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Does Breast Reconstruction Impact the Decision of Patients to Pursue Cosmetic Surgery?
Vivian M. Hsu, MD1, Ari M. Wes, BS1, Chen Yan, BA1, Jesse C. Selber, MD2, Jonas M. Nelson, MD1, Anthony J. Taglienti, MD1, Stephen J. Kovach, MD1, Liza C. Wu, MD1, Joseph M. Serletti, MD1.
1University of Pennsylvania, Philadelphia, PA, USA, 2MD Anderson Cancer Center, Houston, TX, USA.

BACKGROUND:
Breast reconstruction is an integral component of breast cancer treatment, often aiding in the restoration of a patient’s sense of femininity. However, some women remain concerned with their body image after reconstruction. Many patients choose to have subsequent cosmetic surgery, such as body contouring and facial rejuvenation procedures.
The purpose of this study is to investigate the factors that motivate patients who have had plastic surgery for breast reconstruction to have subsequent cosmetic surgery. The incidence, outcomes, and motivations of these patients were reviewed.
METHODS:
The authors performed a retrospective study examining patients who had breast reconstruction and subsequent cosmetic surgery in the University of Pennsylvania Health System between January 2005 and June 2011. All autologous and implant reconstructions were included. Cosmetic surgeries were considered procedures requiring general anesthesia. This cohort of patients received a questionnaire developed to assess the influences and impact of reconstructive and cosmetic procedures.
RESULTS:
Sixty-two patients who underwent breast reconstruction had a total of 82 cosmetic surgeries, predominantly trunk liposuction (35.4%), rhytidectomy (18.3%), and blepharoplasty (15.9%). Forty-five patients had autologous breast reconstruction (72.6%) while the remainder had implant reconstruction. Twenty-five patients responded to the survey (40.3%); of these, 19 had autologous breast reconstruction (76%).
Thirty-four cosmetic procedures were performed in survey respondents, including blepharoplasty (23.5%), trunk liposuction (23.5%), and rhytidectomy (20.6%). Sixteen patients (64%) cited a desire to improve self-image as the main reason for having cosmetic surgery, while four patients (16%) attributed having prior breast reconstruction as the primary reason for having their elective procedure and four patients (16%) described having always planned on undergoing cosmetic surgery. Eighteen patients (72%) reported becoming more conscious of their appearance after breast reconstruction, and 15 patients (60%) stated that they would not have undergone cosmetic surgery had they not had prior breast reconstruction. While there was no difference in overall patient satisfaction with body image after having breast reconstruction (p=0.46), there was a significant improvement in overall patient satisfaction with body image after having subsequent cosmetic surgery (p=0.0044).
CONCLUSIONS:
The decision of breast reconstruction patients to undergo cosmetic surgery appears to be influenced by multiple factors, including prior experience with plastic surgery. Patients who become more aware of their appearance after breast reconstruction can pursue the opportunity to address their concerns through further procedures. Cosmetic surgery after breast reconstruction may improve body image satisfaction of patients and help to more fully meet their needs and expectations.


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