PURPOSE: Although past prospective outcome studies have evaluated breast augmentation or reduction, there have been no previously published prospective outcome studies that include mastopexy and augmentation/mastopexy patients.� It is important to evaluate these groups because mastopexy patients have been a source of difficulty.� Furthermore, concern has been raised about doing a mastopexy and augmentation in combination and in treating patients secondarily.� Patients often ask about the amount of pain and recovery time.� These questions are important in terms of patient expectations and planning and need to be answered specifically in terms of relevant activities of daily life and based on patient-reported data.� They have not been assessed in previous outcome studies.� This prospective study evaluates and compares 4 cosmetic breast procedures � augmentation, mastopexy, augmentation/mastopexy, and reduction.� This study is part of a four-pronged evaluation of female cosmetic breast surgery patients, which also includes a prospective clinical study, a photometric study of breast morphology, and a photometric study of mastopexy/reduction publications.

METHODS: Over a 5-year period, January, 2002 to September, 2007, 394 consecutive female patients underwent 406 cosmetic breast procedures.� A total of 331 interviews were conducted with 325 patients for a response rate of 81.5 percent, using an in-person interview conducted by one of the nurses. A vertical technique was used for all mastopexies and breast reductions. Questions were asked in 6 categories: patient data, indications, recovery (including discomfort level), results, complications, and psychological effects.� A follow-up study was included to determine duration of nipple numbness (fig. 1).� Patients who completed the breast augmentation survey were also asked to look at a page of photographs of a patient who underwent a breast augmentation, before, one month, and three months after surgery, to determine preferred breast proportions

RESULTS: Patients reported using prescription analgesics an average of 5.4 days, resumed driving in 5.8 days, returned to work 7.5 days, and felt �back to normal� in 27.8 days.� The mean length of time patients needed assistance after surgery was 3.1 days, help with their children 5.0 days, and return to full exercise, 36.9 days.� Patients reported being able to sleep comfortably on average 19.5 days after surgery.�

Pain rating was moderate overall (5.4/10), higher for breast augmentation (5.9) and lower for breast reduction (3.3) (fig. 2)� Both mastopexy and breast reduction patients reported a significant reduction in physical symptoms after surgery (p < 0.001).� Bra cup sizes are shown in figures 3 and 4.� The mean results rating was 9.2/10, similar (p > 0.05) for all procedures (fig. 5).� Almost all patients (326/329, 99.1 percent) would �do it again.�� Breast augmentation and reduction patients were most inclined to find the surgery exceeded their expectations (p < 0.05).� The complication rate reported by patients was 40/331 (12.1 percent).� All procedures reduced breast self-consciousness after surgery (p < 0.001).�

CONCLUSIONS: Almost all patients desire an improvement in the appearance of their breasts, including breast reduction patients.� Results ratings were very high (9.2/10), with comparable ratings for breast augmentation, mastopexy, augmentation/mastopexy and reduction.� Higher results ratings correlated with larger implant volumes and a lack of complications.� Primary versus secondary surgery and smoking history did not correlate significantly with results rating.� All four procedures provided a high level of patient satisfaction, improvement in self-esteem and quality of life.� Symptomatic improvement was reported by both mastopexy and reduction patients.� Nipple numbness was common (42.9 percent) but eventually resolved in 87.9 percent of patients who experienced it.� Most patients preferred a convex breast shape.�

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Fig. 1.� Nipple sensation follow-up study.� Mean follow-up time was 29. 4 months (range 2.5 months � 67.9 months).

Fig. 2.� Pain rating.� Scale of 1 (no pain) to 10 (most severe pain).

Fig. 3.� Bra cup size before surgery.

Fig. 4.� Bra cup size after surgery.

Fig. 5.� Results rating.� Scale of 1 to 10.