Extracting big data from the internet to support the development of a new patient-reported outcome measure for breast implant illness: a proof of concept study.

PURPOSE: Individuals with health conditions often use online patient forums to share their experiences. These patient data are freely available and have rarely been used in patient-reported outcomes (PRO) research. Web scraping, the automated identification and coding of webpage data, can be employed to collect patient experiences for PRO research. The objective of this study was to assess the feasibility of using web scraping to support the development of a new PRO measure for breast implant illness (BII). METHODS: Nine publicly available BII-specific web forums were chosen post-consultation with two prominent BII advocacy leaders. The Python Selenium and Pandas packages were used to automate extraction of de-identified text from the individual posts/comments into a spreadsheet. Data were coded using a line-by-line approach and constant comparison was used to create top-level domains and sub-domains. RESULTS: 6362 unique codes were identified and organized into four top-level domains of information needs, symptom experiences, life impact of BII, and care experiences. Information needs of women included seeking/sharing information pre-breast implant surgery, post-breast implant surgery, while contemplating explant surgery, and post-explant surgery. Symptoms commonly described by women included fatigue, brain fog, and musculoskeletal symptoms. Many comments described BII's impact on daily activities and psychosocial wellbeing. Lastly, some comments described negative care experiences and experiences related to advocating for themselves to providers. CONCLUSION: This proof-of-concept study demonstrated the feasibility of employing web scraping as a cost-effective, efficient method to understand the experiences of women with BII. These data will be used to inform the development of a BII-specific PROM.

Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results.

PURPOSE: Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results. METHODS: Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q™), and breast volumetry based on 3D scans (Vectra® H2, Canfield Scientific). RESULTS: Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively. CONCLUSION: Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.

The Impact of Obesity on Patient-Reported Outcomes Following Autologous Breast Reconstruction.

BACKGROUND: Obesity is a significant public health concern and clear risk factor for complications following breast reconstruction. To date, few have assessed patient-reported outcomes (PROs) focused on this key determinant. OBJECTIVE: Our study aimed to investigate the impact of obesity (body mass index ≥ 30) on postoperative satisfaction and physical function utilizing the BREAST-Q in a cohort of autologous breast reconstruction patients. METHODS: An Institutional Review Board-approved prospective investigation was conducted to evaluate PROs in patients undergoing autologous breast reconstruction from 2009 to 2017 at a tertiary academic medical center. The BREAST-Q reconstruction module was used to assess outcomes between cohorts preoperatively and at 6 months, 1 year, 2 years, and 3 years after reconstruction. RESULTS: Overall, 404 patients underwent autologous breast reconstruction with abdominal free-tissue transfer (244 non-obese, 160 obese) and completed the BREAST-Q. Although obese patients demonstrated lower satisfaction with breasts preoperatively (p = 0.04), no significant differences were noted postoperatively (p = 0.58). However, physical well-being of the abdomen was lower in the obese cohort compared with their non-obese counterparts at long-term follow-up (3 years; p = 0.04). CONCLUSION: Obesity significantly impacts autologous breast reconstruction patients. Although obese patients are more likely to present with dissatisfaction with breasts preoperatively, they exhibit comparable PROs overall compared with their non-obese counterparts, despite increased complications.

Frequency, Determinants, and Satisfaction of Breast Augmentation in Trans Women Receiving Hormone Treatment.

INTRODUCTION: As breast development in trans women (male sex assigned at birth, female gender identity) who receive gender-affirming hormone treatment is often moderate, they may choose breast augmentation as part of their treatment. AIM: The aim of the study was to investigate the frequency, determinants, and satisfaction of breast augmentation among trans women receiving hormone treatment. METHODS: Trans women who started hormone treatment between 1972 and 2018 at our center received an anonymous questionnaire. MAIN OUTCOME MEASURE: The questionnaire contained questions about the start date of hormone treatment, the current age of the respondent, whether or not she underwent breast augmentation, what her considerations in this decision were, and, if the respondent did have breast implants, whether she was satisfied with the result and/or experienced health complaints she attributed to her breast implants. RESULTS: A total of 3,073 questionnaires were distributed, of which 773 were retrieved back (median age of the respondents: 50 years, interquartile range: 35-59). Age and year of start of hormone treatment was comparable between responders and nonresponders. The frequency of breast augmentation varied from 70% in trans women who started hormone treatment between 1980 and 2000 to 20% in those who started between 2010 and 2015. Trans women underwent breast augmentation median 2 years after the start of hormone treatment (interquartile range: 2-4), and 80% was satisfied with the result. Approximately one-third experienced health complaints they attributed to their breast implants. People who considered breast augmentation reported financial limitations as an important reason not to undergo breast augmentation. CLINICAL IMPLICATIONS: This study shows that it is important to discuss pros and cons of breast augmentation to support trans women in making a well-informed decision. STRENGTHS & LIMITATIONS: This is the largest study performed on the frequency and satisfaction of breast augmentation among trans women, which also includes health complaints and considerations in the decision whether or not to undergo breast augmentation. One of the limitations was that we were unable to link other clinical data. CONCLUSION: 4 of 5 trans women either chose or considered breast augmentation as part of their gender-affirming treatment. Most of the trans women who underwent breast augmentation were satisfied with the result, although approximately one-third experienced health complaints they attributed to their breast implants. Reasons not to undergo breast augmentation included financial limitations. This study shows that it is important to discuss with trans women the positive effects and possible side-effects of breast augmentation to help them make a well-informed decision whether or not to undergo breast augmentation. de Blok CJM, Staphorsius AS, Wiepjes CM, et al. Frequency, Determinants, and Satisfaction of Breast Augmentation in Trans Women Receiving Hormone Treatment. J Sex Med 2020;17:342-348.

[Patients' satisfaction after immediate breast reconstruction: Comparison between five surgical techniques]. / Satisfaction des patientes après reconstruction mammaire immédiate : comparaison entre cinq techniques chirurgicales.

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.

Quality of Life After Breast Enlargement With Implants Versus Augmentation Mastopexy: A Comparative Study.

BACKGROUND: Research regarding quality of life (QoL) among women who have undergone breast aesthetic surgery is expanding. A comparative, anonymous study between the two main breast aesthetic procedures is needed. OBJECTIVES: The authors compared patient characteristics and aspects of QoL among women who underwent breast enlargement with implants (BI group) and those who underwent augmentation mastopexy (AM group). METHODS: Patients at the Oslo Plastic Surgery Clinic were given a 47-question survey to measure QoL. The survey was anonymous; 61 patients who received breast implants and 37 patients who underwent augmentation mastopexy between 2005 and 2009 responded. Answers were processed by a QuestBack return mail system and sent to the authors. Statistical analyses were performed to evaluate significance between the groups. RESULTS: The response rate was 67% in the BI group and 88% in the AM group. Mean follow-up time was 2.8 years in both groups. Motivation for surgery was primarily cosmetic (65%) and emotional (48%) in the BI group as well as cosmetic (78%) and physical (31%) in the AM group. The effects on psychosocial aspects were significant in the BI group regarding life changes and feeling like a "whole" person (68.9% vs 40.5% and 73.8% vs 40%). BI group also had a significantly higher satisfaction with overall cosmetic result, enlargement, and breast volume (93.4 %, 90.2%, 80% vs 69.4%, 70.2% vs 67% in AM group). Additionally, the BI group was more satisfied with shape, scar, and symmetry (90.1% vs 63.9%, 70.6% vs 40.5%, and 83.6% vs 54.0%, respectively). CONCLUSIONS: None of our patient groups were stereotypical and motivation for surgery was primarily cosmetic in both groups. BI patients were significantly more satisfied with the aesthetic outcome and the QoL of many psychosocial aspects. AM patients may have had different expectations than BI patients and a significant dissatisfaction was reported in shape, scarring, symmetry, and the nipple-areola complex.

The Impact of Animation Deformity on Quality of Life in Post-Mastectomy Reconstruction Patients.

Background: Animation deformity after subpectoral breast implant placement has been documented; however, the actual prevalence and effect on patient quality of life has not been studied much. Objectives: The purpose of this study was to show that all patients with subpectoral implants experience some degree of animation deformity and that it can affect their quality of life, including causing embarrassment and discomfort in reconstructed patients. Methods: Patients who underwent breast implant surgery were contacted for inclusion in the study. Patients were obtained from a single surgeon's practice but included patients operated on outside the practice, and those seen in the practice for a consultation. A six-item questionnaire was developed by the senior author (H.B.) and the medical student (N.F.) involved in the study, to assess quality of life related to animation deformity. Patients had their degree of animation deformity assessed by the senior author and a medical student. Results: Of 25 patients who agreed to the questionnaire and assessment, 20% had grade I distortion, 44% grade II, 24% grade III, and 12% grade IV. Of the patients questioned, 80% were bothered by an animation deformity and 45% of those patients were bothered to a significant degree (≥6 out of 10). In addition, 48% of patients felt that the animation deformity interfered with their daily life, and 28% (7/25) of patients underwent, or were scheduled to undergo, revision of their reconstruction at the time of interview. The degree of the clinically observed animation deformity was correlated with patient dissatisfaction, with an R value of 0.47 (P value = 0.0145). Conclusions: All patients with subpectoral implant positioning will experience some degree of animation deformity. Especially in the reconstructed breast population, animation deformity, and its severity, affects patients' quality of life. Other approaches to reconstruction should be considered to prevent animation deformity in this population. Level of Evidence: 4.

Halo and spillover effect illustrations for selected beneficial medical devices and drugs.

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.

Explicating perceived barriers to mammography for the USCREEN project: concerns about breast implants, faith violations, and perceived recommendations.

In line with the health belief model, perceived barriers have proven to be a key determinant of intentions to screen for breast cancer. The standard measure of perceived barriers to breast cancer screening is an 11 item scale developed by Victoria Champion. However, perceived barriers emerge and change over time, and Champion's perceived barriers scale was last revised in 1999. Moreover, the original scale did not address barriers which may be more pronounced in particular populations, such as congruity of action with faith. As part of the Utah Screening Project, a sample of women 40-74 (N = 341, Mage = 51.19, SD = 8.11) were recruited from four Utah counties in 2014 to complete a survey. The results revealed that the four new perceived barrier items explained 6.4 % of intentions to screen, above and beyond other predictors. In addition to barriers identified in past research, the current study identified several novel barriers including (a) concerns about negative effects to breast implants, (b) perceived conflict with faith, and the (c) perception that mammography is no longer recommended. The new perceived barriers items are useful to researchers interested in exploring barriers not addressed by the original instrument. The barriers also suggest potential belief-based targets and channels (e.g., plastic surgery clinics, faith-based interventions) for delivering mammography interventions.

Impact of delayed implant and DIEP flap breast reconstruction on body image and sexual satisfaction: a prospective follow-up study.

OBJECTIVE: Prospective studies regarding the psychosexual impact after different types of breast reconstruction (BR) are scarce. The impact of either implant or deep inferior epigastric artery perforator (DIEP) flap BR on body image and sexual relationship satisfaction was investigated in time. METHODS: At baseline, 98 women opting for delayed implant or DIEP flap BR after mastectomy for breast cancer completed a survey. The majority was followed up at 6 months (96%) and 20 months (86%) postoperatively. Questionnaires included the body image scale, Dutch Relationship Questionnaire, Short Form - 36 Health Survey and the Impact of Event Scale. RESULTS: Mixed modeling analyses indicated that preoperative body image improved significantly after 20 months (p < 0.001), and there was no statistically significant difference between the two types of BR. A better body image was related to a better general mental health (p = 0.02), less cancer distress (p < 0.001) and a higher partner relationship satisfaction (p < 0.001). Sexual relationship satisfaction also increased after 20 months (p = 0.01), and it was positively related to higher partner relationship satisfaction but negatively affected by hormonal therapy. CONCLUSIONS: Body image and sexual relationship satisfaction significantly improved after BR, and this was not related to the BR type. Psychosexual consequences from previous cancer treatment may interfere. Lower general mental health, higher cancer distress, less partner relationship satisfaction or receiving hormonal therapy can negatively affect body image or sexual relationship satisfaction.

Quality of life and anxiety of patients affected by the PIP/Rofil Medical breast implant recall: results from a prospective monocentre cohort study.

BACKGROUND: The PIP/Rofil Medical breast implant recall affected around 40,000 women worldwide. An impact on quality of life (QoL) has been suspected but not yet reported. OBJECTIVE: To quantify QoL and anxiety in affected women with respect to implant indication and their removal. PATIENTS AND METHODS: Women who attended consultation and opted for implant removal between December 2011 and 2012 were eligible for study. Quality of life and anxiety were measured using validated questionnaires pre- and postoperatively. RESULTS: Fifty-five patients completed at least one questionnaire, of which 32 had received implants for breast cancer, 15 for aesthetic augmentation, and 8 for primary breast malformations. Removal of the implants improved QoL in every group, especially those who had malformations. The QoL of breast cancer patients was generally better compared to the patients with implant for other reasons. CONCLUSION: The recall of PIP/Rofil Medical breast implants had a measurable impact on QoL in affected women and no pathological worry was measurable among those women.

Patient factors associated with cancer worry post-breast reconstruction: A cross-sectional study.

PURPOSE: The BREAST-Q Breast Cancer module is a patient-reported outcome measure for women with breast cancer diagnosis. Our research team developed and validated a novel BREAST-Q scale for this module that measures quality of life outcomes specific to cancer worry. The aim of this study was to investigate patient related breast reconstruction factors that are associated with worse scores on the new BREAST-Q Cancer Worry Scale. METHODS: Women with a history of breast cancer treated with mastectomy and reconstruction, aged ≥18 years, and English-speaking were recruited through the Love Research Army between October and November 2019. Participants completed demographic and clinical questions alongside the BREAST-Q Cancer Worry Scale. Univariable and multivariable regression analyses were used to identify participant characteristics associated with cancer worry scores. RESULTS: Among the 554 potential respondents, 538 (97.1%) completed the Cancer Worry Scale. The average patient age was 58.4 (+9.8) years. Cancer Worry scores were normally distributed with a mean of 46.4 (+17.2). Cancer Worry scores were significantly associated (p < 0.01) with younger age, history of radiation therapy, complications associated with breast surgery since diagnosis, use of textured breast implants, and shorter duration since surgery. CONCLUSIONS: This exploratory analysis provides evidence of patient characteristics that may be associated with cancer worry following postmastectomy breast reconstruction.

The short-term psychological impact of complications after breast reconstruction.

OBJECTIVES: Few studies have focused on the psychological impact of postoperative complications after breast reconstruction (BR). As postoperative complications after BR usually lead to a prolonged recovery time and sometimes require additional surgery, the short-term impact on distress was investigated. METHODS: Pre- and postoperatively, psychological questionnaires were sent to 152 women who underwent either implant BR or deep inferior epigastric artery perforator flap BR (DIEPBR). In addition, patients and physicians' reports of postoperative complications during the first 4-6 weeks after BR were scored. The course of anxiety, depression and cancer-specific distress, and the effect of complications on distress were investigated. RESULTS: Implant BR patients reported decreased anxiety after surgery, and both groups reported reduced cancer-specific distress after surgery. However, depressive symptoms tended to increase after DIEPBR. If complications occurred, both reconstruction groups reported increased depressive and anxiety symptoms, and DIEPBR patients even had depressive symptoms of clinical concern. A significant number of patients with complications reported alarming levels of distress. Timing and laterality were not significantly correlated with distress. CONCLUSIONS: Complications after BR have a significant impact on emotional well-being shortly after surgery. As distress affects quality of life and health outcomes, it is of great importance to offer psychological support to these patients. Distress can be evaluated by monitoring the emotional impact of BR during post-surgery consults, or with the standard use of short psychological questionnaires that patients can complete at home.

Analysis of satisfaction and well-being in the short follow-up from breast augmentation using the BREAST-Q, a validated survey instrument.

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.

Secondary lipofilling after breast reconstruction with implants.

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.

[Oncologic, functional, and aesthetics results; evaluation of the quality of life after latissimus dorsi flap breast reconstruction. About a retrospective series of 450 patients]. / Résultats oncologiques, fonctionnels et esthétiques ; évaluation de la qualité de vie après reconstruction mammaire par lambeau de muscle grand dorsal. À propos d'une série rétrospective de 450 patientes.

Retrospective assesssment from 1998 to 2005 from women who have a breast reconstruction by autologus latissimus flap or by latissimus flap and silicone breast implant for differed breast reconstruction (DBR) or mastectomy and immediate breast reconstruction (MIBR). PATIENTS AND METHOD: Analysis of oncologic results on 450 patients. Analysis of aesthetic, functional results and of quality of life by an anonymous questionnaire in the non progressive patients (407): 263 appraisable answers (13 DBR, 127 MIBR). Middle age: 49.8 years. RESULTS ONCOLOGIC: Forty-three patients (9.5%) had a relapse of their disease, 33 patients died (7.2%). The relapse of the disease was done in the form of metastasis alone: 29 (67.4%), metastasis and local recurrence: three (7%), local recurrence only: four (9.3%), not specified: seven (16.3%). The average time between the breast reconstruction and the relapse was 18.25±15.4 months. AESTHETIC RESULTS: The overall assessment is of 7.68/10. There is no statistical difference between immediate reconstruction and delayed reconstruction. A total of 11.2% patients considered it to be bad (<5/10). The symmetry between the two breasts in time is of 6.6/10 and 19.9% patients considered it to be bad (<5/10). The scar ransom, considered to be most important, is mostly in the back (4.1/10) then on the controlateral breast and then the breast reconstruction. This ransom is not easily acceptable in 15 to 20% of the patients. FUNCTIONAL RESULTS: The discomfort and the pain prevail above all in the back (3.56 and 2.59/10). Weaker symptoms in the event of immediate reconstruction than delayed reconstruction. We noted that 77.2% had kinesitherapy after surgery and 18.9% continues to have kinesitherapy, long time after surgery, mainly for massages of the back. The handicap is considered to be overall low 2.5/10 but 10% of the patients keep a feeling of important handicap (>7.5/10). QUALITY OF LIFE RESULTS: Seventy-one of the patients are serene. The discomfort to wear a bathing suit or to look at bare-chested is low (2.59 and 2.44/10). However 8.9% are in a very discomfort to see themselves bare-chested and 17.6% to show themselves to their spouse, with an impact on their emotional and sexual life in 36.4% of the cases. There is no significant difference between MIBR and DBR but on the other hand according to the judgement of the woman of her aesthetic result. A total of 95.7% do not regret having made this breast reconstruction. CONCLUSION: This study makes it possible to concentrate on the group of non satisfied patient for better determining the causes and the improvements of the surgical techniques to bring but also the overall surgical management of the patient even if most of the patients were mainly satisfied with their breast reconstruction.

Thinking Outside the Black Box: Current Perceptions on Breast Implant Safety and Utility.

BACKGROUND: There is growing public concern surrounding breast implant safety. In fact, the U.S. Food and Drug Administration recently proposed changes to breast implant labeling, which include a boxed warning. Given such efforts to increase transparency on breast implant safety, this study assessed laywomen's perceptions of breast implant safety, and the impact of proposed changes to breast implant labeling on laywomen's decision-making regarding breast implants. METHODS: This was a cross-sectional investigation of women recruited through Amazon Mechanical Turk. Discrete choice modeling was used to query opinions on breast implants after viewing proposed labeling changes. Chi-square and analysis of variance were used for subgroup analyses, and McNemar analyses were used to assess changes in participants' responses. RESULTS: The authors received 500 survey responses. At baseline, 353 participants (70.6 percent) considered breast implants to be at least somewhat safe. After viewing the proposed boxed warning, 252 participants (50.4 percent) responded that they would be less likely to receive implants. In fact, a significantly greater proportion of participants considered breast implants to be either unsafe or very unsafe after viewing suggested changes to implant labeling than at baseline (58.4 percent versus 28.8 percent; p = 0.001). By the end of the survey, willingness to consider alternative options for breast augmentation/reconstruction increased significantly from baseline. CONCLUSIONS: Improved labeling can enhance laywomen's understanding of breast implant safety and can impact decision-making. However, greater scrutiny of breast implants should not prevent women who need implants from receiving them. Transparency and objectivity in the surgeon-patient dialogue can ensure the appropriate use of medical devices such as breast implants.

Two-person screening of mental well-being before primary breast augmentation: Can we do more?

Patients choosing aesthetic surgery are asymptomatic individuals opting for surgery. Psychologists and surgeons have been interested in identifying characteristics of these individuals' preoperative as well as postoperative psychological changes. It was identified that a small number of patients have a primary issue with self-body image, which resulted in altered perceptions and attitudes such that the preoccupation with perceived deficiencies continued even after surgery. The recommended course is to attempt to screen for the patients' mental well-being, as surgery alone does not improve the patients' symptoms. In the first author's practice, each prospective patient is reviewed by two individuals on separate occasions in order to discuss surgery and assure their mental and physical suitability. However, we encountered four patients who exhibited a strong negative reaction to their new shape, to the point that it necessitated explanation in the immediate postoperative phase in two of them. To our knowledge, this situation has not been described in the literature. We discuss the available literature as well as our consent process for breast augmentation. The first author has since introduced BREAST-Q to assess general patient well-being in the pre- and post-operative phases as a result of this experience. We also discuss the results for each of its domains and offer our thoughts about the management of such a situation.

Adjunctive Procedures and Informed Consent with Breast Implant Explantation.

BACKGROUND: The use of injectable or implantable materials or devices in the breast for augmentation or reconstruction has a history of innovation and controversy. Staying current in the field of breast implant management today means understanding not just the published literature but also its absence. Cutting edge breast implant treatment also means awareness of patient and media-driven interests and requests. METHODS: Adjuvant treatments to optimize physical and psychological well-being with breast implant explantation, without replacement, will be addressed through literature review and analysis. RESULTS: The body of literature demonstrates evidence of variable, and sometimes contradictory, methods to address adjunctive management of systemic concerns, the capsule, soft tissue of the native breast/chest, and treatment timing related to explantation. Few approaches are supported by very strong evidence. Many treatment methodologies are defensible. Any current attempts at optimizing management in patients undergoing explantation will be somewhat impaired by the ongoing nebulousness of related issues, such as breast implant illness. It seems clear, therefore, that plastic surgeons must fulfill their duty as caregivers to provide explantation surgery, either to attempt to improve physical health, mental well-being, or simply to respect patients' wishes. A well-informed surgeon will likely employ a variety of approaches, adapted to the unique patient presentations at hand. CONCLUSION: It is expected that consultations, incisions, tissue rearrangements, surgical timing, and treatment indications will continue to vary as scientific investigation strives to understand and to optimize treatment of patients experiencing difficulty with breast implants.

"You Helped Create This, Help Me Now": A Qualitative Analysis of Patients' Concerns about Breast Implants and a Proposed Strategy for Moving Forward.

BACKGROUND: Some women with breast implants express concern about the safety of implants, fearing the possibility of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and breast implant-related illness. METHODS: A qualitative analysis was performed to examine the perceived challenges, barriers, and worries experienced by these women. Convenience sampling was used to elicit responses from members of Canadian BIA-ALCL Facebook advocacy groups. Three independent coders read and reread the transcripts, using thematic analysis to identify emerging themes. RESULTS: Sixty-four women answered questions posed by the president of the Canadian Society of Plastic Surgeons regarding concerns about their breast implants. Five themes were identified: informing, listening, acknowledging, clarifying, and moving forward. Patients desire improved communication about possible risks before implantation and as new information becomes available (informing), sincere listening to their concerns (listening), acknowledgement that these disease entities may be real and have psychosocial/physical impact on patients (acknowledging), clarification of implant-related problems and their treatment (clarifying), and improved processes for monitoring and treatment of patients with identified problems (moving forward). Consideration of these themes in the context of the five domains of trust theory (i.e., fidelity, competence, honesty, confidentiality, and global trust) suggests significant breakdown in the doctor-patient relationship for a subset of concerned women. CONCLUSIONS: Concerns related to BIA-ALCL and breast implant-related illnesses have undermined some women's trust in plastic surgeons. Consideration of these five themes and their impact on the five domains of trust can guide strategies for reestablishing patients' trust in the plastic surgery community.