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Jud SM, Brendle-Behnisch A, Hack CC, Preuss C, Arkudas A, Horch RE, Beckmann MW, Lux MP. Macromastia: an economic burden? A disease cost analysis based on real-world data in Germany. Arch Gynecol Obstet 2020; 303:521-531. [PMID: 33123809 PMCID: PMC7858209 DOI: 10.1007/s00404-020-05841-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/13/2020] [Indexed: 11/09/2022]
Abstract
Purpose Symptomatic macromastia causes physical and psychological problems that can lead to restrictions in the patients’ social and working lives and a reduced quality of life. Associated medical treatments also have a considerable impact on health-care costs. Several studies have assessed these costs, but the total disease costs of macromastia have never been evaluated on the basis of real-world data. Methods The data for 76 patients who underwent reduction mammoplasty between 2008 and 2016 were collected using a two-part questionnaire (preoperative and postoperative), as well as the patient files. Topics surveyed, besides demographic data, included physician visits, medical imaging, medical procedures, medical treatments, rehabilitation and convalescent measures, drug intake, medical aids, exercise activity, and sick leave days before surgery, to calculate the costs per year of conservative treatment of symptomatic macromastia. Results The mean time from start of symptoms to surgery was 11.82 years. The data for this group of patients with symptomatic macromastia show that costs per patient amount to €1677.55 per year. These costs include medical consultation, radiological imaging, medical treatments and procedures, physical therapy and rehabilitation, medication, special brassieres, exercise classes costs for sick leave due to problems with macromastia, and travel expenses. Conclusions These results show that considerable health-care costs arise due to macromastia with conservative treatment. Overall, macromastia costs €1677.55 per patient/year. In particular, lost productivity due to sick days and the costs of physiotherapy are factors driving the high costs.
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Affiliation(s)
- Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Anne Brendle-Behnisch
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Caroline Preuss
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Andreas Arkudas
- Department of Plastic Surgery and Hand Surgery, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Raymund E Horch
- Department of Plastic Surgery and Hand Surgery, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Frauenklinik St. Louise, Paderborn, St. Josefs-Krankenhaus, Salzkotten, Frauen- Und Kinderklinik St. Louise, St. Vincenz GmbH, Husener Strasse 81, 33098, Paderborn, Germany.
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Goren A, McCoy J, Krychman M, Brandt L, Lah A, Lonky N. Topical Alpha-1 Adrenergic Receptor Agonist Applied to the Nipple/Areola Complex Improves Female Orgasmic Function. J Womens Health (Larchmt) 2020; 29:1017-1020. [PMID: 32397852 DOI: 10.1089/jwh.2019.8188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The impact of nipple sensation and its relationship to sexual function have often been neglected in medical literature. However, several recent studies report the importance of the nipple/areola complex (NAC) in sexual arousal and overall function. The nipple is composed of smooth muscle that can be erected via adrenergic nerves. In two complementary studies, we demonstrate that stimulation of the alpha-1 adrenergic receptor in the NAC with topical adrenergic agents can initiate erection of the nipple, increase NAC sensitivity, and improve sexual function. Materials and Methods: Thirteen breast surgery patients with nipple sensitivity loss were recruited to an unblinded study of topical phenylephrine hydrochloride. Sensitivity to pressure was measured before and after the application of the intervention to the NAC. In a second pilot study, 35 women completed a double-blinded placebo-controlled trial of a novel formulation, RJ101, containing a norepinephrine releasing agent. The intervention or placebo was applied to the NAC 30 minutes before sexual activity over the 4-week trial period. The arousal, lubrication, and orgasm domains of the female sexual function index (FSFI) were used to measure sexual function. Results: The application of phenylephrine hydrochloride was shown to increase nipple sensitivity to pressure by an average of 20% in our cohort of 13 breast augmentation patients. In addition, it was shown that intermittent application of the alpha-1 agonist for 8 weeks increased basal NAC sensitivity. In the follow-up pilot study, we demonstrate that stimulation of the NAC with RJ101 produced statistically significant increases versus placebo in the lubrication and orgasm domains of the FSFI, p = 0.0226 and p = 0.0269, respectively. Conclusion: For the first time, we demonstrate that the application of a topical alpha-1 adrenergic receptor agonist or a norepinephrine-releasing agent increases the sensitivity of the NAC and subsequently significantly improves sexual function.
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Affiliation(s)
- Andy Goren
- Applied Biology, Inc., Irvine, California, USA.,Department of Dermatology and Venereology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - John McCoy
- Applied Biology, Inc., Irvine, California, USA
| | - Michael Krychman
- Southern California Center for Sexual Health and Survivorship Medicine, Newport Beach, California, USA
| | | | | | - Neal Lonky
- Department of Obstetrics and Gynecology, University of California, Irvine, California, USA
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Pérez-Panzano E, Gascón-Catalán A, Sousa-Domínguez R, Carrera-Lasfuentes P, García-Campayo J, Güemes-Sánchez A. Reduction mammaplasty improves levels of anxiety, depression and body image satisfaction in patients with symptomatic macromastia in the short and long term. J Psychosom Obstet Gynaecol 2017; 38:268-275. [PMID: 28075191 DOI: 10.1080/0167482x.2016.1270936] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate the psychological consequences (anxiety, depression and body image dissatisfaction) of symptomatic macromastia and the effectiveness of breast reduction surgery in re-establishing the mental health of the patient in the short and long term. METHOD 119 patients over 18 years old who had been diagnosed with symptomatic macromastia were assessed, before surgery, one month after the operation and one year later. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Body Image Dissatisfaction subscale of the Eating Disorders Inventory (EDI-2). Participants were also asked about their physical appearance, social relationships and their satisfaction with regards to clothing and dress. RESULTS The average age of the patients was 40.7 (SD = 12.02), 80.2% had a body mass index ≥25 kg/m2. Before surgery, we found psychological distress with values indicating clinical anxiety and body image dissatisfaction. Younger women (< 36 years old) were more psychologically affected. At one month after surgery, there were significant improvements: there were lower scores for anxiety (p < 0.001), depression (p < 0.001) and body image dissatisfaction (p < 0.001). When compared with the pre-surgery scores, all these results showed improvement one year after the intervention (p < 0.001). There were also improvements in social relationships (p < 0.001) and satisfaction with clothing and dress. CONCLUSION Reduction mammaplasty can alleviate the psychological impact of symptomatic macromastia.
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Affiliation(s)
- Esther Pérez-Panzano
- a Deparment of Surgery , Clínico Lozano Blesa University Hospital , Zaragoza , Spain
| | | | - Ramón Sousa-Domínguez
- a Deparment of Surgery , Clínico Lozano Blesa University Hospital , Zaragoza , Spain.,c Faculty of Medicine , Zaragoza University , Zaragoza , Spain
| | | | - Javier García-Campayo
- c Faculty of Medicine , Zaragoza University , Zaragoza , Spain.,d Department of Psychiatry , Miguel Servet University Hospital , Zaragoza , Spain
| | - Antonio Güemes-Sánchez
- a Deparment of Surgery , Clínico Lozano Blesa University Hospital , Zaragoza , Spain.,c Faculty of Medicine , Zaragoza University , Zaragoza , Spain
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Garcia ES, Veiga DF, Sabino-Neto M, Beraldo Cardoso FNM, Batista IO, Leme RM, Cabral IV, Novo NF, Ferreira LM. Sensitivity of the Nipple-Areola Complex and Sexual Function Following Reduction Mammaplasty. Aesthet Surg J 2015; 35:NP193-202. [PMID: 26319082 DOI: 10.1093/asj/sjv034] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The sensitivity of the nipple-areola complex (NAC) is very relevant to female sexuality. OBJECTIVE To evaluate NAC sensitivity and sexual function after breast reduction, and to assess whether altered NAC sensitivity is related to sexual dysfunction. METHODS The study included 80 patients, who were allocated to a control group with eutrophic breasts (CG, n = 20), a hypertrophy group without surgery (HG, n = 20), or a mammaplasty group (MG, n = 40). The MG was assessed preoperatively and 6 months postoperatively. The HG and CG were evaluated once. NAC sensitivity was assessed for touch, temperature, vibration, and pressure in four areola quadrants and the nipple. Sexual function was assessed with the Brazilian version of the Female Sexual Function Index, which has six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and a total score that indicates the presence or absence of sexual dysfunction. RESULTS Compared to the CG, the MG had worse sensitivity to temperature and pressure in the nipple and areola medial quadrants postoperatively (P < 0.01). Compared to their preoperative assessment, the MG had reduced temperature and pressure sensitivity in the nipple and areola medial quadrants postoperatively (P < 0.05). Compared to the CG and HG, patients in the MG had higher postoperative scores of excitation (P = 0.0001), lubrication (P = 0.0004), orgasm (P < 0.0001), and satisfaction (P < 0.0001). There was an association between sexual dysfunction and low NAC sensitivity to temperature and vibration (P ≤ 0.041) in the MG's preoperative and postoperative scores, and to touch, temperature, and pressure across all three groups. CONCLUSIONS Breast reduction with a superomedial pedicle reduced NAC sensitivity but did not interfere with sexual function.
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Affiliation(s)
- Edgard S Garcia
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Daniela F Veiga
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Miguel Sabino-Neto
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Flávia N M Beraldo Cardoso
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Israel O Batista
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Renata M Leme
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Isaias V Cabral
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Neil F Novo
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
| | - Lydia M Ferreira
- Dr Garcia is a PhD Student in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, MG, Brazil. Dr Veiga is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil, and a Medical Assistant Preceptor in the Division of Plastic Surgery at the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Sabino-Neto is an Associate Professor in the Translational Surgery Graduate Program at the Universidade Federal de São Paulo - UNIFESP, Brazil. Dr Beraldo-Cardoso is Psychologist and PhD in Translational Surgery at Universidade Federal de São Paulo - UNIFESP, Brazil. Drs Batista and Cabral are Residents in the Division of Plastic Surgery; Dr Leme is a Resident in the Division of Gynecology and Obstetrics; and Dr Novo is a Full Professor in the Department of Biostatistics of the Universidade do Vale do Sapucaí - UNIVÁS, Pouso Alegre, Brazil. Dr Ferreira is a Full Professor in the Division of Plastic Surgery and the Translational Surgery Graduate Program of the Universidade Federal de São Paulo - UNIFESP, Brazil
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Isiguzo C, Ogbonnaya SI, Udezue AO. Reduction Mammoplasty in a Developing Country: A 10-year Review (2001-2010) at the National Orthopaedic Hospital, Enugu. Niger J Surg 2015; 21:21-5. [PMID: 25838761 PMCID: PMC4382637 DOI: 10.4103/1117-6806.152719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: Large breast is a major problem because of associated symptomatology and aesthetic concerns. Reduction mammoplasty (RM) resolves the symptom and at the same time improves the aesthetic appearance of the breast, hence improving self-esteem and social integration. Aims: To describe the pattern of RM in a hospital in the developing world and its impact on postgraduate surgical training. Settings and Design: A retrospective review of all the RMs done in the National Orthopaedic Hospital, Enugu (a major plastic surgery training center in Nigeria) over a ten-year period (2001–2010), in the developing country of Nigeria. Subjects and Methods: All RMs done in the hospital were reviewed after retrieving their records from operation register and medical records department. Fifteen (15) cases were retrieved and analyzed. Data Analysis: Data was analyzed with Microsoft excel 2007. Results: Average age of female patients who had RM was 26.5 years and 83.3% were single. The most common complaint was abnormally large breast (macromastia). Inferior pedicle technique was commonly used. Conclusions: The results of RM are remarkable as it impact positively on the quality of life of the patients. However, the level of awareness about the availability of this service is still low in the region as shown by few cases done over the period of review and this impacts negatively on the training. The need for public awareness cannot be overemphasized.
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Affiliation(s)
- Chimaobi Isiguzo
- Department of Surgery, Enugu State University Teaching Hospital, Enugu, Nigeria
| | | | - Anthonia O Udezue
- Department of Plastic Surgery, National Orthopaedic Hospital, Enugu, Nigeria
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Abstract
BACKGROUND As the American population ages, a growing number of women may suffer from symptomatic macromastia in their later years. OBJECTIVES The authors analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program database to investigate effects of age on 30-day surgical outcomes for reduction mammaplasty with the hope of improving patient care, counseling, and risk stratification. METHODS Overall, 3537 patients were included in the analysis. Outcome variables included 30-day postoperative major surgical, medical, and wound complications. Patients were initially stratified into 2 groups: <60 years and ≥60 years. The World Health Organization defines age >60 years as elderly. The authors then performed a subgroup analysis, further stratifying the younger cohort into <50 years and 50-60 years of age. Univariate analysis was performed to assess the dependency of preoperative factors on surgical outcomes (P < .05). RESULTS Of the 3547 patients, 3050 were <60 years of age (39.7 ± 11.8 years) and 487 were ≥60 years of age (65.1 ± 4.7 years). A total of 182 thirty-day postoperative surgical complications were documented. Stratifying patients into 2 age groups did not reveal an association between age and any surgical complication (P = .26). CONCLUSIONS This population-level analysis of reduction mammaplasty indicated that, with proper patient selection, the procedure can be performed safely on older patients.
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Affiliation(s)
- Jonas A Nelson
- Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Firat C, Erbatur S, Aytekin AH. The influence of reduction mammaplasty on dermato-psychiatric disorders. Eurasian J Med 2012; 44:68-72. [PMID: 25610212 DOI: 10.5152/eajm.2012.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/25/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Macromastia can cause psychiatric disorders, such as anxiety and depression, and decreases in self-esteem and self-confidence. These problems often externalize themselves on the skin, causing lesions characterized by various degrees of excoriations and lichenified plaques. Mammaplasty operations are very effective in the treatment of neurotic excoriations and similar skin lesions as well as any underlying psychiatric disorders. MATERIALS AND METHODS This study included 17 patients with macromastia and neurotic excoriation lesions who underwent psychiatric treatment for various reasons. Follow ups were performed using routine photographs used in breast surgeries. RESULTS During the postoperative follow ups, the excoriations for nearly every patient healed within 2 weeks. Some lesions healed with atrophic scars and some with permanent hyperpigmentation. Patients' physical complaints, such as backache, shoulder ache and submammary pruritic dermatitis, were also observed to heal. In addition, the patients stated that they felt better psychologically, and most also reported stopping psychiatric treatment. CONCLUSION The psychological problems caused by macromastia include neurotic excoriation and similar skin problems, and aesthetic reduction mammaplasty surgeries are very effective in the treatment of these lesions. Body image perception comprises an important part of self-respect and self-esteem, and psychological-status cosmetic surgery can be evaluated as an alternative to psychological treatment.
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Affiliation(s)
- Cemal Firat
- Department of Plastic Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Serkan Erbatur
- Department of Plastic Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ahmet Hamdi Aytekin
- Department of Plastic Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
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Shridharani SM, Magarakis M, Manson PN, Rodriguez ED. Psychology of Plastic and Reconstructive Surgery: A Systematic Clinical Review: . Plast Reconstr Surg 2010; 126:2243-51. [DOI: 10.1097/prs.0b013e3181f445ae] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This study explored experiences of women with large breasts who were considering or had had breast reduction surgery. Open-ended questionnaires were returned via email from 32 women, 13 of whom were seeking breast reduction and 19 who had already undergone breast reduction surgery. Transcripts were analyzed using Interpretative Phenomenological Analysis (IPA). Themes arising from this analysis included physical symptoms, information, and body image and self-esteem. Implications for Health Psychology are discussed, including the necessity to assist women to cope with pain prior to breast reduction, and assisting health professionals to develop more effective communication skills.
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Saariniemi KM, Joukamaa M, Raitasalo R, Kuokkanen HO. Breast reduction alleviates depression and anxiety and restores self-esteem: A prospective randomised clinical trial. ACTA ACUST UNITED AC 2009; 43:320-4. [DOI: 10.1080/02844310903258910] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sarwer DB, Thompson JK, Mitchell JE, Rubin JP. Psychological Considerations of the Bariatric Surgery Patient Undergoing Body Contouring Surgery. Plast Reconstr Surg 2008; 121:423e-34e. [DOI: 10.1097/prs.0b013e3181772aa8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pusic AL, Chen CM, Cano S, Klassen A, McCarthy C, Collins ED, Cordeiro PG. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg 2007; 120:823-837. [PMID: 17805107 DOI: 10.1097/01.prs.0000278162.82906.81] [Citation(s) in RCA: 193] [Impact Index Per Article: 11.4] [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: 11/26/2022]
Abstract
BACKGROUND Patient-reported outcomes in cosmetic and reconstructive breast surgery are increasingly important for clinical research endeavors. Traditional surgical outcomes, centered on morbidity and mortality, remain important but are no longer sufficient on their own. Quality of life has become a crucial research topic augmenting traditional concerns focused on complications and survival. Given this, reliable and valid patient questionnaires are essential for aesthetic and reconstructive breast surgeons. METHODS The authors performed a systematic literature review to identify patient-reported outcome measures developed and validated for use in cosmetic and reconstructive breast surgery patients. Qualifying instruments were assessed for adherence to international guidelines for health outcomes instrument development and validation. RESULTS The authors identified 227 health outcomes questionnaires used in breast surgery studies. After 135 generic instruments, 65 ad hoc instruments, seven oncologic instruments, 11 education questionnaires, and two non-English-language questionnaires were excluded, seven measures remained. Detailed analysis revealed that six of the seven measures had undergone limited development and validation. Only one measure, the Breast-Related Symptoms Questionnaire, demonstrated adequate development and validation in its target population. It had, nevertheless, significant content limitations. CONCLUSIONS Valid, reliable, and responsive instruments to measure patient-reported outcomes in cosmetic and reconstructive breast surgery are lacking. To demonstrate the benefits of aesthetic and reconstructive breast surgery, future research to rigorously develop and validate new cosmetic and reconstructive breast surgery-specific instruments is needed.
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Affiliation(s)
- Andrea L Pusic
- New York, N.Y.; London, United Kingdom; Vancouver, British Columbia, Canada; and Lebanon, N.H. From the Memorial Sloan-Kettering Cancer Center, University College London, University of British Columbia, and Dartmouth-Hitchcock Medical Center
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Abstract
BACKGROUND Reduction mammaplasty substantially alleviates physical and psychological symptoms of mammary hyperplasia, but the effect on psychosexual function has not been analyzed so far. The aim of this study was to assess the impact of this common procedure on both operative and psychosexual satisfaction. METHODS All women who underwent reduction mammaplasty (n = 90) at the Royal Free and University College London Hospitals between 1997 and 2000 were sent a series of questionnaires on their psychosexual health and satisfaction with operative outcome and postoperative sexual function. RESULTS Of the 80 women who responded (response rate, 89 percent), 76 percent were satisfied with their operative results. Postoperative sexual satisfaction was improved in 28 percent, worsened in 19 percent, and unchanged in 53 percent of patients. Nobody dissatisfied with surgical outcome reported improved sexual satisfaction. A strong correlation was found between these two main outcome measures and General Health and Female Sexual Function Index scores. Significant correlations were also noted for breast shape, sensation, and symmetry (p < 0.001) and change in nipple sensation (p < 0.01). In contrast, breast size and scars did not significantly affect patient operative and sexual satisfaction (p > 0.1). When compared with the satisfied group, women unhappy with surgical results were more likely to suffer from postoperative anxiety (58 versus 18 percent) and depression (42 versus 8 percent). CONCLUSIONS This study confirms that operative outcome following breast reduction does correlate with postoperative psychosexual function, mental health, and some breast parameters. Now that the link is identified, a prospective analysis may clarify the precise relationship between the patient's preoperative psychological status and operative and psychosexual satisfaction.
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Affiliation(s)
- Sonja Cerovac
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, England.
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Thoma A, Sprague S, Veltri K, Duku E, Furlong W. Methodology and measurement properties of health-related quality of life instruments: a prospective study of patients undergoing breast reduction surgery. Health Qual Life Outcomes 2005; 3:44. [PMID: 16042775 PMCID: PMC1196297 DOI: 10.1186/1477-7525-3-44] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2005] [Accepted: 07/22/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast hypertrophy is associated with clinically important morbidity. A prospective study was conducted to assess the change in health-related quality of life (HRQL) following breast reduction mammoplasty. This paper describes the measurement properties of each of the HRQL questionnaires used. METHODS The reliability, responsiveness, and the construct validity of each HRQL instrument (the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) and the Breast Reduction Assessment Value and Outcomes (BRAVO) instruments) were assessed. The BRAVO instruments are a set of separate instruments including the Short Form-36 (SF-36), the Multidimensional Body Self Relations Questionnaire Appearance Assessment (MBSRQ-AS), and the Breast Related Symptoms Questionnaire (BRSQ). RESULTS The HUI2, the HUI3, the MBSRQ-AS, and the breast severity symptom (BSS) score from the BRSQ all demonstrated good test-retest reliability. The SF-36 physical component summary, the MBSRQ-AS, and the BSS score demonstrated high responsiveness. The SF-36 mental component summary and the HUI3 had a moderate effect size and the HUI2 had a small effect size. All of the changes in scales are correlated in the same direction except for the SF-36 physical component summary and the SF-36 mental component summary. CONCLUSION All four instruments were found to be reliable and responsive. These instruments can be used in similar clinical settings to evaluate the change in patients' HRQL.
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Affiliation(s)
- Achilleas Thoma
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Surgical Outcomes Research Centre (SOURCE), McMaster University, Hamilton, Ontario, Canada
| | - Sheila Sprague
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Surgical Outcomes Research Centre (SOURCE), McMaster University, Hamilton, Ontario, Canada
| | - Karen Veltri
- Department of Surgery, Division of Plastic and Reconstructive Surgery, St. Joseph's Healthcare, Hamilton, Ontario, Canada
- Surgical Outcomes Research Centre (SOURCE), McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - William Furlong
- Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Health Utilities Inc, Dundas, Ontario, Canada
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