The Influence of Personality on Health Complaints and Quality of Life in Women With Breast Implants

BACKGROUND: A causal relation between systemic symptoms and breast implants is not established. Psychological factors, such as personality and psychological distress, are strongly associated with the development of medically unexplained symptoms. It could be hypothesized that psychological factors may be related to the development of breast implant illness (BII). OBJECTIVES: This study was conducted to evaluate the correlation between self-reported health complaints, health- and breast-related Quality of Life (QoL), and personality, in women with cosmetic breast implants. METHODS: Women who attended the plastic surgery outpatient clinic of Maastricht University Medical Center between October 2020 and October 2021 for reasons related to their implants and women recruited for one of our BII-studies during this period were invited to this study. Only women who underwent cosmetic breast augmentation were eligible. Participants completed a physical complaints score form and BREAST-Q, SF-36, EPQ-RSS questionnaires via an online survey. RESULTS: In total, 201 women completed the questionnaires. Extroversion and social desirability were predominant personality traits in women with breast implants, followed by neuroticism. Relatively high levels of neuroticism were found compared to normative data. Neuroticism correlated significantly with health status and breast-related QoL. Health related QoL had the strongest correlation with neuroticism (β= -3.94, β= -4.86 p <.001). CONCLUSIONS: Personality can play a role in the development of complaints. High levels of neuroticism are seen in cosmetic surgery patients and are negatively correlated with subjective health and patient-reported outcomes in women with breast implants. Therefore, neuroticism may be a factor in the development of BII

Neuroimaging in Breast Implant Illness, an fMRI Pilot Study

BACKGROUND: Some women with breast implants report systemic and cognitive symptoms known as breast implant illness (BII), which are very similar to those of fibromyalgia. Functional MRI has shown altered brain activity in fibromyalgia patients. OBJECTIVES: In this pilot study, we investigated whether brain alterations could be observed in BII patients using fMRI. METHODS: Women aged 18 to 76 with silicone breast implants for cosmetic reasons were recruited through a Dutch online BII support organization (MKS) and through Maastricht University Medical Center. Twelve women with BII and twelve women without symptoms were included. Participants completed questionnaires regarding demographic characteristics, medical history, psychosocial complaints (4DSQ), cognitive failure (MSSE), pain intensity and pain-related disability (CPGS). Subsequently, brain images of all participants were obtained using resting-state fMRI (rs-fMRI) and Diffusion Tensor Imaging (DTI) at a 3 Tesla MRI scanner (Siemens Medical System, Erlangen, Germany). RESULTS: Eleven BII patients and 12 healthy controls were included for analysis. Baseline characteristics were similar in the two groups and the mean silicone exposure was 15 years. Patients scored significantly higher on both pain intensity and disability than controls. Patients scored worse on depression, somatization, distress, and anxiety compared to asymptomatic women. MMSE scores were normal. However, the analyses of both functional connectivity and structural integrity showed no significant differences between the two groups. CONCLUSIONS: This pilot study showed no evidence of brain alterations in BII patients. However, patients scored significantly worse on psychosocial symptoms than controls. Psychological factors appear to play an important role in BII and should be further investigated

Clinical Relevance of Sensory Nerve Coaptation in DIEP Flap Breast Reconstruction Evaluated Using the BREAST-Q

INTRODUCTION: Sensory nerve coaptation in autologous breast reconstruction positively affects the sensory recovery in the reconstructed breast. However, patient-reported outcomes are currently lacking and no conclusions on the clinical relevance of nerve coaptation could be drawn. The aim of this study was to evaluate the clinical relevance of nerve coaptation in deep inferior epigastric perforator (DIEP) flap breast reconstruction. METHODS: A prospective cohort study was conducted with patients with innervated or noninnervated DIEP flap breast reconstruction between August 2016 and August 2018, and completed a BREAST-Q questionnaire at a minimum of 12 months postoperative, in combination with a preoperative questionnaire or at 6 months postoperative. The domain "Physical well-being of the chest" was the primary outcome and patients answered additional sensation-specific questions. Sensation was measured using Semmes-Weinstein monofilaments. RESULTS: In total, 120 patients were included (65 innervated and 55 noninnervated reconstructions). A clinically relevant difference was found in BREAST-Q scores in favor of patients with innervated reconstructions in general, and for delayed reconstructions in specific. Patients with sensate breast reconstruction more often experienced better and pleasant sensation. CONCLUSIONS: This study demonstrated that nerve coaptation in DIEP flap breast reconstruction, specifically in delayed reconstructions, resulted in clinically relevant higher patient-reported outcomes for the BREAST-Q domain "Physical well-being of the chest" and that better sensation was perceived pleasantly. However, the BREAST-Q does not adequately address sensation, and the introduction and validation of new scales is required to fill in these gaps to confirm the clinical relevance of nerve coaptation reliably

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema:results over 24-months follow-up

PURPOSE: Lymphedema is a debilitating condition that significantly affects patient's quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema. METHODS: A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes. RESULTS: One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group. CONCLUSIONS: LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented

Outcomes following lymphaticovenous anastomosis (LVA) for 100 cases of lymphedema: results over 24-months follow-up

PURPOSE: Lymphedema is a debilitating condition that significantly affects patient's quality of life (QoL). The aim of this study was to assess the long-term outcomes after lymphaticovenous anastomosis (LVA) for extremity lymphedema. METHODS: A single-center prospective study on upper and lower extremity lymphedema patients was performed. All LVA procedures were preceded by outpatient Indocyanine Green (ICG) lymphography. Quality of life measured by the Lymph-ICF was the primary outcome. Limb circumference, use of compression garments, and frequency of cellulitis episodes and manual lymphatic drainage (MLD) sessions were secondary outcomes. RESULTS: One hundred consecutive patients, predominantly experiencing upper extremity lymphedema following breast cancer (n = 85), underwent a total of 132 LVAs. During a mean follow-up of 25 months, mean Lymph-ICF score significantly decreased from 43.9 preoperative to 30.6 postoperative, representing significant QoL improvement. Decrease in upper and lower limb circumference was observed in 52% of patients with a mean decrease of 6%. Overall mean circumference was not significantly different. Percentage of patients that could reduce compression garments in the upper and lower extremity group was 65% and 40%, respectively. Number of cellulitis episodes per year and MLD sessions per week showed a mean decrease of respectively 0.6 and 0.8 in the upper extremity and 0.4 and 1.0 in the lower extremity group. CONCLUSIONS: LVA resulted in significant QoL improvement in upper and lower extremity lymphedema patients. Limb circumference did not significantly improve but good results concerning compression garments, cellulitis episodes, and MLD sessions were obtained. Additionally, a simple and patient-friendly method for outpatient ICG lymphography is presented

Donor site complications and satisfaction in autologous fat grafting for breast reconstruction:A systematic review

BACKGROUND: Breast cancer is the most common cancer in females worldwide. One option for total breast reconstruction following total breast amputation is autologous fat transfer (AFT). However, this is still an upcoming reconstruction technique, and little is known about the donor site complications and their influence on the patient's overall satisfaction. OBJECTIVES: This systematic review aims to review the current literature regarding donor site complications and donor site satisfaction following AFT for total breast reconstruction. SEARCH METHODS: A literature search was performed in PubMed, Web of Science, Embase, Cochrane, TRIP pro, and Prospero. All published original literature reporting on complications or satisfaction at the donor site in patients who underwent liposuction, followed by high-volume lipofilling was considered. MAIN RESULTS: This systematic review resulted in the inclusion of 21 cohort studies, consisting of 2241 participants. None of the studies reported donor site satisfaction scores of any kind. The most frequently reported donor site complication was ecchymosis (268 cases), followed by pain (122 cases), haematoma (58 cases), irregularities (12 cases), burns (four cases), and infection (three cases). Reports on follow-up and management of donor site complications were generally lacking. AUTHOR'S CONCLUSIONS: Results regarding the donor site are inconclusive. Pre-specified complications, a standardized manner of reporting, long-term follow-up, and patient-reported outcome measures are lacking in most of the studies. The impact of the donor site on quality of life after autologous fat grafting in breast reconstruction remains a blind spot. PROSPERO registration number: CRD42020222870