing Chao-Yang Hospital
| | - Feng Xu
- Department of Breast Surgery
| | - Jie Li
- Department of Breast Surgery
| | | | - Shan Guan
- Department of General Surgery, Beijing Tongren Hospital
| | - Xiang Wang
- Department of Breast Surgery, Cancer Hospital, Chinese Academy of Medical Sciences
| | - Bing Wen
- Department of Plastic and Reconstructive Surgery, The First Hospital of Peking University
| | - Jinfeng Li
- Department of Breast Center, Peking University Cancer Hospital
| | - Xiru Li
- Department of General Surgery, General Hospital of People's Liberation Army, Beijing
| | - Cuizhi Geng
- Breast Center, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei
| | - Jian Yin
- Department of Breast Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Durry A, Baratte A, Mathelin C, Bruant-Rodier C, Bodin F. [Patients' satisfaction after immediate breast reconstruction: Comparison between five surgical techniques]. ANN CHIR PLAST ESTH 2019; 64:217-223. [PMID: 30595378 DOI: 10.1016/j.anplas.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/05/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The purpose of this study is to evaluate patients' satisfaction after immediate breast reconstruction (IBR) according to the surgical technique. METHODS Included patients had an IBR between 2012 and 2017 and finished their reconstruction since a year. Patients were contacted by phone and their satisfaction was evaluated with the Breast Q questionnaire. According to the surgical technique, patients were divided into 5 groups: DIEP, gracilis, Latissimus Dorsi flap, definitive implant and expander implant. Techniques were grouped into two categories: free flaps and prothesis. Nipple reconstruction techniques were also evaluated: toe pulp grafting, nipple sharing and local flap. RESULTS Nighty-five patients on the 103 who were eligible accepted to answer the questionnaire. Satisfaction with breasts was stastistically higher in the free flap group (72.6/100) than in the prothesis group (62.7/100) (P<0.01). Physical well-being (chest) was better for the free flap group than for the prothesis group (92.2/100 vs. 85.2/100, P=0.02). Nipple reconstructions with nipple sharing and free flap give a better satisfaction for patients than toe pulp grafting (75.3/100 and 73.5/100 vs. 47.8/100, P<0.01). CONCLUSION IBR with free flap give, in a short time, a statistically higher satisfaction for breast than prothesis. Nipple reconstructions with free flap and nipple sharing give a better satisfaction too.
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Affiliation(s)
- A Durry
- Service de chirurgie plastique, hôpital Civil Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France.
| | - A Baratte
- Service de chirurgie plastique, hôpital Civil Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
| | - C Mathelin
- Service de sénologie, hôpital Hautepierre, 1, avenue Molière, 67200 Strasbourg, France
| | - C Bruant-Rodier
- Service de chirurgie plastique, hôpital Civil Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
| | - F Bodin
- Service de chirurgie plastique, hôpital Civil Strasbourg, 1, place de l'hôpital, 67091 Strasbourg, France
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Timman R, Gopie JP, Brinkman JN, Kleijne A, Seynaeve C, Menke-Pluymers MBE, ter Kuile MM, Tibben A, Mureau MAM. Most women recover from psychological distress after postoperative complications following implant or DIEP flap breast reconstruction: A prospective long-term follow-up study. PLoS One 2017; 12:e0174455. [PMID: 28346508 PMCID: PMC5367706 DOI: 10.1371/journal.pone.0174455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
Abstract
Background Substantial complication rates after postmastectomy breast reconstruction (BR) in breast cancer patients have been reported. Few studies have reported on the resulting psychological distress (PD) and satisfaction with the aesthetic result in relation to postoperative complications after completion of implant or DIEP flap BR. The present study investigated whether women were able to recover from complication related distress in the long term. Methods PD was prospectively measured using questionnaires regarding anxiety, depression and cancer distress. Eligible patients completed questionnaires before BR (T0, n = 144), after one month (T1, n = 139) and after completion of BR, approximately 21 months after initial reconstructive surgery (T2, n = 119). Satisfaction with the aesthetic result was assessed 21 months after BR. Data concerning complications, subsequent additional surgery and total reconstruction failure up to T2 were collected from the medical records. Analyses were performed using multi-level regression analyses correcting for age. Results One or more complications occurred in 61 patients (42%) and 50 women required subsequent surgery (35%). In time, mean PD significantly declined towards baseline scores independent of complications. However, a total reconstruction failure (n = 10) was significantly associated with a large temporary increase in depression scores. After additional surgery due to complications patients were less satisfied with aesthetic outcome, although patient satisfaction was independent of PD. Conclusions PD outcomes generally declined to normal levels after completion of the entire BR course. Patients experiencing a total reconstruction failure reported more depression after this loss, but in the long term recovered to the same level as women without complications. These findings indicate that women generally can cope efficiently with these serious adverse events, even if they were less satisfied with the aesthetic result.
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Affiliation(s)
- Reinier Timman
- Department of Psychiatry, section of Medical Psychology and Psychotherapy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Jessica P. Gopie
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - J. Nick Brinkman
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annelies Kleijne
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Caroline Seynaeve
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marian B. E. Menke-Pluymers
- Department of Surgical Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Breast Clinic, Albert Schweitzer Hospital, Rotterdam, the Netherlands
| | - Moniek M. ter Kuile
- Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aad Tibben
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc A. M. Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Kerger BD, Bernal A, Paustenbach DJ, Huntley-Fenner G. Halo and spillover effect illustrations for selected beneficial medical devices and drugs. BMC Public Health 2016; 16:979. [PMID: 27630095 PMCID: PMC5024505 DOI: 10.1186/s12889-016-3595-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/18/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Negative news media reports regarding potential health hazards of implanted medical devices and pharmaceuticals can lead to a 'negative halo effect,' a phenomenon whereby judgments about a product or product type can be unconsciously altered even though the scientific support is tenuous. To determine how a 'negative halo effect' may impact the rates of use and/or explantation of medical products, we analyzed the occurrence of such an effect on three implanted medical devices and one drug: 1) intrauterine contraceptive devices (IUDs); 2) silicone gel-filled breast implants (SGBI); 3) metal-on-metal hip implants (MoM); and 4) the drug Tysabri. METHODS Data on IUD use from 1965 to 2008 were gathered from the Department of Health and Human Services Vital and Health Statistics and peer-reviewed publications. Data regarding SGBI implant and explantation rates from 1989 to 2012 were obtained from the Institute of Medicine and the American Society of Plastic Surgeons. MoM implant and explantation data were extracted from the England and Wales National Joint Registry and peer-reviewed publications. Tysabri patient data were reported by Elan Corporation or Biogen Idec Inc. Data trends for all products were compared with historical recall or withdrawal events and discussed in the context of public perceptions following such events. RESULTS We found that common factors altered public risk perceptions and patterns of continued use. First, a negative halo effect may be driven by continuing patient anxiety despite positive clinical outcomes. Second, negative reports about one product can spill over to affect the use of dissimilar products in the same category. Third, a negative halo effect on an entire category of medical devices can be sustained regardless of the scientific findings pertaining to safety. Fourth, recovery of a product's safety reputation and prevalent use may take decades in the U.S., even while these products may exhibit widespread use and good safety records in other countries. CONCLUSIONS We conclude that the 'negative halo effect' associated with a stigma, rather than an objective risk-benefit assessment of medical products can increase negative health outcomes for patients due to reduced or inappropriate product usage.
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Affiliation(s)
| | - Autumn Bernal
- Cardno ChemRisk, 130 Vantis, Suite 170, Aliso Viejo, CA 92656 USA
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Maijers MC, de Blok CJM, Niessen FB, van der Veldt AAM, Ritt MJPF, Winters HAH, Kramer MHH, Nanayakkara PWB. Women with silicone breast implants and unexplained systemic symptoms: a descriptive cohort study. Neth J Med 2013; 71:534-540. [PMID: 24394743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Since their introduction, the safety of silicone breast implants has been under debate. Although an association with systemic diseases was never established, women continuously blamed implants for their unexplained systemic symptoms. In 2011, a pattern of symptoms caused by systemic reactions to adjuvants (e.g. vaccines, silicone) was identified: 'autoimmune syndrome induced by adjuvants' (ASIA). Our aim was to collect a cohort of women with silicone breast implants and unexplained systemic symptoms to identify a possible pattern and compare this with ASIA. METHODS Women with silicone breast implants and unexplained systemic symptoms were invited through national media to visit a special outpatient clinic in Amsterdam. All were examined by experienced consultant physicians and interviewed. Chest X-ray and laboratory tests were performed. RESULTS Between March 2012 and 2013, 80 women were included, of which 75% reported pre-existent allergies. After a symptom-free period of years, a pattern of systemic symptoms developed, which included fatique, neurasthenia, myalgia, arthralgia and morning stiffness in more than 65% of women. All had at least two major ASIA criteria and 79% fulfilled ≥ 3 typical clinical ASIA manifestations. After explantation, 36 out of 52 women experienced a significant reduction of symptoms. CONCLUSIONS After excluding alternative explanations, a clear pattern of signs and symptoms was recognised. Most women had pre-existent allergies, suggesting that intolerance to silicone or other substances in the implants might cause their symptoms. In 69% of women, explantation of implants reduced symptoms. Therefore, physicians should recognise this pattern and consider referring patients for explantation.
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Affiliation(s)
- M C Maijers
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, the Netherlands
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Coriddi M, Angelos T, Nadeau M, Bennett M, Taylor A. Analysis of satisfaction and well-being in the short follow-up from breast augmentation using the BREAST-Q, a validated survey instrument. Aesthet Surg J 2013; 33:245-51. [PMID: 23324359 DOI: 10.1177/1090820x12472980] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Improvements in satisfaction and quality of life following breast augmentation have been shown in the literature. However, few studies have used validated survey instruments. The BREAST-Q is a strong and validated questionnaire for breast augmentation. OBJECTIVE The authors implement the BREAST-Q to analyze patient-reported satisfaction and quality of life following breast augmentation. METHODS In this prospective study, all patients who underwent breast augmentation with a single surgeon (AT) between January 2008 and May 2009 were asked to fill out BREAST-Q surveys anonymously during the preoperative and 6-week postoperative periods. Statistical analysis was performed and a P value of <.05 was considered significant. RESULTS Of the 155 patients who underwent breast augmentation during the study time period, 59 (38%) completed the preoperative survey and 70 (45%) completed the postoperative survey. Significant improvements were seen for satisfaction with breast appearance (P < .001), psychosocial well-being (P < .001), and sexual well-being (P < .01) between pre- and postoperative surveys. Conversely, a significant decrease was seen in the physical well-being category (P < .001). Satisfaction with overall outcomes most strongly correlated to satisfaction with appearance of breasts (r = 0.8) and less strongly with psychosocial well-being and sexual well-being (r = 0.6). No correlation was found between satisfaction with overall outcomes and physical well-being (r = 0.0). CONCLUSIONS As the implementation of evidence-based medicine continues to grow in everyday practice, there is increasing pressure to use validated survey instruments to demonstrate patient-reported outcomes. In this study, the authors have shown that breast augmentation significantly improves satisfaction with breast appearance, psychosocial well-being, and sexual well-being and that overall satisfaction is most strongly correlated with breast appearance satisfaction.
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Affiliation(s)
- Michelle Coriddi
- Department of Plastic Surgery, Wexner Medical Center at the Ohio State University, Columbus, OH 43212,
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Cigna E, Ribuffo D, Sorvillo V, Atzeni M, Piperno A, Calò PG, Scuderi N. Secondary lipofilling after breast reconstruction with implants. Eur Rev Med Pharmacol Sci 2012; 16:1729-1734. [PMID: 23161048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Several Authors have reported on the use of lipoinjection as a low-risk and low-morbidity procedure that gives good results for the correction of soft-tissue defects. AIM The purpose of this study was to review our caseload of fat grafting after breast reconstruction with prosthesis. PATIENTS AND METHODS Between January 2008 and December 2011, 20 patients were treated for breast asymmetries with secondary autologous fat injection after nipple-sparing, skin-sparing and skin-reducing mastectomies breast reconstruction in our Departments. Exclusion criteria was postoperative radiotherapy. In order to assess aesthetic satisfaction, patients and an independent plastic surgeon filled an evaluation form (VAS = 1-10) preoperatively one and six months after surgery. RESULTS In postoperative days no major complications occurred. Donor sites looks completely healthy and no scars were evident. The average values of aesthetic satisfaction in patients (VAS) were 5.2 (range 3-7) preoperatively, 7.9 (range 5-9) one month post-operatively and 7.2 six months postoperatively (range 5-9). Values reported by the surgeon team were an average of 4.9 (range 4-6) preoperatively, 7.6 after one month (range 6-9) and 7.1 after six months (range 5-9). CONCLUSIONS Acquired contour deformities of the reconstructed breast are relatively common and independent from the technique used. Therefore, they present a frequent therapeutic challenge to reconstructive surgeons. Lipomodelling offers an "easy to perform" and predictable cosmetic solution to these patients. An objective examination of aesthetic results, in addition to our clinical analysis shows a significant improvement of cosmetic outcomes; moreover, all patients were satisfied for their final appearance.
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Affiliation(s)
- E Cigna
- Department of Surgery, Sapienza University of Rome, Rome, Italy.
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Lowen JT. Reshaping lives. Minn Med 2012; 95:20-24. [PMID: 22866495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Kiefer B. [Breast implants: the clash of cultures]. Rev Med Suisse 2012; 8:248. [PMID: 22338539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Spyropoulou A, Konstantopoulou V. [Cosmetic breast augmentation and suicide risk: a puzzling association]. Psychiatriki 2011; 22:34-42. [PMID: 21688523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The goal of the present article is to examine the unexpected association between cosmetic breast augmentation and suicide found in recent epidemiological investigations. During the last decade, seven epidemiological studies coincide in the high risk of suicidality among women with breast implants. More specifically, the rate of suicide among these patients appears doubled or tripled than expected in the general population. The absence of etiological answers that could interpret this association remains a serious limitation in this field of research. However, the preoperative psychopathology among women with breast implants, their motives and expectations, and their psychosocial characteristics are important factors that may contribute in the relationship between cosmetic breast augmentation and risk of suicide. Body image disorders, most common of which is the body dysmorphic disorder, along with high rates of depression and anxiety disorders are psychopathologic features found in a substantial number of cosmetic breast implant patients. Possible future research directions are proposed, in order to better understand the relationship between breast augmentation and suicide. In the meantime, the consistency of epidemiologic results on the high risk of suicide among breast implant patients suggests the need for interdisciplinary collaboration between plastic surgeons and mental health professionals, at least for those breast implant patients who present with preoperative psychopathology.
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Affiliation(s)
- A Spyropoulou
- 1st Department of Psychiatry, Women's Mental Health Department, Eginition Hospital, Medical School, University of Athens, Athens, Greece.
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Abstract
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.
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Affiliation(s)
- Jennifer L Walden
- Lenox Hill Hospital/Manhattan Eye, Ear, and Throat Institute, 50 East 71st Street, New York, NY 10021, USA.
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Chia HL, Breitenfeldt N, Canal ACE, Malata CM. Implant augmentation after perforator flap breast reconstruction. J Plast Reconstr Aesthet Surg 2010; 63:e172-3. [PMID: 19362527 DOI: 10.1016/j.bjps.2009.02.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Accepted: 02/23/2009] [Indexed: 11/19/2022]
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Riggio E, Spano A, Ottolenghi J, Nava MB. Maximizing the use of abdominoplasty incision in oncoplastic and aesthetic breast surgery: four transabdominal (transumbilical-like) augmentations. Aesthetic Plast Surg 2008; 32:130-5. [PMID: 17962992 DOI: 10.1007/s00266-007-9047-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The transabdominal (transumbilical [TUBA]) procedure for breast implant insertion is known for aesthetic aims, but cosmetic and psychosocial improvements reported in aesthetic surgery should be transferred to breast reconstruction patients. METHODS Surgical and psychological aspects were analyzed in four cases through clinical evaluation and psychosocial assessment. Three patients were candidates for postmastectomy reconstruction by transverse rectus abdominis myocutaneous (TRAM) flap, and one patient was a candidate for cosmetic abdominoplasty. The expectations of the patients were met, and body image improvement was provided through contralateral breast augmentation in all cases. Details of the surgical approach focused on the inframammary fascial system. The psychosocial implications of the TUBA-like breast augmentation combined with the abdominoplasty procedure were emphasized through the analysis of the technical details and the psychological behaviors affecting the surgery. RESULTS The result, after long-term clinical follow-up (37 months) and administration of a satisfaction questionnaire (CSQ-8), established the importance of scarless surgery to healthy breast tissue and the positive reception by women with different life histories. CONCLUSION This report concerns only a few potential patients, but supports a trend that surgeons should consider. An elective indication for transabdominal breast augmentation can be represented even by those few patients who are candidates for TRAM flap reconstruction, who are agreeable to a small augmentation in the absence of a scar on their healthy breast, and whose reconstructed breast is larger and more prominent at the central part of the mound than on the contralateral side.
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Affiliation(s)
- Egidio Riggio
- Department of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milano 20133, Italy.
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Chang JTC, Chen CJ, Lin YC, Chen YC, Lin CY, Cheng AJ. Health-Related Quality of Life and Patient Satisfaction After Treatment for Breast Cancer in Northern Taiwan. Int J Radiat Oncol Biol Phys 2007; 69:49-53. [PMID: 17482771 DOI: 10.1016/j.ijrobp.2007.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Revised: 02/12/2007] [Accepted: 02/14/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate health-related quality of life (QoL) and attitudes toward surgical procedures for breast cancer among patients in northern Taiwan. METHODS AND MATERIALS Two hundred twenty posttreatment breast cancer patients completed a QoL survey at two different hospitals in northern Taiwan. Patients (median age, 49 years; range, 32-69 years) had either undergone mastectomy (n = 157) or breast conservation treatment (BCT) (n = 63). The Functional Assessment of Chronic Illness Therapy-Breast questionnaire was used to assess QoL. The patients were also asked about breast reconstruction or use of an artificial breast or not, as well as the decision-making process. RESULT There was no significant difference in QoL between patients treated with BCT or mastectomy. Significantly more mastectomy patients had had breast reconstruction or wore an artificial breast (49.7% vs. 3.2%; p < 0.001). Of those who had BCT, 81% would make the same choice again, compared with only 49% of mastectomy patients (p < 0.001). Only 7.6% of patients who made the treatment decision themselves were dissatisfied with their treatment, compared with 25% for whom the decision was made by someone else (p = 0.004). CONCLUSIONS Taiwanese women with breast cancer who had undergone mastectomy did not report a worse QoL than those who received BCT, but they were more likely to be concerned about their resulting body image. Half would have chosen a less extensive procedure if they had it to do over. Women were more likely to be satisfied with the results of their treatment if they had decided themselves.
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Affiliation(s)
- Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou Medical Center, Taoyuan, Taiwan.
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Nowak R. Special report: cosmetic surgery. When looks can kill: the nip and tuck generation faces a danger far worse than the operation going wrong. New Sci 2006; 192:18-21. [PMID: 17165220 DOI: 10.1016/s0262-4079(06)60771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Spear SL, Pelletiere CV, Menon N. One-stage augmentation combined with mastopexy: aesthetic results and patient satisfaction. Aesthetic Plast Surg 2004; 28:259-67. [PMID: 15529204 DOI: 10.1007/s00266-004-0032-6] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 05/26/2004] [Indexed: 11/25/2022]
Abstract
Since the original descriptions by Gonzales-Ulloa in 1960 and Regnault in 1966, breast augmentation in combination with mastopexy has remained a difficult, and often polarizing, topic in plastic surgery, not only because of its results but also because of its litany of potential complications. Over the past few years, there has been an increase in the discussion of one-stage augmentation combined with mastopexy throughout the literature. However, a critical analysis of the aesthetic results, as well as patient satisfaction with the procedure, continues to be absent. Because there have not been any reported studies on the aesthetic results or patient satisfaction with augmentation and mastopexy, we undertook this retrospective review in an attempt answer a fundamental question: is one-stage breast augmentation combined with mastopexy aesthetically and functionally worthwhile for both the physician and patient? All 34 patients reviewed for this retrospective study underwent bilateral, one-stage breast augmentation and mastopexy between April 1996 and December 2002. Patient charts were reviewed for a number of parameters including previous breast surgery, degree of preoperative ptosis, type of mastopexy used, size and type of implants placed, implant position, postoperative complications, and any revision surgeries performed. Patient photographs were evaluated by observers blinded to the study, and patients were asked to complete a satisfaction questionnaire. Ptosis was graded according to the Regnault classification. As a result, 14 women had grade 1 ptosis (41%), fourteen had grade 2 ptosis (41%), one had grade 3 ptosis (3%), two had pseudoptosis (6%), and two had tuberous breasts (6%). The grade of ptosis in one patient was not defined. The patient complication rate was 8.8% (3 patients). For the aesthetic rating scale, preoperative and postoperative photographs taken after more than 1 year were evaluated. On the scale of 1 (poor) to 4 (excellent), overall ptosis correction was rated as 3.4, asymmetry correction as 3.4, postoperative breast symmetry as 3.2, scar quality as 3.3, breast shape as 3.1, nipple/areola size as 2.9, and overall result as 3. Only 13 of the 34 patients were available for completion of the satisfaction survey. Evaluation of the 13 patient satisfaction surveys showed that, on the average, the patients were satisfied with the various aspects of their surgery. The average overall result and surgical goals both were 3.1. However, 54% of the patients (n = 7) desired revision surgery for various reasons, the most common being a desire for more breast lift. A review of the patients and results, brought a number of issues to light. First, aesthetic results for augmentation and mastopexy truly depend on a number of different factors that must work in harmony to yield an excellent result. Second, what is aesthetically pleasing to the surgeon may not be pleasing to the patient, and vice versa. Third, although the patient aesthetic results were good, they were not consistently rated as excellent, nor were the patients totally satisfied with their outcomes. This perhaps reflects the more complex nature of both the patient's problems and the surgical procedure itself. Finally, although the overall results of one-stage breast augmentation and mastopexy are good, and the patients generally are satisfied, this study raises the question whether staging the surgery by performing the mastopexy first may not yield significantly better results than the combined simultaneous procedure.
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Affiliation(s)
- Scott L Spear
- Division of Plastic Surgery, Department of Surgery, Georgetown University Hospital, Washington, D.C. 20007, USA.
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McLaughlin JK, Wise TN, Lipworth L. Increased Risk of Suicide Among Patients With Breast Implants: Do the Epidemiologic Data Support Psychiatric Consultation? Psychosomatics 2004; 45:277-80. [PMID: 15232039 DOI: 10.1176/appi.psy.45.4.277] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Four epidemiologic studies have examined mortality among women with cosmetic silicone gel-filled breast implants and have found that risk of death from suicide is two- to threefold higher in this group than among women of comparable age in the general population. The authors review the literature on the psychological and psychiatric hypotheses concerning women undergoing plastic surgery, although these hypotheses do not specifically address the association with suicide. Epidemiologic research is urgently needed to evaluate whether this association is an artifact of a higher prevalence of underlying and unreported psychopathology and other risk factors for suicide among women receiving breast implants or whether implants have an actual causal role in the risk of suicide. Until such studies are completed, psychiatric consultation should be considered before breast augmentation, especially for patients perceived to be at high risk by the plastic surgeon.
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Affiliation(s)
- Joseph K McLaughlin
- International Epidemiology Institute, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilty University Medical Center, Nashville, TN, USA.
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22
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23
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Healey IR. External breast prostheses: misinformation and false beliefs. MedGenMed 2003; 5:36. [PMID: 14600672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
This article discusses common myths associated with the use of external breast prostheses and the impact this misinformation may have on the quality of life of women after mastectomy. A review of the literature reveals that very little research has been conducted on this subject. The majority of information on breast prostheses is provided by the manufacturers and tacitly accepted by healthcare providers and the media in general. Claims regarding the medical necessity of a weighted prosthesis and the suitability of gel fillings are examined and found wanting. Widespread acceptance of these myths may be preventing women from pursuing healthy lifestyle options and restricting the development of more suitable prosthetic products. The article concludes that a rigorous, evidence-based approach to the evaluation of external breast prostheses would enhance both the development of this noninvasive and cost-effective sector of post-mastectomy care, as well as the adjustment, well being and quality of life of breast cancer survivors.
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Affiliation(s)
- J P Fyad
- Service de chirurgie générale et sénologique, Institut Curie, 26, rue d'Ulm, 75005 Paris, France
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27
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Giard S. [What kind of reconstruction after mastectomy? Different reconstruction]. Gynecol Obstet Fertil 2003; 31:478-80. [PMID: 14567130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- S Giard
- Département de sénologie, centre Oscar-Lambret, 3, rue Frederic-Combemale, 59020 Lille, France.
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28
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Affiliation(s)
- V C M Koot
- Julius Centre for Health Sciences and Primary Care, University Medical Centre, Box 85500, 3508 GA Utrecht, Netherlands.
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29
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Abstract
The fitting of soft breast prostheses is an essential nursing duty on breast cancer surgery wards, but it appears to be performed on an ad hoc basis, without evidence-based guidelines. A diagnosis of breast cancer carries enormous implications for the patient in terms of physical and psychological health. For this reason, it is vital that nurses respond sensitively to these needs and assist women to cope with the changes in body image. This includes ensuring that knowledge underpins practice when fitting the soft breast prosthesis. This article outlines a 12-point plan devised by the authors, giving guidance on how to fit temporary breast prostheses.
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Cash TF, Duel LA, Perkins LL. Women's psychosocial outcomes of breast augmentation with silicone gel-filled implants: a 2-year prospective study. Plast Reconstr Surg 2002; 109:2112-21; discussion 2122-3. [PMID: 11994621 DOI: 10.1097/00006534-200205000-00049] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined the experiences of 360 women receiving bilateral breast augmentation with Dow Corning's Silastic MSI (textured) or Silastic II (smooth) gel-filled mammary implants. Before surgery, the women completed a quantitative assessment of their surgical expectations and concerns. At 6, 12, and 24 months postoperatively, they rated their satisfaction with surgery and its specific psychosocial outcomes, their concerns, and benefits-to-risks appraisals of the augmentation. The women reported very high levels of satisfaction with the procedure and its psychosocial outcomes, which did not change over time. Throughout the 2-year period, over 90 percent of the women were satisfied with surgery and their resultant body-image changes. Their concerns about risks, reported by 19 percent before surgery, declined after surgery and remained subsequently stable. Most participants (75 to 85 percent) reported that the benefits of surgery exceeded its risks. Postoperative events such as significant capsular contracture that compromised aesthetic results diminished aspects of satisfaction, whereas less obvious events did not. Systematic analysis of attrition (i.e., missing assessments) did not indicate any biases because of complications or psychosocial outcomes. Evaluation of a possible impact of the publicity surrounding the Food and Drug Administration's voluntary moratorium on the use of silicone gel-filled breast implants, which occurred during the study, revealed a limited effect, if any, on women's psychosocial outcomes. Findings are discussed in relation to the study's methodological strengths and limitations and with respect to the broader context of patient care.
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Affiliation(s)
- Thomas F Cash
- Department of Psychology, Old Dominion University, Norfolk, VA 23529-0267, USA.
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Coon SK, Burris R, Coleman EA, Lemon SJ. An analysis of telephone interview data collected in 1992 from 820 women who reported problems with their breast implants to the food and drug administration. Plast Reconstr Surg 2002; 109:2043-51. [PMID: 11994612 DOI: 10.1097/00006534-200205000-00040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
How health care providers deal with concerns and feelings of women who have problems with their breast implants affects the women's satisfaction with their breast implants, yet in 1992 little was known about the concerns and feelings of these women. A qualitative analysis of in-depth telephone interviews conducted in 1992 with 820 women from all regions of the United States who reported problems with their breast implants to the Food and Drug Administration and responded to an invitation to be interviewed provided data. Respondents were primarily 40 to 69 years of age at the time of interview, Caucasian, married, and educated beyond high school. The sample was almost equally divided in reason for breast implants, with 65 percent being dissatisfied with their breast implants. Nearly all of the women had heard of problems with silicone gel-filled implants. Their main sources of information were television, newspapers, and magazines rather than their physicians or the breast implant manufacturers. Some women tried to avoid hearing the reports, and many tried to put the reported problems out of their minds. However, a majority (88.7 percent) wanted more information. The women expressed feelings of anger, regret, and worry, and repeatedly said they needed more information. Women who contacted the Food and Drug Administration about breast implant problems needed accurate and honest information from health care professionals. They wanted their physicians to explore their symptoms, fears, and concerns.
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Affiliation(s)
- Sharon K Coon
- College of Nursing, Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock, AR 72205-7199, USA
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Berner I, Gaubitz M, Jackisch C, Pfleiderer B. Comparative examination of complaints of patients with breast-cancer with and without silicone implants. Eur J Obstet Gynecol Reprod Biol 2002; 102:61-6. [PMID: 12039092 DOI: 10.1016/s0301-2115(01)00561-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To measure the relationship between silicone breast implants and various symptoms using a control group. STUDY DESIGN A matched-pair-analysis of 96 women with breast-cancer (32 with silicone implants (K I); 64 without implants (K II)) was performed with help of a standardized questionnaire in respect to 50 single criteria. The condition of implants was monitored by MR-imaging. RESULTS Athralgias and myalgias were not significantly more frequent in K I. Only six symptoms were reported significantly more often in patients with implants. Positive correlation with implant rupture was given only for the numb feeling/tingling sensation in extremities (P=0.02). There was no correlation between silicone implants and the symptoms of the "chronic-fatigue syndrome" nor any other described silicone-induced disease. CONCLUSIONS According to our analysis many of the symptoms examined here are present in middle-aged women regardless of silicone implants and underlying disease.
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Affiliation(s)
- Imke Berner
- Institute for Clinical Radiology, Universität Münster, Albert-Schweitzer-Street 33, D-48129 Münster, Germany
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Abstract
Twenty-five women with breast implants participated in semistructured interviews designed to reveal their "mental models" of the processes potentially causing local (i.e., nonsystemic) problems. The authors analyzed their responses in terms of an "expert model," circumscribing scientifically relevant information. Most of the women interviewed had something to say about most elements in the expert model. Nonetheless, gaps in their mental models undermined decision making about their implants. One woman misunderstood the terms used by the medical community to describe implant failure (e.g., rupture, leak, and bleed). Another exaggerated the implants' vulnerability to direct impacts, such as car accidents. Participants also overestimated their ability to detect localized problems and to select medical remedies. Although they were generally satisfied with their own implants, many participants were dissatisfied with the decision-making processes that lead to their choice. Their interviews are interpreted by the form and content of communications that women with implants need to help them manage their health decisions better.
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Affiliation(s)
- S Byram
- Department of Psychology, Carnegie-Mellon University, Pittsburgh, Pennsylvania, USA
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Jensen B, Hechmann WI, Friis S, Kjøller K, McLaughlin JK, Bliddal H, Danneskiold-Samsøe B, Olsen JH. Self-reported symptoms among Danish women following cosmetic breast implant surgery. Clin Rheumatol 2002; 21:35-42. [PMID: 11954882 DOI: 10.1007/s100670200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The aim of this study was to examine self-reported symptomatology and to identify distinctive characteristics among women with silicone breast implants (SBI). Using the Danish hospital and population registers we identified three groups of women with a hospital diagnosis of muscular rheumatism (a nonspecific soft-tissue diagnostic code) who had previously undergone SBI surgery (n = 28), breast reduction surgery (n = 29) or no breast surgery (n = 27); and three groups of women without a diagnosis of muscular rheumatism who had undergone SBI surgery (n = 21), breast reduction surgery (n = 27) or no breast surgery (n = 56). All study subjects completed a self-administered questionnaire focusing on sociodemographic factors, lifestyle habits, somatic symptoms and psychological symptoms. Women with SBI and women with breast reduction with no previous diagnosis of muscular rheumatism had similar patterns of reporting for most symptoms and characteristics. They reported significantly more somatic symptoms and psychological distress, including somatisation, obsessive-compulsiveness and depression, than women with no breast surgery. No significant differences in self-reported symptomatology and characteristics were observed among the three groups of women with a previous diagnosis of muscular rheumatism. Overall, women with prior muscular rheumatism reported more symptoms than those without. We concluded that self-reported somatic symptoms among women with SBI were similar to those of controls. Women with cosmetic breast surgery appear to have distinctive psychological characteristics. Our study emphasises the importance of taking the psychological profile and previous history of rheumatic diseases into account when examining women with SBI.
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Affiliation(s)
- B Jensen
- Parker Research Institute, Department of Rheumatology, Frederiksberg Hospital, Denmark.
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Zuckerman D. The breast cancer information gap. RN 2002; 65:39-41. [PMID: 15328867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Affiliation(s)
- Diana Zuckerman
- National Center for Policy Research for Women & Families, Washington, DC, USA
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37
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Abstract
Studies of disease outcomes have not produced an explanation or an intervention for the symptoms and complaints that some women have attributed to breast implants. Reviews of the literature have found no increased risk of specific systemic disease, and no treatment recommendations have emerged. However, similar symptoms in fibromyalgia, chronic fatigue, and other contexts have been considered to be stress or behaviourally mediated, and a number of promising behavioural interventions have been developed. Aetiological, research, and treatment implications may follow from the consideration of such symptoms within a behavioural medicine model that allows for the interaction of physical and psychological influences. In the case of implants, a mass somatisation model may also help to discern the potential effects of litigation and other social influences.
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Affiliation(s)
- D M Dush
- Department of Psychology, 118 Sloan Hall, Central Michigan University, Mt Pleasant, MI 48859, USA
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38
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Thijs-Boer FM, Thijs JT, van de Wiel HB. Conventional or adhesive external breast prosthesis? A prospective study of the patients' preference after mastectomy. Cancer Nurs 2001; 24:227-30. [PMID: 11409067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
After having been subjected to radical mastectomy for breast cancer, women are usually fitted with an external breast prosthesis. Different types of prostheses are available, but oncology nurses have few data enabling them to advise their patients adequately. In this prospective randomized crossover study of 101 women undergoing one-sided mastectomy for breast cancer, the self-adhesive breast prosthesis was compared with the traditional external prosthesis. Questionnaires were used to evaluate the woman's judgment of the prosthesis in relation to her final preference for one type of prosthesis. Complete data were available for 91 women, 59.3% of whom finally preferred the self-adhesive type. Preference was independent of age, randomization, order, or the possible use of adjuvant chemotherapy. Satisfaction with the self-adhesive prosthesis was independent of randomization order but satisfaction with the traditional type was significantly more when it was the first type of prosthesis. Preference for the self-adhesive prosthesis over the traditional type mas mainly related to an increased perception of the prosthesis as a part of the body. Preference for the traditional prosthesis over the other type was mainly related to the greater ease of application and the lesser local irritation of the skin. Findings from this study can be useful in oncology nursing practice.
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Affiliation(s)
- F M Thijs-Boer
- Department of Social Sciences, University of Utrecht, The Netherlands.
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39
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Abstract
This study examined how women's magazines framed breast cancer and silicone implants to determine whether they used a sense-making framework. Sense-making calls for existing gaps to be closed between what one group views as real and what another group experiences (Parrott, 1996). Analysis included 86 articles on cancer and implants published in four women's magazines from 1990 to 1997. Overall findings suggest that women's magazines used a sense-making approach to cancer coverage, framing the disease in terms of coping with its effects, personal experiences, and risk factors. Themes in implant articles pertained to economic concerns of the medical industry and media.
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Affiliation(s)
- J L Andsager
- Edward R. Murrow School of Communication Washington State University, Pullman 99164-2520, USA.
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40
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Abstract
Despite the ban on silicone gel breast implants in 1992, the last decade witnessed a dramatic increase in the number of cosmetic breast augmentation procedures performed in the United States. According to the American Society of Plastic Surgeons, over 132,000 women in this country underwent the procedure in 1998. This is an underestimate of the actual number of breast augmentations performed annually, as increasing numbers of nonsurgeon physicians are now performing cosmetic surgery. Given the rising number of women who now seek cosmetic breast augmentation surgery, it is likely that women's healthcare providers will be asked by their patients about breast augmentation. This review is designed to provide an overview of the medical and psychological literature on cosmetic breast augmentation. We begin with a history of breast augmentation, including an overview of the controversy of silicone breast implants and the Institute of Medicine's report on their safety published in 1999. We also discuss the psychological characteristics of breast augmentation patients, reviewing both preoperative and postoperative studies. We conclude with suggestions for future research as well as a discussion of the clinical relevance of this area for women's healthcare professionals.
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Affiliation(s)
- D B Sarwer
- Department of Psychiatry and Surgery, Edwin and Fannie Gray Hall Center for Human Appearance, University of Pennsylvania School of Medicine, Philadelphia 19104, USA
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41
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Abstract
We report our findings in a retrospective study of patient satisfaction with soybean oil-filled mammary implants. Sixty-two women who had breast augmentation with Trilucent breast implants were sent a questionnaire to assess their satisfaction with implant placement; 19 of the 62 attended for clinical examination. Overall satisfaction with triglyceride implant placement was high: very pleased 45% (18/40), pleased 32.5% (13/40), content 12.5% (5/40). The majority of women felt that it had enhanced their body image and lifestyle (82.5%).
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Affiliation(s)
- A P Armstrong
- Department of Plastic and Reconstructive Surgery, The Wellington Hospital, London, UK
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42
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Abstract
'Medical records of 180 patients who underwent silicone gel-filled breast implant explanation were retrospectively reviewed. The goal of this study was to determine if any patient variable(s) had predictive value for positive quality of life after explanation. The medical complaints, symptoms, and established diagnoses were considered equally and were referred to as self-reported medical problems. The study revealed that no single problem or pairing of problems was associated with or predictive of outcome. The results show, however, that the number of medical problems was significantly predictive of patient perception of quality of life. A total of 50 explanation patients completed quality-of-life surveys. Specifically, those patients who reported five or fewer medical problems that predated explantation were significantly more likely to perceive an increased quality of life after surgery than those who reported nine or more medical problems (p < 0.04). In conclusion, it is difficult to correlate subjective patient symptoms with postoperative improvements in quality of life after explantation.
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Affiliation(s)
- R J Rohrich
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9132, USA.
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Abstract
When silicone gel breast implants became the subject of a public health controversy in the early 1990s, the most pressing concern was safety. This paper looks at another, less publicized issue: the need for implants. Using a symbolic interactionist approach, the author explores the social construction of the need for implants by tracing the history of the 3 surgical procedures for which implants were used. Stakeholders in this history constructed need as legitimized individual desire, the form of which shifted with changes in the technological and social context.
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Affiliation(s)
- N Jacobson
- Mental Health Services Research Training Program, University of Wisconsin, Madison 53792, USA
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