Surgical Treatment of Breast Asymmetry Improves Quality of Life in Adolescents and Young Women
Laura C. Nuzzi, BA, Joseph M. Firriolo, MD, Carolyn M. Pike, MPH, Brian I. Labow, MD.
Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
BACKGROUND: Breast asymmetry that persists beyond skeletal maturity is associated with psychosocial deficits. This longitudinal cohort study measures the impact of surgical correction of breast asymmetry on the health-related quality of life of adolescents and young women.
METHODS: Validated surveys were administered to skeletally mature females with breast asymmetry undergoing surgical correction and comparably aged female controls: Short-Form 36v2 (SF-36), Rosenberg Self-Esteem Scale (RSES), and Eating-Attitudes Test-26 (EAT-26). Cohorts completed surveys at baseline and postoperatively/at follow-up at 6 months, 1 year, 3 years, 5 years, 7 years, and 9 years.
RESULTS: The mean ages of breast subjects (n=42) at surgery and controls (n=103) at baseline were 17.4 and 16.7 years, respectively (p=0.08). All forms of asymmetry were included, regardless of etiology: breast asymmetry without deformity (45%), tuberous breast deformity (29%), unilateral macromastia (12%), Poland syndrome (7%), amastia (5%), and amazia (2%). At baseline, asymmetry subjects performed significantly worse than controls in the role-emotional SF-36 domain and on the RSES and EAT-26. Postoperatively asymmetry subjects experienced significant improvements in three SF-36 domains (social functioning, role-emotional, and mental health) and on the EAT-26. These results largely did not vary by age, body mass index (BMI) category, and asymmetry severity. Postoperatively, patients who underwent correction of asymmetry performed equally to or more favorably than controls in all eight SF-36 domains (physical functioning, role-physical, general health, bodily pain, vitality, social functioning, role-emotional, and mental health), and on the RSES and EAT-26.
CONCLUSIONS: Surgical correction of breast asymmetry in adolescents and young women is associated with improved psychosocial wellbeing, largely unaffected by age, BMI category, or severity. Postoperatively, patients treated for asymmetry performed comparably to unaffected controls. Providers should be aware of the psychosocial improvements surgery can provide adolescents with persistent, distressing asymmetry.
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