Aesthetic Breast Surgery Research Articles

The Brussels Breast Surgery Fellowship | A Three-Month Experience in Advancing Skills in Breast Surgery.

The Brussels Breast Surgery Fellowship at Brussels University Hospital offers a unique 3-month clinical immersion in reconstructive and aesthetic breast surgery. Under the guidance of fellowship director Prof. Moustapha Hamdi and his esteemed colleagues, the fellow is exposed to a high volume and wide breadth of cases spanning autologous and implant-based breast reconstruction, oncoplastic surgery, breast reduction and mastopexy, implant augmentation, revision breast surgery, and fat grafting. The multidisciplinary team approach, involving close collaboration with breast surgeons, provides valuable experience in oncoplastic planning and execution. In addition to time in the operating theater, the fellow gains knowledge through outpatient clinics, didactic teaching sessions, and clinical research opportunities leveraging the department's extensive prospective database. As the 2023 fellowship awardee, I had the privilege of learning directly from Prof. Dr. Moustapha Hamdi and participating in over 130 cases across the reconstructive and aesthetic spectrum. Unique features of the fellowship included exposure to lymphedema surgery utilizing the Symani robotic system, advanced techniques like the internal bra, volume distribution mastopexies, observation of private aesthetic clinic cases, and optional participation in academic workshops. This fellowship represents an outstanding opportunity to refine one's skills in breast surgery and microsurgery while experiencing the rich culture of Belgium.

Local Anesthetic Infiltration for Pain Control in Aesthetic Breast Reduction Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Aesthetic breast surgeries, including breast reduction, are commonly performed surgical procedures associated with postoperative pain. Pain control is essential to patient comfort, satisfaction, and early recovery. This systematic review is the first to conduct both qualitative and quantitative analysis to evaluate the efficacy and safety of local anesthetic infiltration in reducing pain after breast reduction surgeries. This systematic review is registered in PROSPERO, assessed for bias using the RoB2 tool, and follows the PRISMA guidelines. A full electronic search was performed in different databases for all clinical papers on adult female patients undergoing cosmetic breast reduction surgery who were given local anesthetic infiltration for postoperative pain relief. A systematic review of five randomized clinical trials with a total of 191 patients found that local anesthetic infiltration significantly reduces postoperative pain in breast reduction surgery, reduces opioid consumption, and improves patient outcomes. A meta-analysis of two trials reported the mean VAS score for postoperative pain in the local anesthetic and placebo groups. A systematic review and a meta-analysis show a significant reduction in postoperative pain following local anesthetic infiltration, but further research is needed to understand its effectiveness and potential adverse effects. 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 .

Long-term Outcomes of Poly-4-Hydroxybutyrate (P4HB) in Aesthetic Breast Surgery.

Over the past decade, the use of poly-4-hydroxybutyrate (P4HB) in aesthetic breast surgery has grown in popularity. Published data on long-term outcomes, however, is scarce. The purpose of this study was to assess long-term outcomes when using P4HB in various aesthetic breast procedures. A retrospective review of all patients undergoing breast procedures with P4HB performed by the senior author (WPA) between July 2012 and March 2022. All patients with greater than one year of follow-up were evaluated, including demographics, surgical indications, complications, secondary procedures, and patient satisfaction. A Kruskal-Wallis test was performed to assess the stability of satisfaction over time. A total of 248 patients were evaluated. The mean follow-up length was 2.9 years (range, 1-9.3y). The most common surgical indication was breast ptosis, which comprised 68 percent (n=167) of patients. The overall complication rate was 8.0 percent (n=20), with an unplanned reoperation rate of 2.8 percent (n=7). Across the entire study population, the mean satisfaction score was 3.42 out of 4. When satisfaction scores were compared to follow-up length, Kruskal-Wallis test demonstrated no statistical differences (H = 18.2, p = 0.89, df = 2), suggesting stability of satisfaction over time. This study presents the senior author's entire experience with P4HB across a wide range of aesthetic breast procedures. With an average follow-up length of almost 3 years, P4HB appears to be both a safe and effective tool to support soft tissue in aesthetic breast surgery. Further, high patient satisfaction appears stable.

Pathological Changes Screening after Aesthetic Breast Surgery: a Retrospective Study and Systematic Review of Literature

Pathological Changes Screening after Aesthetic Breast Surgery: a Retrospective Study and Systematic Review of Literature

Correlation Between Medically Diagnosed Anxiety and Depression Disorder and Self-Reported Breast Implant Illness.

Anxiety disorders, both with and without comorbid depression, are widespread globally. In this study we investigate the intersection of anxiety, depression, and self-reported breast implant illness (BII) in females undergoing aesthetic breast surgery. The objective of our research was to enhance understanding about mental health history, psychotropic medication use, and its relation to BII symptoms. A cohort of 240 consecutive female patients undergoing elective breast surgery was studied. In the study we categorized patients by groups based on the presence of self-reported BII symptoms and the type of breast surgery performed. Mental health history, psychotropic medication use, and time spent in treatment for mental illness were scrutinized. Statistical analyses were conducted, including multiple regression analysis. Results revealed that patients with self-reported BII symptoms often had a preexisting anxiety/depression disorder treated medically before obtaining breast implants, and this disorder predicted the occurrence of BII symptoms. These patients tended to be diagnosed with anxiety and depression at a younger age, initiate medication therapy earlier, take more medications for their condition, and spend more time in therapy compared with others undergoing elective breast surgery. Implications of this study highlight the need for comprehensive counseling between plastic surgeons and patients with self-reported BII symptoms. Understanding the role of anxiety/depression in the pathogenesis of self-reported BII is crucial, and collaboration with psychiatrists and other mental health professionals can ensure improved supportive care. The findings contribute to a better understanding of the psychological aspects surrounding breast implant surgery and self-reported BII and emphasize the importance of preoperative mental health assessments in appropriate patient selection for elective breast surgery.

Advancements in Aesthetic Breast Augmentation: Evaluating the Safety, Efficacy, and Naturalistic Outcomes of Ergonomix2 Implants.

This pioneering study evaluates the safety, efficacy, and Aesthetic outcomes of Ergonomix2 Motiva Ergonomic Implants in breast augmentation. It aims to assess their capability to offer more natural touch and dynamics, delineate the learning curve for surgical techniques, and examine their safety profile compared to Ergonomix1 implants. A prospective cohort study was conducted, comparing 31 patients who received Ergonomix2 implants with a control group of 51 patients with Ergonomix1 implants. Eligible patients were those seeking Aesthetic breast augmentation without prior surgeries or chronic illnesses. Detailed documentation of surgical techniques, implant characteristics, and patient demographics was performed. The study assessed surgical learning curve, implant positioning accuracy, and short-term and early complications. Aesthetic outcomes were evaluated using the BreastQ questionnaire and quantitative elastography. Patients with Ergonomix2 implants showed significant improvements in Aesthetic outcomes, including breast contour symmetry and natural feel. The learning curve demonstrated a decrease in surgical time and higher implant positioning accuracy. The safety profile was favorable, with a low complication rate and high patient satisfaction levels. Ergonomix2 implants exhibited enhanced softness and pliability, closely mimicking natural breast tissue, as confirmed by elastographic analyzes. Ergonomix2 implants represent a significant advancement in Aesthetic breast surgery, offering natural-feeling and dynamically adaptable outcomes. Despite the promising results, the need for specialized surgical techniques and further research on long-term safety and efficacy is emphasized. This study contributes foundational knowledge to the field of ergonomic breast implants and their application in modern plastic surgery. 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 .

Four-Layer Wound Closure Technique with Barbed Sutures for Inframammary Fold in Mastopexy Augmentation.

The inframammary fold (IMF) is an important landmark in breast aesthetic surgery. In augmentation mastopexy procedures, secure and accurate placement of the IMF is essential to aesthetic outcomes and to allow the new IMF to heal in the correct position without displacement. The authors present a simple and efficient four-layer wound closure technique using barbed sutures for closure of the repositioned IMF in augmentation mastopexy procedures. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. A retrospective review was undertaken of 335 patients who underwent bilateral breast augmentation mastopexy procedures with a Wise pattern technique at a single unit. The newly reset IMF was closed using barbed sutures and a four-layer closure technique. There were no cases of complications related to wound healing or wound dehiscence. One patient required explantation for an infected implant. The four-layer wound closure technique with barbed sutures provides a quick and efficient method for accurate closure of the newly reset IMF, with positive outcomes related to wound healing. Secure and accurate placement of the inframammary fold is crucial in augmentation mastopexy procedures. The use of a four-layer wound closure technique with barbed sutures provides an efficient method for accurate closure of the newly reset inframammary fold. This method was previously described by the first author for reset of the IMF in breast augmentation surgery and has been adapted to the longer IMF incision in augmentation mastopexy procedures. 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 .

Pain Levels Following Cosmetic Breast Surgery and An Easy-To-Use Pain Treatment Algorithm for Plastic Surgeons.

The purpose of this study was to examine the degrees of pain experienced following various breast cosmetic surgery procedures and to evaluate the existing pain treatment methods. Patients who underwent subpectoral breast augmentation, mastopexy, or breast reduction between 2017 and 2022 were evaluated retrospectively. A total of 90 patients were randomly selected, with 30 patients in each group. The visual analog scale (VAS) was used to assess pain levels. The data were analyzed using the statistical program SPSS 22.0 (IBM Corp., Armonk, NY, USA). The subpectoral breast augmentation group exhibited the highest recovery VAS score. Postoperative 1, 2, 4, 6, 12, and 24-h VAS values were higher in the breast augmentation group than in the breast reduction and mastopexy groups. No statistically significant difference observed between mastopexy and breast reduction in terms of VAS scores during the evaluation periods. Statistically significant higher VAS scores were observed for subpectoral breast augmentation at all times compared to the preoperative period. Subpectoral breast augmentation is associated with higher levels of postoperative pain compared to breast reduction and mastopexy. Effective postoperative pain prevention is crucial following aesthetic breast surgeries. It not only helps to reduce hospital stays but also aids in patient recovery, facilitates a quicker return to daily activities, and enhances patient satisfaction. To achieve this objective, it is advantageous to utilize a practical pain treatment algorithm that is readily applicable. 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 .

Publication Trends in Aesthetic Breast Surgery: A Bibliometric Analysis.

Aesthetic breast surgery (ABS) encompasses breast augmentation, breast reduction, mastopexy, and mastopexy augmentation. This topic has seldom been assessed as a bibliometric study. This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. Bibliometrics, the quantitative analysis of publications, particularly scholarly literature, offers valuable insights into research trends and impact. This analysis aims to address this gap and identify trends in ABS literature to guide future research areas. The 100 most-cited publications in ABS were identified on Web of Science (Clarivate Analytics, Philadelphia, PA), across all available journal years (from 1953 to 2024). Study details, including the citation count, main content focus, and outcome measures, were extracted and tabulated from each publication. The Oxford Centre for Evidence Based Medicine and levels of evidence (LOE) of each study were assessed. The 100 most-cited publications in ABS were cited by a total of 11,522 publications. Citations per publication ranged from 46 to 1211 (mean 115.2 ± 135.7), with the highest-cited study being the Pusic BREAST-Q paper (n = 1211). A majority of publications were LOE 4 (n = 30), representative of the large number of case series. The number of publications for LOE 5, 3, 2, and 1 was 12, 28, 21, and 9, respectively. The main content focus was "outcomes" in 52 publications, followed by "nonoperative management" (n = 12) and "surgical technique" (n = 12). Patient-reported outcome measures (PROMs) were used in 29 publications, and 53 publications reported aesthetic outcome measures. This analysis highlights that research methodologies in ABS studies should be improved. This necessary improvement would be facilitated by vigorous, high-quality research, and the implementation of validated ABS-specific PROMs enhancing patient satisfaction, particularly in aesthetic procedures, such as BREAST-Q.

New Insights Into Breast and Chest Wall Asymmetry in the Aesthetic Patient

Abstract Background Asymmetry, a prevalent phenomenon throughout the human body, prompts this retrospective study, in which the authors aim at discerning potential patterns in its manifestation. Building upon our previous investigations in which left-sided chest wall and pelvic bone width surpassed their right-sided counterparts, a hypothesis is formulated suggesting the likelihood of the right breast being narrower and longer compared with the left. Objectives Our objective in this study is to investigate the correlation between the left-sidedness phenomenon in the chest wall and breast shape and appearance, with the aim of understanding its potential impact on outcomes in breast aesthetic surgery. Methods A random selection of pictures from 600 female patients undergoing various aesthetic breast procedures formed the basis of this study. Exclusion criteria involved the elimination of 254 pictures with nonstandard photography. Horizontal and vertical parameters of breasts and chest walls were measured, and the results on both sides were systematically compared to validate our hypothesis. Results On the left side, the chest wall, the distance between the nipple and the midline, and that of the nipple and the anterior axillary line were significantly wider. Vertical measurements, including the sternal notch to the nipple, the clavicle to the nipple, and the clavicle to inferior breast distance, although longer, did not exhibit statistical significance. Conclusions Approximately 77% of patients displayed wider breasts and chest walls on the left side. However, this observed asymmetry did not yield a statistically significant impact on the length of the breasts. Level of Evidence: 3 (Diagnostic)

Fat Grafting to the Breast for Aesthetic Indications: Techniques and Outcomes in 165 Consecutive Patients.

Fat grafting to the breast for aesthetic indications has become increasingly popular. Herein, methods, aesthetic outcomes, and complications are reviewed in a retrospective case series. Female patients (n=165) with an average age of 45years (range: 17-78years) who underwent fat grafting to breast were evaluated. Demographic parameters, the type of procedure, the amount of fat transferred, the site(s) of fat harvest, operative times, and the patient's postoperative recovery and outcomes were recorded. Of the 165 patients, 105 had breast augmentation with fat only. Of these 105 patients, 14(8%) had implant removal with and without capsulectomy, and 61(37%) had mastopexies. Composite augmentation was performed in the remaining 60 patients. The average amount of fat used was 208 cc (range: 10 to 945cc) per breast. Forty-five patients (27%) underwent a second procedure. Of the 165 patients, 37(22%) had adverse events unrelated to the fat graft, including suture abscesses, scarring, and minor incision cite skin breakdown. Four patients (2.4%) had a complication related to fat grafting including 'lump' formation between the breast, abnormal mammograms, and the need for simple aspiration of a lipid cyst. Autologous fat grafting should be considered for both primary and secondary aesthetic breast surgery to enhance outcomes. Complications related to fat grafting are uncommon. Revisional and secondary surgeries may be needed to achieve the desired outcome. Power-assisted liposuction, with vibratory infiltration of the tumescent solution, auto-infusion of fat, and Expansion Vibration Lipofilling using a closed system has become our preferred technique. Fat grafting to breast can be considered for both primary and secondary aesthetic breast surgery Complications related to fat grafting are uncommon There does not appear to be an overall increase in complications of associated mastopexy and composite augmentation LEVEL OF EVIDENCE V: 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 .

Tension Reduction With Force Modulating Tissue Bridges Reduces Wounds in Breast Surgery.

Tension on healing wounds increases the risk of dehiscence and poor or pathologic scar formation. Force modulating tissue bridges (FMTBs) represent a new class of wound closure and support devices designed to offload tension on healing wounds to improve wound healing and scar outcomes. The study was undertaken to assess the efficacy of FMTBs to reduce the risk of wound healing complications in elective breast surgery. One hundred twenty-two consecutive patients undergoing bilateral aesthetic breast surgery underwent intraoperative placement of FMTBs on the vertical limb closure site. A matched case-control cohort of 121 consecutive patients was established for comparison. Wounds were considered significant if larger than 3 mm in diameter. The primary outcome of breast wounds >3 mm was reported with a relative risk, and all outcomes were framed with number needed to treat. The control and intervention cohorts had similar demographics, comorbidities, type of operation, and incision pattern utilized. Within the FMTB group, 96.7% (n = 118) patients completed treatment per protocol. Significant wounds occurred in 1.7% (n = 2) of patients in the tissue bridge vs 15.2% (n = 19) in controls on a per patient/per protocol basis (89% reduction, P < .001). Statistically significant improvements were maintained on sensitivity analyses with intention to treat, even when minor wounds were included. There were no complications noted related to FMTBs. FMTBs are safe and highly effective at reducing the risk of wound formation in elective breast surgery. Results are consistent with sensitivity analyses based on clinical and methodological factors. Further research will assess long-term scar outcomes.

Aesthetic Breast Surgery: What Do the Measurements Reveal? A Practical Visual Application of the Results.

The results of preoperative and 1-year postoperative measurements in aesthetic breast surgery were outlined in chart form in the Aesthetic Surgery Journal in 2020. Measurements were performed preoperatively and postoperatively, but the authors concentrated on 1-year follow-up because it was generally accepted as the minimum time to define a stable surgical result. Extensive statistical analysis was outlined in the previous paper. This paper translates those results into a visual form so that the surgeon can see the changes that occur in breast reduction, breast augmentation, mastopexy, mastopexy-augmentation, and implant removal with mastopexy. There were 548 patients in the breast augmentation group, 388 patients in the breast reduction group, 244 patients for mastopexy-augmentation, and 90 patients for mastopexy. Only primary surgeries that had a full year follow-up comparing preoperative and postoperative measurements were reviewed. Measurements were performed by E.H.F. preoperatively and at each postoperative visit. The measurements that were included in this study were clavicle to upper breast border, upper breast border to nipple, suprasternal notch to nipple, suprasternal notch to inframammary fold, and midline to nipple. The preoperative and postoperative measurement changes in aesthetic breast surgery were consistent, with minimal variation for each of the aesthetic breast surgery procedures. The visual interpretation of these results allows the surgeon to accurately plan preoperatively to achieve good, predictable results.

Breast tissue density as a predictor of complications in reconstructive and plastic surgery

Aesthetic breast surgery is consistently a leading position in plastic surgery. According to the International Society of Aesthetic Plastic Surgery (ISAPS), in 2019, 1 795 551 breast augmentations were performed. However, as the number of primary surgeries increases, so does the percentage of complications and consequent patient dissatisfaction with the primary intervention results. Approximately 20% of women experience postoperative complications, such as breast asymmetry, implant displacement, double fold (“double bubble”), rippling, capsular contracture, seroma, hematoma, suture dehiscence, and others. Women with decreased breast tissue tone due to postinvolutive changes are at risk for postoperative complications. The risk of complications also increases when not just breast augmentation, but a combination of augmentation and mastopexy is required. In most cases, when a surgical intervention is recommended in several stages, patients are not willing to wait for a long time. This group of women is the most difficult for the clinician and therefore requires an analysis of all possible risk factors for complications development. Therefore, finding new possible ways to predict complications in reconstructive and plastic breast surgery is a relevant and priority direction.Purpose of a study: to develop a technique for preventing complications in reconstructive and plastic breast surgery.Material and methods. The results of 37 breast augmentation surgeries with T-shaped mastopexy in patients with different breast tissue density were analyzed, based on which an improved method of this operation was proposed. A comparative analysis of postoperative complications in early and late postoperative periods was carried out, and patients were surveyed before breast reconstruction and plastic surgery and 3, 6, and 12 months after plastic surgery to evaluate patient satisfaction with the outcome.Results. The analysis of the obtained data showed that breast tissue density plays a key role in choosing the tactics of breast augmentation with T-shaped mastopexy and is a predictor of complications development in the postoperative period.Conclusion. The planning of breast augmentation with T-shaped mastopexy should be carried out taking into account the determination of a patient's breast tissue density, which can affect the reduction of the risk of surgical complications during the surgery and in the postoperative period. The use of mastopexy technique with a preliminary marking of incisions with a margin of 1 cm to the central line from the classical V-shaped marking line is expedient in the presence of dense breast tissue in the patient.

Comparing the efficacy of antimicrobial pocket-irrigation protocols in an in vivo breast implant infection model

Breast implant infection and biofilm formation are major concerns in reconstructive and esthetic breast surgery, with significant medical and economic consequences. Staphylococcus is the common pathogen, with rapidly increasing rates of methicillin-resistant Staphylococcus aureus (MRSA). There is no consensus on prevention practices. This study compares the effect of several pocket irrigation and antibiotic prophylaxis regimens on implant colonization and biofilm formation in an established rat model of MRSA-infected silicone breast implants. Silicone discs were inserted in a sub-pectoral pocket in 57 rats (114 implants). Implant infection was induced by injection of free planktonic MRSA into the surgical pocket. Rats were allocated to study groups treated by different antimicrobial protocols: pocket irrigation with vancomycin, povidone-iodine, or saline. Each group was divided into subgroups treated with or without additional peri-operative systemic vancomycin. Implant colonization or overt infection was assessed at post-operative day 14 both clinically and by cultures. Pocket irrigation with vancomycin prevented contamination in 87% of implants. Irrigation and systemic vancomycin prevented contamination in 100% of implants with no difference between a single preoperative dose and a 48-h regimen. Systemic vancomycin alone or irrigation with povidone-iodine alone resulted in 100% contamination rates. In this in vivo model, combination of systemic vancomycin with vancomycin pocket irrigation was the most effective regimen, preventing contamination in 100% of implants. Continuation of post-operative antibiotic treatment showed no added advantage.

PECS 1 block as analgesic adjuncts in breast augmentation surgery

The analgesic benefits of using pectoral nerve (PECS) block as regional analgesia in breast cancer surgery have been widely published. However, the use of PECS block in aesthetic breast surgery remains underreported. Breast augmentation is one of the most popular plastic surgery procedures. Pain and discomfort are common after breast augmentation surgery. We report a case series using ultrasound-guided PECS 1 block as part of multimodal analgesia, which further enhanced the recovery experience in patients undergoing primary augmentation mammaplasty using silicone implants in a day-surgery setting.

Enhanced Recovery After Surgery (ERAS) Pathways for Aesthetic Breast Surgery: A Prospective Cohort Study on Patient-Reported Outcomes

BackgroundPatients’ expectations of an anticipated timeline of recovery and fear of anesthesia in aesthetic breast surgery have not been studied.ObjectiveThis study aims to assess patient anxiety, expectations, and satisfaction after Enhanced Recovery after Surgery (ERAS) pathways for aesthetic breast surgery and the progress of postoperative recovery.Materials and methodsAll consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022 were included in this single-center prospective cohort study. The ERAS protocol consists of more than 20 individual measures in the pre-, intra-, and postoperative period. Epidemiological data, expectations, and recovery were systematically assessed with standardized self-assessment questionnaires, including the International Pain Outcome Questionnaire (IPO), the BREAST-Q or BODY-Q, and data collection forms.ResultsIn total, 48 patients with a median of 30 years of age were included. Patients returned to most daily activities within 5 days. Eighty-eight percent of patients were able to accomplish daily activities sooner than expected. The time of return to normal daily activities was similar across all procedure types. There was no statistically significant difference regarding postoperative satisfaction between patients who recovered slower (12%) and patients who recovered as fast or faster (88%) than anticipated (p=0.180). Patients reporting fear of anesthesia in the form of conscious sedation significantly diminished from 17 to 4% postoperatively (p<0.001).ConclusionEnhanced Recovery after Surgery (ERAS) pathways for aesthetic breast surgery are associated with rapid recovery and high patient satisfaction. This survey study provides valuable insight into patients’ concerns and perspectives that may be implemented in patient education and consultations to improve patient satisfaction following aesthetic treatments.Level of Evidence IVThis 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.

Differential Preferences in Breast Aesthetics by Self-identified Racial Demographics Assessed on a National Survey

Abstract Goals/Purpose Breast aesthetics are a highly discussed topic within plastic surgery. However, there is a paucity of literature examining how preferences differ amongst various demographic groups. The objective of this study was to assess how perceptions of the ideal breast differ between respondents stratified by self-identified race. Methods/Technique A cohort of 25 patients from the senior surgeons’ practices presenting for aesthetic or reconstructive breast surgery was assembled. This cohort was selected with the aim of choosing a sample that maximized diversity on the basis of breast size and shape, skin tone, and nipple-areola complex size and position. Pre-operative anteroposterior photographs from these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents’ impressions of “breast attractiveness.” Respondents were asked to rate breasts on a Likert scale of 1 to 5, with 1 being not at all attractive and 5 being most attractive. Survey responses were analyzed for differences in breast aesthetic preferences by race using ANOVA and t-tests where appropriate. Results/Complications A total of 1,021 survey responses were collected. The majority of survey respondents identified as White or Caucasian (73%). A total of 18% of individuals self-identified as Black or African-American, while 5% identified as Asian. The remaining 3% of respondents identified as Other, Native American, or selected multiple categories and groups were too small for cross-group comparison and were thus excluded. On average, individuals in the White or Caucasian group rated any given pair of breasts 8% more attractive than Black or African-American individuals and 14% more attractive than Asian individuals. ANOVA testing revealed significant differences amongst groups (p=0.014). Subgroup comparison revealed a significant difference between ratings of breast attractiveness between White or Caucasian individuals and Asian respondents (2.61 vs 2.25; p=0.002). Comparisons between White or Caucasian respondents and Black or African-American individuals were not significant (2.61 vs 2.40; p=0.06) as was the analysis between Black or African-American respondents and Asian individuals (2.40 vs 2.25; p=0.08). While these intergroup comparisons did not reach significance in the current sample, perhaps with a larger sample size a difference between these groups might be elucidated. Despite these racial discrepancies in breast attractiveness, regression analysis revealed that the ratings amongst each of the groups were highly correlated with one another: White or Caucasian and Black and African-American (R=0.68; R2=0.46; p&amp;lt;0.001), Black or African-American and Asian (R=0.72; R2=0.52; p&amp;lt;0.001), and White or Caucasian and Asian (R=0.86; R2=0.73; p&amp;lt;0.001). Conclusion In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by race. On average, White or Caucasian respondents rated a given pair of breasts as more aesthetically pleasing than Black or African-American and Asian counterparts. While this difference was observed, it is important to note that ratings amongst racial groups were highly correlated with one another across all photographs presented. In other words, while Black or African-American and Asians rated breasts lower than their White or Caucasian counterparts, relative attractiveness for the breasts amongst groups paralleled one another. While self-identified racial groups rated the breasts similar relative to one another, there were distinct differences in numerical ratings that may be reflective of broader, more generalized sentiments and preferences that were not able to be captured by our survey instrument. These findings merit further investigation to understand these trends and observations. Doing so will enable plastic surgeons to have a better understanding of patient preferences and expectations when seeking reconstructive or aesthetic breast surgery and thereby improve patient satisfaction.

Introducing Aesthetic Breast Reconstruction and Aesthetic Breast Surgery

Introducing Aesthetic Breast Reconstruction and Aesthetic Breast Surgery

A computer program for predicting the risk of complications in aesthetic breast surgery

A computer program for predicting the risk of complications in aesthetic breast surgery