Patient-reported outcome measurement compared with professional judgment of cosmetic results after breast-conserving therapy.

Background: In the present study, we set out to compare patient-reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome. Methods: Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years' follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair-poor Harvard score was estimated using logistic regression analysis. Results: The study included 108 female patients (age: 40-91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38-0.50). The items "size" and "shape" were identified as the strongest determinants of cosmetic outcome. Conclusions: Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.

[Formation of a pseudocyst following abdominoplasty]. / Pseudocystevorming na abdominoplastiek.

A 49-year-old woman presented for follow-up examination after an abdominoplasty performed in Germany. She complained of pain in the abdomen and was not satisfied with the final result. The patient presented with a bulging, painful abdomen. The symptoms disappeared for a few weeks after puncture of the seroma, but then returned. Neither haematoma, seroma nor neuroma were found at the first exploration, but a second abdominoplasty revealed a large pseudocyst extending from the epigastric to the supra-pubic area. The pseudocyst was extirpated. Seroma formation is a frequently occurring complication after abdominoplasty, but is ultimately reabsorbed spontaneously. Pseudocyst formation following abdominoplasty is a rare complication, which has been described in the literature only when liposuction was done as well. Liposuction creates multiple channels that result in an open abdominoplasty cavity. Seroma and blood clots provoke an inflammatory response, resulting in a pseudocyst after the formation of a thick capsule. The prevention of seroma and haematoma formation is of essential importance in preventing this rare complication. Sharp dissection, prolonged drainage with high vacuum and a compressive bandage are very important in this connection.

[Iatrogenic cicatricial endometriosis]. / Iatrogene endometriosis cicatricialis.

A woman aged 36, who two years previously had undergone a caesarean section, developed a painful swelling of the scar attributed to cicatricial endometriosis. This is a rare disorder brought about by peroperative displacement of normally or ectopically situated uterine mucous membrane to the surgical wound. There, it may proliferate and cause characteristic signs and symptoms that are simple to diagnose: cyclic pain, swellings and sometimes, bleedings. Pharmaceutical, possible hormonal treatment is of limited value, because cessation of the medication is frequently followed by recurrences. Consequently, ample surgical excision in endometriosis is to be preferred; this is to be regarded as a curative therapy.