Should silicone prostheses be considered for specimen banking? A pilot study into their use for human biomonitoring.

Persistent organic pollutant (POP) biomonitoring in humans is challenging and generally carried out using blood, breast milk or adipose tissue, with concentrations normalised to the lipid content of the sample matrix. The goal of this cross-sectional pilot study was to evaluate the validity and feasibility of explanted silicone prostheses as a matrix for persistent organic pollutant biomonitoring in humans. We postulate that pollutant concentrations in silicone prostheses inserted in the body will equilibrate with that in the body over time and provide a measure of the overall body burden. This study included silicone prostheses from 22 female patients of the Colosseum clinic (Oslo, Norway) collected between September 2010 and April 2012. Absorption of chlorinated and brominated POPs into silicone prostheses during implantation was observed. Relative levels of the different contaminants measured in prostheses were in agreement with those from serum and breast milk analyses from the general Norwegian population. The comparison of serum and breast milk-based literature data with prosthesis concentrations transposed into lipid-normalised concentrations supports the validity of the prosthesis measurements. The median of relative percent differences between measurements with replicate silicone prostheses from 11 patients was below 30%. Observed increases in prosthesis concentrations with patients' age were found to be very similar to literature data from studies of the Norwegian population. Silicone prostheses therefore represent a promising matrix for the biomonitoring of nonpolar and non-ionic pollutants in humans. Sample accessibility and body burden representativeness of the silicone prostheses suggest that specimen banking should be initiated.

Psychosocial changes after cosmetic surgery: a 5-year follow-up study.

BACKGROUND: Most studies examining psychosocial changes after cosmetic surgery have short follow-up periods and therefore provide limited information about long-term effects of such surgery. Moreover, studies that identify whether preexisting patient characteristics are associated with poor psychosocial outcomes after cosmetic surgery are lacking. The current study provides information about both of these issues. METHODS: Questionnaire data from 130 female Norwegian cosmetic surgery patients were obtained before and 5 years after surgery. The questionnaire consisted of measures on appearance satisfaction, self-esteem, psychological problems, and patients' evaluation of the outcome of surgery. Data from a representative sample of 838 Norwegian women, aged 22 to 55 years, were used for comparison purposes. RESULTS: Analyses revealed an improvement in both general appearance satisfaction and satisfaction with the body part operated on 5 years after surgery. A small increase in self-esteem was observed as well. High rates of preoperative psychological problems and low self-esteem were related to more negative changes in some of the psychosocial measures after surgery compared with patients with better psychological health. Furthermore, factors associated with the actual decision to undergo surgery were related to changes in psychological health and patients' evaluation of the outcome of surgery. CONCLUSIONS: This study indicates that cosmetic surgery has positive long-term effects on appearance-related variables. However, surgeons should be particularly aware of patients with psychological problems, as these may compromise patient satisfaction with the effects of cosmetic surgery. Factors affecting the decision itself to undergo cosmetic surgery may also be relevant for subsequent psychosocial outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Motivational factors and psychological processes in cosmetic breast augmentation surgery.

BACKGROUND: We investigated how and why prospective cosmetic breast augmentation patients decide to undergo such surgery. The results can offer important insights to plastic surgeons in addressing their patients' motives and expectations, and thereby avoiding potential patient dissatisfaction and disappointment. It is also a necessary first step to better understand the increasing tendency among women in the Western society to seek cosmetic breast augmentation. METHOD: A qualitative, descriptive and phenomenological design was employed. Fourteen female prospective breast augmentation patients, aged 19-46 years, were recruited from a private plastic surgery clinic and interviewed in depth based on an informant-centred format. The interviews were tape-recorded, transcribed verbatim and coded and analysed phenomenologically using a QSR-N*Vivo software program. RESULTS: We detected four psychological processes associated with cosmetic breast augmentation surgery (create, improve, repair and restore). The data could further be categorised into one basic drive (femininity), six generating factors (appearance dissatisfaction, ideal figure, self-esteem, comments, clothes and sexuality) and five eliciting factors motivating the decision (media, knowledge of former patients, physicians, finances and romantic partner). CONCLUSION: These new insights into how and why women seek cosmetic breast augmentation may aid plastic surgeons in enhancing their communication with patients. This can be achieved by addressing the patient's psychological process and motives, and thereby better assist them in making the best decision possible in their particular situation. It may also lay the groundwork for future quantitative studies on the prevalence of certain motives for undergoing such surgery and, as such, help explain the increasing popularity of cosmetic breast-augmentation surgery.

Psychosocial factors predicting the motivation to undergo cosmetic surgery.

BACKGROUND: The present study investigates psychological factors expected to predict the motivation to undergo cosmetic surgery. It is hypothesized that body image, self-esteem, teasing history, acceptance of cosmetic surgery in the individual's environment, and self-monitoring relate to motivation to have cosmetic surgery. METHODS: Questionnaire data were obtained from 907 participants who responded to a survey distributed to a representative sample of Norwegian women aged 22 to 55 years. A second sample of 195 female prospective cosmetic surgery patients was recruited from a plastic surgery clinic. Measures of the hypothesized predictor variables were obtained from both samples. Surgery motivation was operationalized in two different ways. First, the women in the first sample were asked to indicate whether they wished to undergo cosmetic surgery, such that women who wished to have surgery could be compared with those who did not. Second, prospective patients were compared with women from the first sample who indicated that they did not wish to have cosmetic surgery. RESULTS: Analyses revealed all predictor variables but self-esteem to be related to either the wish or the decision to undergo surgery, or to both. Social acceptance of cosmetic surgery and body image were the strongest predictors of cosmetic surgery motivation. CONCLUSIONS: The study gives new insights into psychological factors predicting cosmetic surgery motivation. Furthermore, the influence of social factors on cosmetic surgery motivation is emphasized, and it is suggested that these factors be included in future research designs.

The interplay of personality and negative comments about appearance in predicting body image.

This study investigates how personality traits in combination with frequency of and emotional reaction to negative comments about appearance while growing up are related to appearance evaluation and orientation among adult women. Nine hundred and seven participants from a representative sample of Norwegian women aged 22-55, answered questions measuring body image, personality (Big Five), and history of experiencing negative comments about appearance. Results indicated that only emotional reaction to negative comments about appearance significantly predicted both appearance evaluation and orientation, while frequency of negative comments did not. Being extrovert predicted more positive appearance evaluation and being more appearance oriented than being introvert. Scoring high on neuroticism was related to negative appearance evaluation and high appearance orientation. The findings demonstrate the importance of differentiating between the frequency and the emotional impact of teasing as well as including personality traits when studying body image.

Reduction mammaplasty: a prospective study of symptom relief and alterations of skin sensibility.

The aim of the present study was to evaluate the alterations of symptoms and tactile sensibility of the breast after reduction mammaplasty. In a prospective study, 10 women were operated on using the inferior pedicle technique. The patients were examined and interviewed preoperatively and at 2 weeks and 3 and 12 months postoperatively. Tactile sensibility was assessed by Somedic monofilaments applied on nine points on each breast: the nipple, four points on the areola, and in four quadrants of the skin. Preoperative tactile sensibility was compared with tactile sensibility in 10 normal controls. A median of 744 g of tissue was removed. All patients reported relief of shoulder and neck discomfort and improvement of skin sensibility 1 year after the operation. Two weeks after the operation, the sensibility of the areola was reduced (p < 0.05), but the skin sensibility of two quadrants was improved (p < 0.05). The sensibility of the areola was restored to preoperative values during the observation period. At 12 months, sensibility was improved compared with preoperative values both in the upper part of the areola and in three quadrants of the skin (p < 0.05). Significant improvement of skin sensibility was found between 3 and 12 months postoperatively in two quadrants of the breast. Also, the erectile function of the nipple was not altered by the operation. In conclusion, the sensibility of the breast was improved or unchanged 1 year after reduction mammaplasty using the Robbins technique. Continuous improvement of sensibility was found during the 1-year observation period. The evidence provided by this prospective study rules out the common misconception that a reduction mammaplasty gives the patient reduced areola sensibility and altered erectile function.