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Lindau ST, Pinkerton EA, Abramsohn EM, Fuller CM, Grubb D, Mendoza T, Siston AK. Importance of Breast Sensation After Mastectomy: Evidence from Three Sources. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:594-602. [PMID: 38099078 PMCID: PMC10719638 DOI: 10.1089/whr.2023.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/17/2023]
Abstract
Background Every year, more than 90,000 U.S. women undergo mastectomy. More than 40% have reconstruction. Following reconstruction, most women experience persistent partial or complete numbness of the reconstructed breasts, and many experience pain. Yet, breast reconstruction procedures focus largely on esthetic outcomes with mixed impact on sensory outcomes and little attention to pain. This study examines whether and how breast sensation is important to women. Materials and Methods Conventional content analysis of extant qualitative data from a clinical registry (29 women with prior breast surgery for cancer, 2008-2022), a volunteer community sample (qualitative interviews with 6 women with and 5 without breast cancer, 2019), and from a Twitter social media survey (N = 32, 2022). Results Functions of the breast identified by women with and without cancer include breastfeeding, sexual function, and femininity. Five interrelated themes on the importance of breast sensation emerged among women with breast cancer history: sexual function, experience of partnered sex or relationship with one's sexual partner, breast embodiment, effect of breast pain on sexual function, and importance to psychological wellbeing. Women, advocates, and clinicians described a lack of patient-physician communication in this domain that exacerbates the negative impact of breast sensation loss on health and wellbeing. Conclusions Breast sensation is important to women following mastectomy, yet a gap exists in patient-physician communication about the impact of mastectomy and reconstruction on breast sensory function. Lessons for physicians, scientists, and skeptics are conveyed about why the basic integrity of women's bodies matters for practice and science.
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Affiliation(s)
- Stacy T. Lindau
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
- Department of Medicine-Geriatrics, The University of Chicago, Chicago, Illinois, USA
| | - El A. Pinkerton
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Emily M. Abramsohn
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Charles M. Fuller
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Danielle Grubb
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Tania Mendoza
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Amy K. Siston
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA
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Guimarães PAMP, Aihara EMK, Sabino M, Marchi MLD, Ferreira LM. Impact of breast augmentation on female sexuality. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S105. [PMID: 37556624 PMCID: PMC10411706 DOI: 10.1590/1806-9282.2023s105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/15/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The breasts are symbols of femininity, sexuality, and maternity. Breast augmentation is among the most sought-after procedures for women and has a positive impact on quality of life. Sexuality is one of the items that contribute to increased quality of life. Surgical outcomes can be evaluated from the patients' perspective using developed and validated questionnaires. For the assessment of sexuality, the most commonly used instruments are the Female Sexual Quotient and the Female Sexual Function Index, which estimate several domains of sexuality and can be used to evaluate the impact of surgery on it. OBJECTIVE The objective of this study was to evaluate the impact of breast augmentation on female sexuality. METHODS We selected 87 patients from the Plastic Surgery Outpatient Clinic of Hospital São Paulo (Federal University of São Paulo) who wished to undergo breast augmentation. The patients were classified into two groups: the Female Sexual Quotient questionnaire was applied to one group, and the Female Sexual Function Index questionnaire was applied to the other group to evaluate sexuality preoperatively as well as at 2 and 4 months postoperatively. RESULTS In both groups, there was a significant increase in the total score of the Female Sexual Quotient and Female Sexual Function Index questionnaires, and an individual increase in each domain assessed, with a significant increase in the domains of orgasm and sexual satisfaction, as well as foreplay and arousal, indicating an improvement in the patients' sexuality postoperatively. CONCLUSION Breast augmentation has a positive impact on female sexuality; furthermore, the Female Sexual Quotient and Female Sexual Function Index are sensitive in detecting this impact.
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Affiliation(s)
| | | | - Miguel Sabino
- Universidade Federal de São Paulo, Plastic Surgery Division – São Paulo (SP), Brazil
| | - Mateus Leme De Marchi
- Universidade Federal de São Paulo, Plastic Surgery Division – São Paulo (SP), Brazil
| | - Lydia Masako Ferreira
- Universidade Federal de São Paulo, Plastic Surgery Division – São Paulo (SP), Brazil
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Revisiting the No-vertical-scar, Free Nipple Graft Breast Reduction. Plast Reconstr Surg Glob Open 2022; 10:e4508. [PMID: 36128435 PMCID: PMC9481446 DOI: 10.1097/gox.0000000000004508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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] [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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Lonie S, Sachs R, Shen A, Hunter-Smith DJ, Rozen WM, Seifman M. A systematic review of patient reported outcome measures for women with macromastia who have undergone breast reduction surgery. Gland Surg 2019; 8:431-440. [PMID: 31538069 DOI: 10.21037/gs.2019.03.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patient satisfaction and outcomes following reduction mammoplasty is important to measure, being a being a reconstructive procedure with physical and cosmetic benefits. This study aimed to evaluate patient satisfaction and the various questionnaires that have been devised for this measurement. A systematic search of literature was performed in PubMed, Cochrane Library, Medline and Scopus databases from 1966 to July 2018 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After application of pre-determined inclusion criteria by two authors, 95 articles were included. Data was extracted from included studies relating to demographics, surgical technique, questionnaires used and physical, psychological and aesthetic outcomes. Of the 95 studies included (9,716 patients), 58 studies (5,867 patients) reported on overall satisfaction with a mean rate of 90.26%. Researchers' own non-validated questionnaire was most commonly used in 52.6% of studies. Validated questionnaires used were most commonly the SF-36 (25.3%), Rosenberg self-esteem scale (RSES) (9.5%) and BREAST-Q (8.4%). All showed improvement in physical and mental health. Our findings suggest that women who have undergone reduction mammoplasty for breast hypertrophy report postoperative satisfaction and improvement in quality of life. Of the validated questionnaires used, a combination of those assessing both mental, physical and psychosocial health as well as breast-specific surveys were most commonly used and may provide an accurate assessment of patient outcomes.
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Affiliation(s)
- Sarah Lonie
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Roger Sachs
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - Amanda Shen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia
| | - David J Hunter-Smith
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Warren M Rozen
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia.,Peninsula Clinical School, Central Clinical School at Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Marc Seifman
- Department of Plastic, Reconstructive and Hand Surgery, Peninsula Health, Frankston, Victoria, Australia.,Department of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Prevalence of Depressive Symptoms in Patients Requesting Cosmetic Breast Surgery in Midwestern Brazil. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1899. [PMID: 30534484 PMCID: PMC6250461 DOI: 10.1097/gox.0000000000001899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 06/19/2018] [Indexed: 11/26/2022]
Abstract
Background The prevalence of depressive symptoms (DS) before cosmetic breast surgery was analyzed in the public (PbI) and private (PrI) institutions, comparing types of surgery and patients' sociodemographic characteristics. Methods A cross-sectional, observational, analytical study to evaluate the prevalence of DS in 185 patients of 18-71 years of age requesting 4 different cosmetic breast surgeries (with and without implants) at public and private institutions. Patients were assessed using the Beck Depression Inventory and analyzed for statistical comparison. Results The most common surgical procedures were reduction mammoplasty in the PbI and augmentation mammoplasty in the PrI. The prevalence of the positive risk for depressive disorder (≥15 points in Beck Depression Inventory) in the PbI was 25.8%, whereas in the PrI: 11.4% (P = 0.012). Moderate and severe DS were, respectively, 120% and 242% higher in the PbI than in the PrI. No patients requesting mastopexy without implants had DS. The highest prevalence (51.4%) of DS occurred in patients with breast implants indications (augmentation mammoplasty and mastopexy with implants). The presence (P = 0.12) or absence (P = 0.33) of implant did not demonstrate a higher risk of DS. Among all patients, 7% answered positively to the statements on suicide ideation, with predominance within the group of implants (54.5%). There were significant differences between the PbI and PrI. Conclusions The prevalence of DS was high (18.9%), with the risk being 2.3 times greater in the PbI. Patients from PbI and PrI showed significant different profiles. Patients for breast implants showed a higher score for suicide ideation.
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Predictors of Recovery After Conservative Treatment of AO-Type A Thoracolumbar Spine Fractures Without Neurological Deficit. Spine (Phila Pa 1976) 2018; 43:141-147. [PMID: 20736893 DOI: 10.1097/brs.0b013e3181cdb5fc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective, correlational, exploratory, clinical research. OBJECTIVE To identify the factors determining a patient's recovery after conservative treatment of compression fractures of the thoracolumbar spine. SUMMARY OF BACKGROUND DATA The reported results of compression fractures are poor. These results are not influenced by the severity of compression, the fracture site, or the residual deformity. Otherwise, the factors that determine a patient's recovery are unknown. METHODS In 48 conservatively treated patients the preinjury versus the 12-month follow-up differences (Δ) in back pain (visual analogue scale for pain), Oswestry disability index (ODI), and the Greenough and Fraser low back outcome scale were prospectively recorded. For these differences and for time lost from work and satisfaction, multiple linear regressions with combinations of 16 factors were performed. RESULTS At 1 year, patients with an income-insurance were 9% (P = 0.096) more disabled than those without. They reported a 15% less favorable global outcome and 27% less participation. Smokers were 13% (P = 0.010) more disabled and 11% (P = 0.044) less satisfied. With each increase of the AO-fracture type from A1 to A3 the disability was 8% worse. Patients with pre-existent chronic low back pain (CLBP) returned two points (on a visual analogue scale [VAS] pain total of 10) more closely (P = 0.041) to their preinjury pain level than those without but were 21% (P = 0.001) less satisfied. Our model offers an explanation for more than 25% of the variability of ΔODI and of the satisfaction. For sick leave, no significant predictors were found. CONCLUSION Smoking and insurance status are the strongest negative predictors for recovery. LBP patients returned more closely to their preinjury back pain level, but were less satisfied. The AO fracture type had a marked influence on disability, the sagittal deformity had not. The time lost from work did not depend on patient or injury-related factors. LEVEL OF EVIDENCE N/A.
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Bayramiçli M, Şirinoğlu H, Yalçın D. Outcome After Breast Reduction Considering Body Mass Index and Resection Amount. Aesthet Surg J 2017; 37:1103-1110. [PMID: 29044364 DOI: 10.1093/asj/sjx110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is presumed that breast reduction improves patients' quality of life and promotes weight loss. Preoperative body mass index (BMI) and the amount of breast tissue (breast reduction amount [BRA]) in proportion to the patient's body weight are important variables to affect the breast reduction outcome. OBJECTIVE This study was designed to evaluate the short and long-term effects of breast reduction from the perspective of BMI and BRA. METHODS One hundred fifty-seven consecutive patients were invited to participate in the study. All clinical information was recorded on a breast surgery form. Patients completed a standardized questionnaire preoperatively, at postoperative year 1, and after postoperative year 5. Patients were grouped according to their BMI as "normal weight" and "overweight" and according to BRA as "minor/moderate reductions" and "major reductions." The differences in the BMI values and the life scores were compared between the BMI and BRA groups. RESULTS Sixty-four patients were included in the study. Postoperative year 1 BMIs were significantly lower than both the preoperative BMIs and postoperative year 5+ BMIs. The year 1 BMI decrease in the major reduction group was higher than the decrease in the minor/moderate reduction group. The postoperative life scores of all subgroups were better than the preoperative life scores. CONCLUSIONS Reduction mammaplasty has a significant effect on short-term weight loss and the improvement in lifestyle. Patients tend to return to their original body weight in the long term. BRA is a significant variable in short-term weight loss, but neither BMI nor BRA has any other significant effect on the outcome in any time section. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mehmet Bayramiçli
- Dr Bayramiçli is a Professor and Dr Yalçın is a Plastic Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Marmara University School of Medicine, İstanbul, Turkey. Dr Şirinoğlu is a Plastic Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Hakan Şirinoğlu
- Dr Bayramiçli is a Professor and Dr Yalçın is a Plastic Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Marmara University School of Medicine, İstanbul, Turkey. Dr Şirinoğlu is a Plastic Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Doğuş Yalçın
- Dr Bayramiçli is a Professor and Dr Yalçın is a Plastic Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Marmara University School of Medicine, İstanbul, Turkey. Dr Şirinoğlu is a Plastic Surgeon, Department of Plastic, Reconstructive, and Aesthetic Surgery, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
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All Seasons Vertical Augmentation Mastopexy: A Simple Algorithm, Clinical Experience, and Patient-reported Outcomes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1170. [PMID: 28293517 PMCID: PMC5222662 DOI: 10.1097/gox.0000000000001170] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Background: The safety of augmentation mastopexy has been questioned. Staging has been recommended for women deemed to be at higher risk, such as women with greater degrees of ptosis. Most existing studies evaluate women treated with multiple methods, including the traditional Wise pattern. This retrospective study specifically evaluates vertical augmentation mastopexy. A simple algorithm is introduced. Methods: From 2002 to 2016, 252 women underwent consecutive vertical augmentation mastopexies performed by the author, with no staged surgery. All patients underwent a vertical mastopexy using a medially based pedicle and intraoperative nipple siting. A subset of women treated from 2012 to 2016 were surveyed to obtain outcome data; 90 patients (inclusion rate, 90%) participated. Results: The complication rate was 32.9%, including persistent ptosis, delayed wound healing, scar deformities, and asymmetry. There were no cases of nipple loss. An increased risk of complications was detected for smokers (P < 0.01), but not for combined procedures, secondary breast augmentations, or secondary mastopexies. The revision rate was 15.5%. Persistent nipple numbness was reported by 13.3% of respondents. Eighty percent of women were self-conscious about their breast appearance before surgery; 22% of respondents were self-conscious about their breasts after surgery. Seventy percent of respondents reported an improved quality of life, 94.4% would repeat the surgery, and 95.6% would recommend it. Conclusions: A simple algorithm may be used to guide treatment in women who desire correction of ptosis and upper pole fullness. An "all seasons" vertical augmentation mastopexy is safe and widely applicable. Staging is unnecessary.
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The Psychosexual Impact of Partial and Total Breast Reconstruction: A Prospective One-Year Longitudinal Study. Ann Plast Surg 2016; 75:281-6. [PMID: 24727443 DOI: 10.1097/sap.0000000000000152] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND This prospective trial sought to explore patients' satisfaction and expectations for surgery in the areas of sexuality and body image and to evaluate outcomes pertaining to sexual well-being after total and partial breast reconstruction (BR). METHODS Patients who underwent mastectomy and immediate total BR (group 1; n = 60) or lumpectomy and reduction mammoplasty (group 2; n = 10) completed a questionnaire preoperatively and 1 year postoperatively to assess their satisfaction with their sex life and body image, perceptions of breasts as a source of sexuality, and expectations of surgery in these areas. Surveys were scored on a 5-point Likert scale, with 5 indicating strongly agree. Change scores were evaluated in the 2 groups (P = 0.05). RESULTS In group 1, satisfaction with sex life and body image was unchanged. Pursuit of sexual attractiveness (from 3.78 to 3.31, P = 0.02) and an improved body image (from 3.89 to 3.33, P < 0.01) were cited as expectations for surgery but were achieved less often. When stratified by different types of reconstruction, there were no discernible differences in responses. In group 2, the patients reported an unexpected increase in their partner's perception of them as womanly (from 1.33 to 2.50, P = 0.01) and greater gains in the ability to wear sexually provocative clothing (from 1.78 to 3.11, P < 0.01).Preoperative expectations for improved body image were more often met in group 2 than group 1 (from 3.60 to 4.00 vs from 3.89 to 3.33, P = 0.02). Group 2 experienced greater improvement in body image satisfaction (from 2.80 to 3.80 vs from 3.37 to 3.44, P = 0.03). CONCLUSIONS Overall satisfaction with sex life and body image was preserved for both groups; however, the oncoplastic approach achieved significantly larger gains in body image perception.
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Sexual Function and Depression Outcomes Among Breast Hypertrophy Patients Undergoing Reduction Mammaplasty. Ann Plast Surg 2016; 76:379-82. [DOI: 10.1097/sap.0000000000000380] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
BACKGROUND The breasts are important for a woman's psychological well-being, which may be negatively affected by distortions of breast size and shape. Improvements in self-esteem and sexuality are important psychological factors associated with motivation for cosmetic surgery. Mammaplasty is among the most sought-after and performed cosmetic procedures. The aim of this study was to evaluate the impact of aesthetic breast surgery on a woman's sexuality. METHODS This study was conducted in a plastic surgery clinic of a hospital university in Brazil, between 2009 and 2012. Forty-six patients with hypomastia and 30 patients with breast hypertrophy, who expressed the desire for aesthetic breast surgery, were selected for the study. The patients were assessed preoperatively and 6 months postoperatively using the sexual quotient-Female version scale (QS-F). The QS-F is a validated Brazilian questionnaire to assess sexual function. It contains ten items covering five domains of female sexual function: desire and interest, foreplay, excitement and harmony, comfort, and orgasm and satisfaction. Higher QS-F scores indicate better sexual functioning. RESULTS There was a significant increase in the mean total QS-F score after surgery in both groups (p < 0.001). No significant improvement in desire and comfort was reported by patients who underwent breast augmentation and in comfort by patients who underwent breast reduction. Improvement in sexuality after surgery was observed in both groups, which is consistent with the literature. CONCLUSION Aesthetic breast surgery has a positive impact on the sexuality of patients. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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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] [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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Üçer O, Sir E, Güngör M, Keçeci Y, Aksoy A, Gümüş B. Assessment of sexual function in women with macromastia and their partners. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
AIM This study aimed to evaluate the effects of reduction mammaplasty operation on sexual functions of the patients with macromastia and of their partners. MATERIALS AND METHODS Thirty-nine patients with macromastia and their partners were assessed for their sexual function before and 6 months after reduction mammaplasty. Sexual function of the women and their partners were evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF), respectively. Controls (n = 33) were chosen from healthy hospital staff and their partners. Preoperative and postoperative scores were statistically compared with the controls' scores by using Student t test. Also, preoperative and postoperative scores were compared by using paired t test. RESULTS The mean of age and body mass index of the women and their partners in the patient and control group were similar (P = 0.07). Before the operation, the mean of IFSF scores in the patient and control group were 22.75 (3.45) and 27.28 (5.05), respectively (P < 0.001). After the operation, the mean of IFSF scores in the patient group increased significantly to 27.67 (P < 0.001). The postoperative scores of all IFSF subscales except lubrication subscale were higher than the preoperative scores. Although there was no significant difference between preoperative and postoperative IIEF-total scores, postoperative IIEF-erectile function and IIEF-intercourse satisfaction scores were significantly reduced (P < 0.05). CONCLUSIONS We found that macromastia adversely affected female sexual function but reduction mammaplasty eliminated this adverse effect. We also found that the partners' erectile function and intercourse satisfaction reduced after the operation. This reduction may be due to psychological effects.
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Swanson E. Correction of Postoperative Nipple/Areola Malposition without Nipple Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e117. [PMID: 25289311 PMCID: PMC4174143 DOI: 10.1097/gox.0000000000000073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Swanson E. Prospective outcome study of 106 cases of vertical mastopexy, augmentation/mastopexy, and breast reduction. J Plast Reconstr Aesthet Surg 2013; 66:937-49. [DOI: 10.1016/j.bjps.2013.03.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 02/17/2013] [Accepted: 03/09/2013] [Indexed: 10/27/2022]
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Saariniemi K, Luukkala T, Kuokkanen H. The outcome of reduction mammaplasty is affected more by psychosocial factors than by changes in breast dimensions. Scand J Surg 2011; 100:105-9. [PMID: 21737386 DOI: 10.1177/145749691110000207] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Several randomised studies have proved the effects of breast reduction surgery. However, search for predictive factors has not been successful. Therefore we decided to analyse breast dimension changes and to see whether these, or patient characteristics or individual psychosocial factors have an effect on the outcome. MATERIAL AND METHODS Twenty-nine patients were assessed at baseline and at six months follow-up. Outcome measures used were two health-related quality of life questionnaires, a breast-associated symptoms questionnaire, a pain-rating questionnaire, and a mood questionnaire. Detailed breast dimensions were recorded. Forward stepwise linear regression was applied to detect possible associations between outcome measure changes and breast dimensions or patient-related factors. RESULTS Preoperatively anxious patients had more improvement in the quality of life index scores, but less improvement in the mental health scores when compared to patients not anxious. Patients with physically demanding work had more improvement in the quality of life index scores and a trend to less improvement in the mental health scores when compared to patients with physically less stressful work. Patients with no overweight had a trend to better improvement in self-esteem. CONCLUSIONS The outcome of reduction mammaplasty is affected more by psychosocial factors than by changes in breast dimensions.
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Affiliation(s)
- K Saariniemi
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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20
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Temperament and character traits of women admitted for breast reduction and comparison with body perception. Aesthetic Plast Surg 2010; 34:359-64. [PMID: 20108091 DOI: 10.1007/s00266-009-9465-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 12/20/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND Reduction mammaplasty improves self-esteem and low body perception. Previous reports comprise either retrospective data or sectional analysis in which women were evaluated postoperatively. Furthermore, temperament and character properties of women applying for breast reduction have not been investigated. This study aimed to compare the temperament and character traits of women admitted for breast reduction surgery with those of healthy volunteers and to investigate the interaction of body perception with temperament and character. METHODS The study enrolled 24 patients admitted for reduction mammaplasty and 24 healthy women. The study participants received the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale (RSE) questionnaires. The RSE questionnaire was completed again by the patients 6 months after the operation. RESULTS Of the temperament scales, the persistence scale was significantly lower for the patients. Only the reward dependence subscale of the temperament scale was significantly higher for the patients. Self-esteem (RSE) was significantly lower for the patients than for the control subjects preoperatively, whereas, it rose significantly after the operation. The RSE showed a negative correlation with self-directedness and its subscales of being responsible and resourceful. A significant negative correlation also was found between RSE and empathy. CONCLUSIONS Women with large breasts try to develop adaptable character properties against chronic troubles. However, the temperament scale of persistence decreases in this process. Similar temperament and character traits of women with and those without large breasts suggest that patients desire breast reduction for functional rather than cosmetic purposes.
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Romeo M, Cuccia G, Zirilli A, Weiler-Mithoff E, Stagno d'Alcontres F. Reduction mammaplasty and related impact on psychosexual function. J Plast Reconstr Aesthet Surg 2010; 63:2112-6. [PMID: 20207212 DOI: 10.1016/j.bjps.2010.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 10/18/2009] [Accepted: 01/01/2010] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Reduction mammaplasty brings an effective improvement, both from the physical and psychological points of view. However, psychosexual consequences are as yet poorly studied, although scars, impairment of sensibility, change in shape and asymmetry can have a negative effect on sexual life. AIM These authors retrospectively reviewed 55 patients to verify the existence of a close relationship between this popular surgical procedure and psychosexual function. MATERIAL AND METHODS All patients were compared to a group (51 healthy women) chosen from the hospital personnel. Both groups answered four psychological questionnaires (Short Form (SF)-36, Hamilton Anxiety Rating Scale (Ham-A), Hamilton Rating Scale for Depression (Ham-D), Female Sexual Function Index (FSFI)) anonymously, in addition to the scar-assessment test as a single physical test. Psychological tests aim to evaluate self-esteem, quality of life (SF-36) and sexual function in women (FSFI, a test based on Erectile Function Index of Male). High levels of anxiety and depression were used as exclusion criteria in our study (Ham-D and Ham-A). Statistical analysis was based on non-parametric correlation test adjusted for small groups and Spearman's rho test to verify the associations among sub-items scales. RESULTS Almost all patients (98%) fulfilled the inclusion criteria for our study. Sexual function index was equal in both groups, but it still showed a higher quality of life in the control group. Nevertheless, the SF-36 value of the patients' group is still enough to allow for acceptable self-esteem. CONCLUSIONS We can confirm that reduction mammaplasty does not impair sexual satisfaction or quality of life; moreover, we believe that this procedure can improve such indices. Further investigation will compare patient's values prior to and following surgery to put in evidence a stronger relationship between mammary reduction and sexual function.
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Affiliation(s)
- M Romeo
- Plastic Surgery Unit, University of Messina, Policlinic, Via Consolare Valeria, 98100 Messina, Italy.
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Resumption of Sexual Activity after Plastic Surgery: Current Practice and Recommendations. Plast Reconstr Surg 2007; 120:1557-1563. [DOI: 10.1097/01.prs.0000282087.22997.86] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Rafic Kuzbari
- Department of Plastic and Reconstructive Surgery, Wilhelminenspital, Montleartstrasse 37, A-1160 Vienna, Austria.
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