Surgeons Are More Critical Than Patients; Preoperative Information Affects Satisfaction Rates

ARLINGTON HEIGHTS, Ill. - Following breast reduction surgery, women generally rate the appearance of their breasts as "good" to "very good"-but plastic surgeons are more critical of the cosmetic results, reports a study in the August issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Patients and surgeons focus on different factors; patients are most concerned about symmetry, while surgeons are focused more on technical factors. The study also suggests that the information provided before breast reduction surgery and the patient's level of confidence have an important impact on satisfaction with the results. The new report by Dr. Line Bro Breiting of Herlev Hospital, Denmark, is one of the first to evaluate the cosmetic outcomes after breast reduction surgery.

Eighty Percent of Women Rate Cosmetic Results Good
In the study, 125 women who had undergone breast reduction surgery (reduction mammaplasty) rated their cosmetic results using a questionnaire. Data was gathered at six months and again one year after surgery.

In addition, plastic surgeons rated the outcomes using standard before-and-after photographs. Surgeon ratings were made by plastic surgeons in the Danish public health care system, as well as by a private practitioner in plastic surgery.

In general, the women rated their cosmetic results higher than the surgeons did. At six months, nearly 90 percent of women rated their cosmetic outcomes as "good" or "very good." At one year, this figure had decreased somewhat, to 80 percent. The surgeon ratings were "good" to "very good" in about 75 percent of cases. The private surgeon was more critical than the public surgeons, rating the results "good" to "very good" in only about 60 percent of women.

The evaluation of specific breast features also differed between patients and surgeons. Patients were most concerned about asymmetry between the breasts. The surgeons were more critical about visible scars. However, over time, the patients became more concerned about scars as well.

The plastic surgeons also focused more on technical details, such as the position of the nipple and shape of the breast. Over the years, the public hospital surgeons increased their focus on achieving a more natural breast shape.

Older women were more critical of their cosmetic results than younger women, while women who had complications were more likely to rate their results "unacceptable." Satisfaction was also related to information about and confidence in the procedure: "The better the information and the higher the confidence level, the better was the outcome," Dr. Breiting and coauthors write.

Reduction mammaplasty is among the most commonly performed breast plastic surgery procedures. Previous studies have found it highly effective in relieving symptoms related to overlarge breasts, such as back, shoulder and neck pain, posture problems, and bra strap compression.
The findings show that most women are satisfied with the appearance of their breasts after reduction mammaplasty, although ratings may decrease over time.

The results also highlight some key factors affecting women's perceptions of their cosmetic results, including the information received and level of confidence before surgery. Dr. Breiting and coauthors conclude, "One must not underestimate the importance of factors like preoperative information about the surgery and complications, together with proper and qualified care."

Plastic and Reconstructive Surgery® is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.

About ASPS

The American Society of Plastic Surgeons (ASPS) is the world's largest organization of board-certified plastic surgeons. Representing more than 7,000 Member Surgeons, the Society is recognized as a leading authority and information source on aesthetic and reconstructive plastic surgery. ASPS comprises more than 94 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada. ASPS advances quality care to plastic surgery patients by encouraging high standards of training, ethics, physician practice and research in plastic surgery. 

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