Subjektive und objektive Langzeitanalyse nach Mammareduktionsplastik in 159 Fällen: Patientinnen urteilen anders als Plastische Chirurgen

Zusammenfassung

Hintergrund Hauptziel der vorliegenden Arbeit war einerseits die Erhebung subjektiver und objektiver postoperativer Parameter nach Mammareduktionsplastik und andererseits der Vergleich derselben zwischen Patientinnen und Plastischen Chirurgen.

Patientinnen und Methode Es konnten 259 Patientinnen in die retrospektive Fallserie eingeschlossen und 159 Patientinnen (61 %) nach einem durchschnittlichen Beobachtungszeitraum von 6.7 ± 2.7 (2 – 13) Jahren nachkontrolliert werden. Das mittlere Alter zum Zeitpunkt der Operation betrug 37 ± 14 (15 – 74) Jahre. Die postoperative Anatomie der Brust sowie weitere anthropometrische Parameter wurden bei stehender Patientin in cm gemessen und die visuellen Analogskala-Werte für Symmetrie, Grösse, Form, Narbenverlauf und Gesamtzufriedenheit zwischen Patientinnen und vier Plastischen Chirurgen verglichen.

Ergebnisse Die subjektiven Beurteilungen durch die Patientinnen waren stets besser als diejenigen der Chirurgen. Gute subjektive Bewertungen der Patientinnen für Form, Symmetrie und Sensibilität korrelierten mit einer guten Bewertung der Gesamtzufriedenheit. Dabei hatte die Form den stärksten Einfluss auf die Gesamtzufriedenheit (Regressionskoeffizient 0.357; p < 0.001) gefolgt von Symmetrie (Regressionskoeffizient 0.239; p < 0.001) und Sensibilität (Regressionskoeffizient 0.109; p = 0.040). Gute subjektive Bewertungen der Patientinnen für Symmetrie waren mit abnehmender Seitendifferenz des Jugulum-Mamillenabstandes (Regressionskoeffizient –0.773; p = 0.002) und abnehmender Seitendifferenz des Mammaunterrand – Bodenabstandes (Regressionskoeffizient –0.465; p = 0.035) korreliert. Es fand sich keine signifikante Korrelation von Alter, Gewicht, Grösse, BMI, Resektionsgewicht, postoperativer Brustgrösse oder Narbenverlauf mit Gesamtzufriedenheit.

Schlussfolgerung Patientinnen beurteilten das Langzeitresultat nach Mammareduktionsplastik signifikant besser als plastische Chirurgen. Gute subjektive Bewertungen der Patientinnen für Form, Symmetrie und Sensibilität der Brust korrelierten mit einer guten Bewertung der Gesamtzufriedenheit. Dabei hatte die Form den stärksten Einfluss, gefolgt von Symmetrie und Sensibilität. Die postoperative Brustgrösse, das Resektionsgewicht, der Narbenverlauf, das Alter und der BMI der Patientin hingegen zeigten keinen signifikanten Einfluss. Symmetrie war der einzige gemessene subjektive Parameter dieser Studie, welcher durch postoperative Messungen objektiviert werden konnte.

Abstract

Introduction This work assessed both subjective and objective postoperative parameters after breast reduction surgery and compared between patients and plastic surgeons.

Patients and Methods After an average postoperative observation period of 6.7 ± 2.7 (2 – 13) years, 159 out of 259 patients (61 %) were examined. The mean age at the time of surgery was 37 ± 14 (15 – 74) years. The postoperative anatomy of the breast and other anthropometric parameters were measured in cm with the patient in an upright position. The visual analogue scale (VAS) values for symmetry, size, shape, type of scar and overall satisfaction both from the patient’s and from four plastic surgeons’ perspectives were assessed and compared.

Results Patients rated the postoperative result significantly better than surgeons. Good subjective ratings by patients for shape, symmetry and sensitivity correlated with high scores for overall assessment. Shape had the strongest influence on overall satisfaction (regression coefficient 0.357; p < 0.001), followed by symmetry (regression coefficient 0.239; p < 0.001) and sensitivity (regression coefficient 0.109; p = 0.040) of the breast. The better the subjective rating for symmetry by the patient, the smaller the measured difference of the jugulum-mamillary distance between left and right (regression coefficient –0.773; p = 0.002) and the smaller the difference in height of the lowest part of the breast between left and right (regression coefficient –0.465; p = 0.035). There was no significant correlation between age, weight, height, BMI, resected weight of the breast, postoperative breast size or type of scar with overall satisfaction.

Conclusion After breast reduction surgery, long-term outcome is rated significantly better by patients than by plastic surgeons. Good subjective ratings by patients for shape, symmetry and sensitivity correlated with high scores for overall assessment. Shape had the strongest influence on overall satisfaction, followed by symmetry and sensitivity of the breast. Postoperative size of the breast, resection weight, type of scar, age or BMI was not of significant influence. Symmetry was the only assessed subjective parameter of this study that could be objectified by postoperative measurements.

Schlüsselwörter

Mammareduktionsplastik - subjektive und objektive Beurteilung - visuelle Analogskala - Zufriedenheit - Langzeitresultate

Key words

breast reduction surgery - subjective and objective parameters - visual analogue scale - satisfaction - long-term outcome

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