Plastic Surgery Research Council

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Surgical Treatment of Breast Asymmetry Improves Quality of Life in Adolescents and Young Women
Joseph M. Firriolo, MD, Laura C. Nuzzi, BA, Carolyn M. Pike, MPH, Brian I. Labow, MD.
Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

PURPOSE: Although common during puberty, persistent breast asymmetry beyond skeletal maturity of at least one cup-size difference is associated with poor self-esteem and emotional wellbeing. This longitudinal cohort study measures the impact of surgical correction of breast asymmetry on adolescent health-related quality of life.
METHODS: The following 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/follow-up at 6 months, 1 year, 3 years, and 5 years.
RESULTS: The mean ages of breast subjects (n=39) at surgery and controls (n=125) at baseline were 18.2 and 16.7 years, respectively. All asymmetry forms were included (most frequent size difference was two cups; mean volume difference was 204.2mL). At baseline, asymmetry subjects performed significantly worse than controls in three SF-36 domains (general health, social functioning, and role-emotional), and on the RSES and EAT-26. By the first postoperative year, asymmetry subjects experienced significant improvements in two SF-36 domains (social functioning and role emotional). These results largely did not vary by age, BMI category, and asymmetry severity. Within the first year, postoperative asymmetry patients performed equally to controls in all SF-36 domains, and on the RSES and EAT-26.
CONCLUSION: Surgical correction of asymmetry in adolescents and young women is associated with improved psychosocial wellbeing, unaffected by age, BMI category, or severity. Postoperatively, breast patients 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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