| Background Choosing the incision location is one of the core steps in the breast augmentation surgery. The current incision locations for augmentation mammaplasty include inframammary fold (IMF), periareola and axillary. Generally speaking, the inframammary fold incision is the most direct and simplest approach because it incurs minimal tissue damage, less pain and a shorter recovery period. The periareola and transaxillary incision may cause more trauma and risk. Breast augmentation through inframammary fold (IMF) incision is the most widely used approach in Western countries, however the dominant incision used in china is axillary. Several theories have been mentioned regarding the differences. Firstly, the incisions for breast augmentation are mainly decided by surgeons, while the patients do not have much choices because of information asymmetries. Secondly, some Chinese women might, to a certain extent, worry about being known about the breast augmentation history by their sexual partners, the scar in axilla is felt to be easier to hide than that at periareola or inframammary fold. Besides, many Chinese surgeons believe that the Asian populations have higher possibility to develop hypertrophic scars, so the scars at inframammary fold are inappropriate for Chinese women. However, systematic preoperative education regarding incision locations of breast augmentation is scarce in China. Few studies have described the decision-making process or investigated the personal views of Chinese patients with respect to incision locations for breast augmentation. In addition, comparative data of scar assessment through different incisions in Chinese patients are scarce.Methods We used a literature review, patient interviews and expert panels to develop the preoperative education material and questionnaire regarding different incision locations. we surveyed the Chinese patients to ascertain their preferences and concerns of incision location based on a comprehensive understanding of different incisions. Furthermore, we performed a prospective cohort study to estimate the incision scars after augmentation surgery with the combined of VSS and patient satisfaction scoring.Results A total of 216 Chinese women participated in the study between 2012.5 and 2014.1. After receiving the preoperative education on incisions, the axillary and periareola approaches decreased to 117 (54.17%) and 13 (6.02%), respectively, while IMF increased to 86 (39.81%). It showed that axillary approach was the first option for more than half of Chinese women mainly because an easily-hidden scar was considered as the primary concern during the decision-making process. However, a considerable number of Chinese women would choose the IMF incision and valued its superiority in terms of lower risk and trauma. The patients with a low BMI and a small preoperative breast cup size were more likely to choose an axillary incision. In addition, the scars of three incisions achieved the similar cosmetic effects and patient satisfaction at 12 months postsurgery.Conclusions The systematic and objective preoperative education material and questionnaire regarding different incision locations helped the Chinese patients fully understand the characteristics of different incision locations, make truly informed decisions and express their personal requirements. Axillary approach was the first option for more than half of Chinese women mainly because of the primary concern of easily-hidden scar. However, a considerable number of Chinese women would choose the IMF incision and valued the superiority in lower risk and trauma. The VSS combined with patient satisfaction scoring constituted an effective tool to evaluate incision scars after augmentation mammaplasty. The scars of three incisions achieved the similar cosmetic effects and patient satisfaction at long-time follow-up. Our findings changed some traditional ideas regarding incision choice for Chinese patients, and provided new evidences for decision-making process in clinical practice. The results contributed to enacting individualized surgical treatment and improving the patient satisfaction. |
PDF Full Text Request