Cutting words: Priming self-objectification increases the intention to pursue cosmetic surgery

We examined whether subtle exposure to sexually objectifying cues increases women’s intentions to have cosmetic surgery. Undergraduate women (N = 116) were randomly assigned to a condition in which they unscrambled sentences containing words associated with sexual objectification, non-self-objectifying physicality, or neutral content. Following a manipulation check of these primes, participants reported their body shame and intentions to have cosmetic surgery in the future. Results revealed that priming a state of self-objectification, compared to the two non-self-objectifying conditions, increased both body shame and intentions to have cosmetic surgery. In a mediational model, the link between self-objectification and intentions to have cosmetic surgery was partially mediated by body shame. Controlling for other key intrapersonal and social motives linked to interest in cosmetic surgery did not alter these patterns. These findings highlight the potential for the consumption of cosmetic surgery to stand as another harmful micro-level consequence of self-objectification that may be perpetuated via subtle exposure to sexually objectifying words, even in the absence of visual depictions or more explicit encounters of sexual objectification

Reconstructive surgery:Risk factors, outcomes and advanced indications

The first part of this thesis investigates outcomes in reconstructive flap surgery using big data analysis. Firstly, outcomes after flap reconstructive surgery for diabetic patients compared to non-diabetic ones, highlighting higher risks of complications for diabetic patients, especially those with insulin-dependent diabetes. Additionally, it examines the impact of age and frailty on postoperative outcomes, emphasizing the importance of considering frailty scores instead of age alone in surgical planning for elderly patients. This thesis also delves into the incidence and risk factors of sepsis following reconstructive flap surgery, revealing significant associations with various patient factors. Moreover, racial disparities in outcomes after breast reconstructive surgery are explored, showing no differences in outcomes between different ethnicities. In the second part of this thesis, alternative surgical approaches for managing complications post-rectal/pelvic cancer surgery are discussed. These include the use of gluteal turnover flaps for perineal closure and a dorsal approach with partial sacrectomy followed by gluteal V-Y fasciocutaneous advancement flaps for treating chronic pelvic sepsis. Both techniques show promise in reducing complications and promoting wound healing. The effectiveness of gluteal fasciocutaneous flaps in treating chronic pelvic sepsis is highlighted specifically, offering a feasible and successful alternative for patients with limited options due to previous surgeries or (chemo)radiotherapy. Limitations of the studies, such as their retrospective nature and diverse patient populations, are acknowledged throughout

Reconstructive surgery:Risk factors, outcomes and advanced indications

The first part of this thesis investigates outcomes in reconstructive flap surgery using big data analysis. Firstly, outcomes after flap reconstructive surgery for diabetic patients compared to non-diabetic ones, highlighting higher risks of complications for diabetic patients, especially those with insulin-dependent diabetes. Additionally, it examines the impact of age and frailty on postoperative outcomes, emphasizing the importance of considering frailty scores instead of age alone in surgical planning for elderly patients. This thesis also delves into the incidence and risk factors of sepsis following reconstructive flap surgery, revealing significant associations with various patient factors. Moreover, racial disparities in outcomes after breast reconstructive surgery are explored, showing no differences in outcomes between different ethnicities. In the second part of this thesis, alternative surgical approaches for managing complications post-rectal/pelvic cancer surgery are discussed. These include the use of gluteal turnover flaps for perineal closure and a dorsal approach with partial sacrectomy followed by gluteal V-Y fasciocutaneous advancement flaps for treating chronic pelvic sepsis. Both techniques show promise in reducing complications and promoting wound healing. The effectiveness of gluteal fasciocutaneous flaps in treating chronic pelvic sepsis is highlighted specifically, offering a feasible and successful alternative for patients with limited options due to previous surgeries or (chemo)radiotherapy. Limitations of the studies, such as their retrospective nature and diverse patient populations, are acknowledged throughout

The effect of hospital financial distress on immediate breast reconstruction

Hospital financial stress is a common problem. From 1995-2010 15-30% of hospitals every year were classified as financially distressed based on a negative total profit margin. However, very few studies to date have assessed the impact of hospital financial distress on quality of care indicators or patient outcomes. A comprehensive and systematic literature review was conducted to assess the state of the science on hospital financial distress and quality of care or patient outcomes. A total of three peer-reviewed articles were found that used a measure of hospital financial distress as an exposure with a quality of care indicator or health-related factor as an outcome. However, despite the limited research on this topic, the evidence suggested there was an important relationship between hospital financial distress and patient outcomes. What became clear after the systematic literature review was that not only had very few studies ever assessed the relationship between hospital financial distress and patient outcomes, but there was also limited evidence on the validity of various measures of hospital financial distress. An analysis conducted as part of this dissertation assessed the validity of profit margin, as well as two composite measures, the Financial Strength Index and the modified z-index, to see how well they predicted hospital closure. Overall, despite the added complexity of the Financial Strength Index and the modified z-index compared to profit margin, all three measures performed similarly with respect to predicting hospital closure. Finally, profit margin, as a measure of hospital financial distress was used to predict the receipt of immediate breast reconstruction. Women undergoing mastectomy at hospitals under high levels of hospital financial distress were significantly less likely to receive immediate breast reconstruction compared to women treated at hospitals under minimal to no financial distress, adjusting for important confounders. This means hospital financial distress is an important, although unwarranted, determinant of breast cancer care

Local safety of immediate reconstruction during primary treatment of breast cancer : direct-to-implant versus expander-based surgery

Introduction: After mastectomy, immediate breast reconstruction is paramount. With the growing number of nipple-sparing mastectomies, the chances of successful one-stage reconstruction with implants are also increasing. Local safety is one of the main issues. This study investigated the factors that could lead to major or minor complications after expander-based versus direct-to-implant (DTI) reconstruction. Methods: The studied factors were age, body mass index (BMI), hypertension, smoking, diabetes, type of mastectomy (nipple-sparing/total), implant size, neoadjuvant/adjuvant chemotherapy, and radiotherapy. The study sample included 294 immediate reconstructions over 3 years. The primary outcome was the incidence of complications, major or minor depending on the necessity of revision surgery. For the DTI pocket, we applied a variant of the conventional submuscular technique. Results: In DTI reconstructions (median follow-up 26 months), the complication rate was 17.2% (4.3% major and 12.8% minor) with no significant association with clinical variables. In expander-based reconstructions (median follow-up 19 months), the complication rate was 18.3% (12.5% major and 5.8% minor). Univariate analysis showed a significant association between overall complications and radiotherapy (P = 0.01) as well as between major complications and expander size (P < 0.005), BMI (P < 0.005), and radiotherapy (P < 0.01); radiotherapy and BMI retained significance in multivariate analysis. Neoadjuvant/adjuvant chemotherapy did not affect the complication rate. Conclusions: There was evidence of an association between major complications and clinical variables in the expander-based cohort. Larger expander size was a predictor of failure, especially combined with radiation. Direct-to-implant reconstruction proved to be safe. We describe a reliable method of reconstruction and a safe range of implant sizes even beyond 500 g

Cost effectiveness of bilateral prophylactic mastectomy with and without different breast reconstruction techniques versus screening in women with high risk of breast cancer in the Canadian province of Ontario

We aimed to investigate the cost-effectiveness of bilateral prophylactic mastectomy (BPM) with and without different reconstruction for the purpose of determining which strategies represent value for money. We developed a decision analytic model to project the lifetime clinical and economic consequences of different strategies. The decision model was parameterized using 10-year follow up and cost data from Ontario administrative health databases and Ontario Cancer registry. Compared to the organized screening-based strategy, surgical strategies ranged from being more effective and cost-saving and up to being associated with an incremental cost effectiveness ratio (ICER) of $63,010 per quality-adjusted life year (QALY) gained, with BPM with immediate one-stage acellular dermal matrix (ADM)-assisted implant breast reconstruction having the greatest incremental QALY of 1.157 and lowest ICER of$9,615. BPM with immediate one-stage ADM-assisted implant breast reconstruction is the most cost-effective strategy and appears to offer the highest value for money

A patient-specific FE-based methodology to simulate prosthesis insertion during an augmentation mammoplasty

[EN] Breast augmentation surgery is a widespread practice for aesthetic purposes. Current techniques, however, are not able to reliably predict the desired final aspect of the breast after the intervention, whose success relies almost completely on the surgeon's skill. In this way, patient-specific methodologies capable of predicting the outcomes of such interventions are of particular interest. In this paper, a finite element biomechanical model of the breast of a female patient before an augmentation mammoplasty was generated using computer tomography images. Prosthesis insertion during surgery was simulated using the theory of finite elasticity. Hyperelastic constitutive models were considered for breast tissues and silicone implants. The deformed geometry obtained from finite element analysis was compared qualitatively and quantitatively with the real breast shape of the patient lying in supine position, with root-mean-squared errors less than 3. mm. The results indicate that the presented methodology is able to reasonably predict the aspect of the breast in an intermediate step of augmentation mammoplasty, and reveal the potential capabilities of finite element simulations for visualization and prediction purposes. However, further work is required before this methodology can be helpful in aesthetic surgery planning. © 2011 IPEM.The support of Instituto de Salud Carlos III (ISCIII) through the CIBER initiative, and the support of Platform for Biological Tissue Characterization of the Centro de Investigacion Biomedica en Red de Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN) are highly appreciated. The translation of this paper was funded by the Universitat Politecnica de Valencia, Spain.Lapuebla-Ferri, A.; Perez Del Palomar, A.; Herrero, J.; Jimenez Mocholi, AJ. (2011). A patient-specific FE-based methodology to simulate prosthesis insertion during an augmentation mammoplasty. Medical Engineering & Physics. 33(9):1094-1102. https://doi.org/10.1016/j.medengphy.2011.04.014S1094110233