Quality of Life Improves after Breast Augmentation
BREAST-Q Shows Gains in Key Areas; Lower Satisfaction in Older Women, Reports Plastic and Reconstructive Surgery

PHILADELPHIA — Women undergoing breast augmentation surgery report substantial gains in psychosocial and sexual well-being and other aspects of quality of life, according to a study in the April issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Breast augmentation is associated with high patient satisfaction and significant improvements in quality of life," write ASPS Member Surgeon Dr. Amy K. Alderman of Alpharetta, Ga., and colleagues.

The study also suggests that it takes some time to regain full physical functioning after breast augmentation using submuscular implants, and that older women may be less satisfied with the results of their the procedure.

Gains in Quality of Life after Breast Enlargement Surgery

The researchers used the validated BREAST-Q© survey to get women's perspectives on the physical and psychological benefits of breast augmentation.

The BREAST-Q questionnaire evaluated changes in six areas affecting quality of life: satisfaction with breasts and with overall outcome; psychosocial, sexual, and physical well-being; and satisfaction with care.

Six hundred eleven women completed the BREAST-Q before breast augmentation surgery and again at six weeks and six months afterwards. Breast enlargement was performed using implants (usually silicone) placed "under the muscle" (submuscular).

The results showed significant improvement in most aspects of quality of life assessed by the BREAST-Q. For example, scores for satisfaction with breasts (on a 100-point scale) increased from about 25 before surgery to about 80 afterward.

There were similar improvements in scores for psychosocial and sexual well-being.

The degree of the improvements in quality of life was rated "very large" on a standard measure of changes in health—the "effect sizes" were comparable to those seen in patients undergoing major orthopedic surgery procedures such as total hip replacement.

Physical Function Scores Decrease; Older Women May Have Lower Satisfaction

One area of quality of life decreased after breast augmentation. BREAST-Q scores for physical functioning were lower at six weeks compared to before surgery, although the scores returned toward normal by six weeks.

This could reflect a delay in complete physical recovery after submuscular implant placement. Dr. Alderman and colleagues suggest. Longer follow-up would be needed to determine whether physical functioning eventually returns to preoperative levels.

In addition, older patients had lower scores for satisfaction with the breasts and with the overall procedure. Average scores for overall satisfaction decreased from about 90 for women under age 30, to 86 for those in their thirties, 82 for those in their forties, and 77 for those older than 50.

"The older patients seem less satisfied with their aesthetic result and less likely to have their expectations met," Dr. Alderman and coauthors write.

Quality of life is increasingly regarded as an important factor in evaluating the benefits of many types of medical or surgical treatments.

Breast augmentation is the most common cosmetic surgical procedure performed in the United States. According to ASPS statistics, about 290,000 women underwent cosmetic breast augmentation in 2013.

It's important to establish the benefits of breast augmentation from the patient's perspective—especially since breast implants have come under scrutiny for potential safety concerns. Dr. Alderman and colleagues conclude, "These data along with other research using the BREAST-Q can be used on the policy level to support the availability of breast implants for women in the US and worldwide."

Plastic and Reconstructive Surgery is published by Lippincott Williams & Wilkins, part of Wolters Kluwer Health.