Abstract
Background
The inframammary fold (IMF) incision is widely used in Western countries for breast augmentation surgery, whereas the axillary incision is the dominant approach used in China, because many Chinese surgeons believe that the Asian population has a higher risk of developing hypertrophic scars. However, comparative data of scar assessment through different incisions in Chinese patients are scarce. The aims of the study were as follows: (1) to evaluate the outcomes of scar assessment using the Vancouver scar scale (VSS), combined with patient satisfaction scoring, in the scar assessment after breast augmentation surgery; (2) to compare the long-term cosmetic effects of surgical scars between axillary and IMF incisions.
Methods
Consecutive patients coming to our department for follow-up care at least 1 year after primary breast augmentation surgeries with axillary and IMF incisions between January 1, 2014 and December 31, 2014 were included in the research. Internal consistency, inter-rater reliability, and convergent validity were examined for the VSS and patient satisfaction scoring. The baseline characteristics and scar scores were tested using the Mann–Whitney U-test and Student’s t test between the two groups.
Results
Sixty-one patients underwent implantation surgeries through the axillary incisions, and 17 patients through the IMF incisions. There were no significant differences in age, follow-up time, body mass index, implant volume, or implant projection between groups. Reliability and validity of the VSS and patient satisfaction scoring were satisfactory. The scores of pigmentation were higher in the IMF group than those in the axilla group with statistical significance (P < 0.05). The scores of other subscales, overall VSS scores, and patient satisfaction were not statistically significant. The scars were significantly longer in the axilla group compared with the IMF group (P < 0.05).
Conclusions
The VSS combined with patient satisfaction scoring constitutes an effective tool to evaluate incision scars after augmentation mammaplasty. Scars in the axilla and IMF can achieve comparable cosmetic effects and patient satisfaction in Chinese women. Chinese patients with proper indications can receive breast augmentation surgery through the IMF incision, with fewer risks and less trauma, and get satisfactory scar appearance as through the axillary incision.
Level of evidence III
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References
Tebbetts JB (2010) Augmentation mammaplasty: redefining the patient and surgeon experience. MOSBY ELSEVIER, Amsterdam
Spear SL, Bulan EJ, Venturi ML (2006) Breast augmentation. Plas Reconstr Surg. 118:188S–196S
Hidalgo DA (2000) Breast augmentation: choosing the optimal incision, implant, and pocket plane. Plast Reconstr Surg. 105:2202–2216 (discussion 2217–2208)
Reece EM, Ghavami A, Hoxworth RE, Alvarez SA, Hatef DA, Brown S, Rohrich RJ (2009) Primary breast augmentation today: a survey of current breast augmentation practice patterns. Aesthet Surg J 29:116–121
Sevin A, Sevin K, Senen D, Deren O, Adanali G, Erdogan B (2006) Augmentation mammaplasty: retrospective analysis of 210 cases. Aesthet Plast Surg 30:651–654
Chinese Society of Plastic Surgery (2013) Guidelines for breast augmentation with silicone implants. Zhonghua Zheng Xing Wai Ke Za Zhi 29:1–4
Cheng MH, Huang JJ (2009) Augmentation mammaplasty in asian women. Semin Plast Surg. 23:48–54
Visscher MO, Bailey JK, Hom DB (2014) Scar treatment variations by skin type. Facial Plas Surg Clin N Am. 22:453–462
Atiyeh BS (2007) Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthet Plast Surg. 31:468–492 (discussion 493–464)
Truong PT, Abnousi F, Yong CM, Hayashi A, Runkel JA, Phillips T, Olivotto IA (2005) Standardized assessment of breast cancer surgical scars integrating the vancouver scar scale, short-form mcgill pain questionnaire, and patients’ perspectives. Plast Reconstr Surg 116:1291–1299
Vercelli S, Ferriero G, Sartorio F, Stissi V, Franchignoni F (2009) How to assess postsurgical scars: a review of outcome measures. Disabil Rehabil 31:2055–2063
Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabil 11:256–260
Sun J, Liu C, Mu D, Wang K, Zhu S, He Y, Luan J (2015) Chinese women’s preferences and concerns regarding incision location for breast augmentation surgery: a survey of 216 patients. Aesthet Plast Surg 39:214–226
Luan J, Mu D, Mu L (2009) Transaxillary dual-plane augmentation mammaplasty: experience with 98 breasts. J Plast Reconstr Aesthet Surg 62:1459–1463
van de Kar AL, Corion LUM, Smeulders MJC, Draaijers LJ, van der Horst CMAM, van Zuijlen PPM (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116:514–522
Carmines EG, Zeller RA (1994) Reliability and validity assessment. Sage Publications, Newbury Park, pp 20–27
Bland JM, Altman DG (1997) Statistics notes: cronbach’s alpha. BMJ 314:572
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174
Alpert BS, Lalonde DH (2008) MOC-PS(SM) CME article: breast augmentation. Plast Reconstr Surg 121:1–7
Haibing Liu, Dan Tang, Haiyan Cao et al (2006) Reliability of Vancouver scar scale. Chin J Rehabil Med 21(3):240–242
Celik M, Tuncer S, Eryilmaz E (2003) Running W incision in open rhinoplasty: better scar quality. Aesthet Plast Surg 27:388–389
Blount AL, Martin MD, Lineberry KD, Kettaneh N, Alfonso DR (2013) Capsular contracture rate in a low-risk population after primary augmentation mammaplasty. Aesthet Surg J. 33:516–521
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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Sun, J., Mu, D., Liu, C. et al. Scar Assessment After Breast Augmentation Surgery with Axillary Incision versus Inframammary Fold Incision: Long-Term Follow-Up in Chinese Patients. Aesth Plast Surg 40, 699–706 (2016). https://doi.org/10.1007/s00266-016-0671-4
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DOI: https://doi.org/10.1007/s00266-016-0671-4