Understanding the effect of breast augmentation on quality of life: prospective analysis using the BREAST-Q.

BACKGROUND: The aim of this study was to prospectively evaluate patient satisfaction and quality of life with elective breast augmentation. METHODS: Patients with bilateral submuscular breast augmentations prospectively completed the BREAST-Q preoperatively and 6 weeks and 6 months postoperatively; t tests compared preoperative and postoperative scores at 6 weeks and 6 months, and standard indicators of effect sizes were calculated. Logistic regression was used to evaluate the association between patient and surgical factors on satisfaction outcomes. RESULTS: The study sample included 611 female patients with the following characteristics: (1) mean age of 33.5 years; (2) mean body mass index of 21.7; (3) and mean implant volume of 360; with (4) 73 percent having received a silicone implant. Significant improvements were found in patient satisfaction with breasts (p < 0.001), psychosocial well-being (p < 0.001), and sexual well-being (p < 0.001) at 6 weeks and 6 months postoperatively, and all were associated with a very large Kazis effect size of 3.66, 2.39, and 2.56 at 6 months, respectively. However, at both 6 weeks and 6 months postoperatively, physical well-being remained significantly below preoperative baseline scores. In addition, satisfaction with breasts and with the overall surgical experience was significantly lower among older patients (p = 0.01 and 0.02, respectively). CONCLUSIONS: Breast augmentation is associated with high patient satisfaction and significant improvements in quality of life. However, physicians should inform patients that submuscular augmentations are associated with a delay in recovery of physical functioning and be aware that older patients may experience diminished satisfaction and should counsel accordingly. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The "anterior-only" approach to neck rejuvenation: an alternative to face lift surgery.

BACKGROUND: The ideal procedure for those patients with aging of the lower face and neck is a cervicofacial rhytidectomy. However, within this group is a subset of patients whose goals can be met with a lesser procedure. These patients must be interested in profile change only, with no desired change in the midface. METHODS: Patients undergoing neck rejuvenation by means of a submental approach fall into three groups: (1) patients with obtuse cervicomental angles and good skin elasticity (who may be treated with liposuction alone); (2) patients with subplatysmal fat or mild to moderate skin and muscle laxity (these patients are best treated by anterior lipectomy and platysmaplasty); and (3) patients with marked skin excess or severe skin laxity (best treated by procedures with excised skin, i.e., traditional face lift or direct excision of neck skin and Z-plasty). RESULTS: Thirty-three consecutive patients with mild (grade II, 16 patients), moderate (grade III, 11 patients), and severe (grade IV, six patients) cervicomental angle deformities were treated with anterior platysmaplasty and submental lipectomy. Twenty of 33 patients improved by one grade (61 percent), whereas 12 of 33 improved by two grades (36 percent). CONCLUSIONS: Young patients with minimal subplatysmal fat can be treated by liposuction alone. Patients with subplatysmal fat and mild or moderate skin or muscle laxity will obtain consistent results with platysmaplasty and submental lipectomy. Skin excisional procedures are reserved for those patients with severe skin excess or laxity.