Does Liposuction Improve Body Image and Symptoms of Eating Disorders?

BACKGROUND: Unpleasant attention to unfavorable fat may have harmful psychological effects in terms of body dissatisfaction. As a consequence, this may cause abnormal eating regulation. It has been noted that women interested in liposuction self-report more eating problems. As far as we know, there are no prospective studies with standardized instruments providing sufficient data regarding the effects of aesthetic liposuction on various aspects of quality of life. Nevertheless, publications on the effects of eating habits are lacking. METHODS: Sixty-one consecutive women underwent aesthetic liposuction. Three outcome measures were applied at baseline and at follow-up: the eating disorder inventory, Raitasalo's modification of the Beck depression inventory, and the 15-dimensional general quality of life questionnaire. RESULTS: The mean age at baseline was 44 years, and the mean body mass index was 26.0. Thirty-six (59%) women completed all outcome measures with a mean follow-up time of 7 months. A significant improvement from baseline to follow-up was noted in women's body satisfaction, and their overall risk for developing an eating disorder decreased significantly. CONCLUSION: Aesthetic liposuction results in a significantly reduced overall risk for an eating disorder in combination with improved body satisfaction.

Abdominoplasty improves quality of life, psychological distress, and eating disorder symptoms: a prospective study.

Background. Only some studies provide sufficient data regarding the effects of nonpostbariatric (aesthetic) abdominoplasty on various aspects of quality of life. Nevertheless, when considering the effects on eating habits, publications are lacking. Therefore we decided to assess the effects of nonpostbariatric abdominoplasty on eating disorder symptoms, psychological distress, and quality of life. Materials and Methods. 64 consecutive women underwent nonpostbariatric abdominoplasty. Three outcome measures were completed: the Eating Disorder Inventory (EDI), Raitasalo's modification of the Beck Depression Inventory (RBDI), and the 15D general quality of life questionnaire. Results. The mean age at baseline was 42 years and the mean body mass index (BMI) 26.4. Fifty-three (83%) women completed all the outcome measures with a mean follow-up time of 5 months. A significant improvement from baseline to follow-up was noted in women's overall quality of life, body satisfaction, effectiveness, sexual functioning, and self-esteem. The women were significantly less depressive and had significantly less drive for thinness as well as bulimia, and their overall risk of developing an eating disorder also decreased significantly. Conclusions. Abdominoplasty results in significantly improved quality of life, body satisfaction, effectiveness, sexual functioning, self-esteem, and mental health. The risk of developing an eating disorder is decreased significantly. This trial is registered with Clinicaltrials.gov NCT02151799.

The effects of aesthetic breast augmentation on quality of life, psychological distress, and eating disorder symptoms: a prospective study.

BACKGROUND: There are only a few studies that provide sufficient data regarding the effects of aesthetic breast augmentation on various aspects of quality of life. Significant improvement in body image, satisfaction with appearance, sexual attractiveness, and self-esteem has been observed in these studies. In contrast, however, a somewhat impaired general health-related quality of life has been reported at follow-up. Nevertheless, when considering the effects of aesthetic breast augmentation on eating habits, publications are lacking. We therefore decided to assess the effects of aesthetic breast augmentation on quality of life, psychological distress, and eating disorder symptoms. METHODS: This study included 79 consecutive women who underwent bilateral aesthetic augmentation mammaplasty. The women completed three outcome measures at baseline and at follow-up: the Eating Disorder Inventory, Raitasalo's modification of the Beck Depression Inventory, and the 15D general quality-of-life questionnaire. RESULTS: The mean age at baseline was 35 years (range = 18-52). The mean body mass index was 21.3 (range = 17.5-27.3). Sixty-five (82 %) women completed the outcome measures with a mean follow-up time of 7 months (range = 4-13). A significant improvement was observed in self-esteem and depression scores as well as body satisfaction from baseline to follow-up. Interpersonal trust also improved, and after the operation the women were more able to tolerate and understand their own feelings and sensations. A significant decrease in the overall risk for an eating disorder was also noted. CONCLUSIONS: Aesthetic breast augmentation results in significant improvement in women's body satisfaction and self-esteem. The level of risk for an eating disorder is also significantly reduced. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article.

Reconstruction of soft tissue defects in the extremities with a pedicled perforator flap: series of 25 patients.

Since the introduction of perforator-based flaps, new flaps have been described for reconstruction of soft tissue defects in the extremities. Pedicled perforator flaps, often called propeller flaps, are based on a single perforator and are local axial flaps that can be rotated up to 180(0) with the single perforator as the pivotal point. Pedicle perforator flaps have gained popularity because they have a shorter operating time than free flaps. However, some concern has been raised about their reliability. Here we report our results of 11 soft tissue reconstructions in the lower leg and 14 in the upper extremity. The defects were mostly traumatic or caused by release of burn scars. The mean size of the flaps in the lower leg was 52 cm(2) (range 126-15 cm(2)). In the upper extremity it was 24 cm(2) (range 12-35 cm(2)). All patients were followed until the wound had healed. In the upper extremity there was only one partial necrosis of the flap, and one patient had an infected wound. One haematoma was evacuated postoperatively, and all the rest healed uneventfully. In the lower leg we had one total necrosis and one partial necrosis of the flap and one infected wound. A free scapular flap was used for salvage in one case, and revision and skin grafting in two. The pedicled perforator flap is reliable, particularly in the upper extremity. The operation is quick and can be done under regional anaesthesia. The flap is thin and has a local texture that gives a good functional and aesthetic result. The pedicled perforator flap is a little unpredictable in the lower leg, probably because the directions of the vessels that arise from the perforator are not consistent.

The cost utility of reduction mammaplasty at medium-term follow-up: a prospective study.

PURPOSE: The effects of reduction mammaplasty (RM) have been proved in several randomised trials. However, publications regarding cost utility are infrequent and lacking with regard to medium-term follow-up. Therefore, we decided to assess the cost utility of RM at 2-5 years' follow-up, when later costs and possible re-operations have been incurred. METHODS: A total of 73 patients had bilateral RM between January 2005 and March 2007 in the Hospital District of Helsinki and Uusimaa, Finland. Health-related quality of life was measured with the 15D. Preoperative data were collected with an interview at an appointment and follow-up data by means of a postal survey. Direct hospital costs were obtained from the Ecomed(®) clinical patient administration database (Datawell Ltd., Espoo, Finland). RESULTS: A total of 62 (85%) patients agreed to participate in the study and returned the follow-up questionnaire. The mean follow-up time was 4.0 years (SD 0.53, range 2.3-4.6 years). The mean improvement in the 15D score change was 0.083 (SD 0.081). The mean number of quality-adjusted life years (QALYs) gained was 3.052 (SD 3.167, range 2.561-17.553). The mean hospital costs of the intervention were €3601 (SD 1321), and the mean cost per QALY gained was €1180. Roughly 76% of the costs were due to the hospital stay during the operation. Eight percent of the costs were incurred more than 6 months after the hospital stay. CONCLUSIONS: The cost per QALY gained by RM is low, even when considering later costs caused by possible re-operations, and compares favourably with a number of other surgical procedures.

The outcome of reduction mammaplasty remains stable at 2-5 years' follow-up: a prospective study.

PURPOSE: Several randomised studies have proved the effectiveness of reduction mammaplasty in short-term follow-up. However, medium-term prospective follow-up studies are rare. Therefore, a prospective study was conducted to assess the medium-term results and to see whether there are any changes in the intervention effect during the first years. METHODS: A total of 73 patients were operated on between January 2005 and March 2007. Patients completed the 15D health-related quality-of-life questionnaire, The Finnish Breast-Associated Symptoms (FBAS) questionnaire and Raitasalo's modification of the short form of the Beck Depression Inventory (RBDI). In July 2009, follow-up data was collected by postal mail. RESULTS: As many as 62 patients (85%) agreed to participate in the study and returned the follow-up data. Non-responders did not differ from responders in baseline characteristics. Mean follow-up time was 4.0 years (range, 2.3-4.6). Preoperatively, patients had significantly inferior quality of life when compared with the age-standardised population (p < 0.001). This health burden was removed after reduction mammaplasty. At follow-up, patients had significantly better quality of life, less breast-associated symptoms, less depression and anxiety and better self-esteem when compared with the preoperative situation (p < 0.001). CONCLUSIONS: Reduction mammaplasty results in remarkable alleviation in breast-associated and psychological symptoms, and improvement in quality of life. This remains clearly significant and stable at 2-5 years follow-up.

Complications of skin-sparing mastectomy followed by immediate breast reconstruction: a prospective randomized study comparing high-frequency radiosurgery with conventional diathermy.

Skin-sparing mastectomy (SSM) followed by immediate breast reconstruction delivers superior cosmetic and functional outcome. However, SSM is vulnerable to complications of the native skin envelope. This study aims to compare the effects of radiofrequency coagulation and conventional diathermy on complications of SSM. Sixty consecutive patients suitable for SSM were randomized into conventional diathermy and radiosurgery groups. These groups were compared and the risk factors for SSM flap complications were evaluated. The SSM flap complication rate was 23.4%. There was no difference between the study groups regarding the SSM flap complications. Increased SSM flap complication rate was associated with smoking and the type of skin incision used. This study shows that high-frequency radiosurgery is comparable to conventional diathermy in terms of complication rates of SSM. Furthermore, this study reports an association between the tennis-racquet-type incision and an increased SSM flap complication rate compared with the round periareolar type incision.

Reduction mammaplasty is effective treatment according to two quality of life instruments. A prospective randomised clinical trial.

PURPOSE: Debate around reduction mammaplasty has continued due to lack of prospective randomised clinical trials (RCTs). Therefore, a prospective randomised clinical trial was designed to assess the effectiveness of reduction mammaplasty performed for symptomatic breast hypertrophy. PATIENTS AND METHODS: 82 patients were randomised, 40 patients to the operative group, and 42 patients to the nonoperative group. Groups were examined at 0 and 6 months. Instruments used were the Short Form-36 quality of life questionnaire (SF-36), the 15D quality of life questionnaire, the Finnish Breast-Associated Symptoms questionnaire (FBAS), and the Finnish Pain Questionnaire (FPQ). Analysis of covariance (ANCOVA) was applied for instrumental data comparison. RESULTS: 29 patients in the operative group and 35 patients in the nonoperative group completed the study. Mean age was 46 years. At second examination, the utility index score (SF-6D) and the physical summary score of SF-36, the index score of 15D, the breast-associated symptoms score of FBAS, and the pain score of FPQ demonstrated high significant statistical (P<0.0001) and clinical difference between groups. For the mental summary score of SF-36 findings were less significant statistically and clinically. CONCLUSIONS: Reduction mammaplasty results in significant improvement of quality of life and decrease in pain and breast-associated symptoms. Future studies should be focused on patient selection and justification of the treatment by comparing with other approved treatments.

Distally-based peroneus brevis muscle flap: a successful way of reconstructing lateral soft tissue defects of the ankle.

Sixteen distally-based peroneus brevis muscle flaps were used to cover soft tissue defects in the lateral side of the ankle. The defect in 13 cases was on the lateral malleolus, in two on the lateral side of the calcaneus, and in one case in the Achilles tendon. The patients were all followed up until full recovery (mean 7.6 months, range 1.5-22 months). One flap failed to cover the defect and was replaced with a microvascular latissimus dorsi flap. In three cases minor revision and new skin grafting of the distal end of the flap was necessary. In 15 of the 16 patients the distally-based peroneus brevis muscle was successful in covering the lateral defect in the ankle. The technique of harvesting a flap is reliable, fast, and the overall success of the flap is good. The flap is particularly suitable for covering small or moderate sized defects on the lateral malleolus.

Reconstruction of soft tissue after complicated calcaneal fractures.

A total of 35 flap reconstructions were done to cover exposed calcaneal bones in 31 patients. All patients had calcaneal fractures, 19 of which were primarily open. Soft tissue reconstruction for the closed fractures was indicated by a postoperative wound complication. A microvascular flap was used for reconstruction in 21 operations (gracilis, n = 11; anterolateral thigh, n = 5; rectus abdominis, n = 3; and latissimus dorsi, n = 2). A suralis neurocutaneous flap was used in eight, local muscle flaps in three, and local skin flaps in three cases. The mean follow-up time was 14 months (range 3 months-4 years). One suralis flap failed and was replaced by a latissimus dorsi flap. Necrosis of the edges that required revision affected three flaps. Deep infection developed in two patients and delayed wound healing in another four. During the follow-up the soft tissues healed in all patients and there were no signs of calcaneal osteitis. Flaps were considered too bulky in five patients. Soft tissues heal most rapidly with microvascular flaps. In the long term, gracilis muscle covered with free skin grafts gives a good contour to the foot. The suralis flap is reliable and gives a good final aesthetic outcome. Local muscles can be transposed for reconstruction in small defects.

Salvage of major amputation stumps of the lower extremity with latissimus dorsi free flaps.

In some severe lower limb injuries, the level of bone trauma enables preservation of the knee joint or adequate length of the femoral stump only if the soft tissues can be reconstructed over the exposed bone. The options for soft-tissue reconstruction of an amputation stump are to use a flap from the amputated distal part, a local flap possibly after tissue expansion or a free flap. To preserve an adequate length of stump we reconstructed 10 stumps with latissimus dorsi free flaps: above the knee in one patient and below the knee in nine. The reconstructions were done during an acute post-traumatic phase in five and for late problems with the stump in four patients. In one patient the reconstruction was done nine weeks after a below-knee amputation for ischaemic necrosis after septicaemia. All flaps survived, but the venous anastomosis had to be revised in three patients in the early postoperative period. All patients regained adequate ambulation for their daily activities. The flap was secondarily debulked in three patients. Every effort should be made to preserve an adequate stump length, particularly in young patients with crushing injuries of the extremities and when there is severe or recurrent late stump ulceration. A latissimus dorsi musculocutaneous soft-tissue reconstruction is a reliable and durable option for stump defects.

Radical excision and reconstruction of chronic tibial osteomyelitis with microvascular muscle flaps.

We report a series of 21 patients with chronic osteomyelitis of the tibia treated with microvascular muscle flap reconstruction. All patients underwent a radical bone and soft-tissue excision until healthy, well-bleeding tissue was exposed. Six patients required cancellous bone grafting. Latissimus dorsi was used in 14 patients, gracilis in 4, and rectus abdominis in 4. One gracilis flap was lost due to vessel thrombosis and was replaced with a rectus abdominis free flap. Average follow-up was 2.5 years. There was no evidence of clinical infection in 20 patients at follow-up; the bone had healed, the soft-tissue cover was stable, and the laboratory parameters were normal. Bone infection recurred in 1 patient, resulting in a below-knee amputation. The radical excision of infected bone and affected soft tissue and reconstruction with a well-vascularized large free-muscle flap is an excellent solution in most difficult chronically infected cases.