Lenox Hill Hospital/Manhattan Eye, Ear, and Throat Institute, 50 East 71st Street, New York, NY 10021, USA.
Aesthet Surg J. 2010 May-Jun;30(3):395-403. doi: 10.1177/1090820X10374101.
Today's breast augmentation (BA) patient obtains information from a variety of sources that may positively or negatively influence her decision.
The authors evaluate the decision-making process of patients undergoing BA, including how they seek information regarding the procedure, potential complications, the medical device itself, referral sources, and surgeon(s).
A written 36-item, blinded survey developed for this study was administered to all patients who underwent aesthetic primary BA by the senior author (JW) over a 12-month period in her metropolitan private practice. Patients were included only if they had undergone surgery after Food and Drug Administration approval of silicone implants and had at least four months of follow-up. Patients were excluded if they underwent reconstruction, revision, augmentation/mastopexy, or implant exchange. Data were analyzed utilizing descriptive statistics; frequencies of responses were calculated with SPSS (version 16).
Of 153 mailed surveys, 100 respondents returned completed questionnaires (65%). Mean age was 30 years (range, 20-50 years). Eighty-eight patients were in the workforce, eight were students, and three were homemakers. Thirty-three percent had completed some graduate work or had a graduate degree, and 41% had a college degree. In terms of how patients began their informational searches, 41% began with Google, 18% began with a BA portal Web site, and 1% went through referral from a primary care provider (PCP)/OB-GYN. The primary influence in a patient's decision to have BA was her own desire to change her appearance (36%), and second was her plastic surgeon's Web site (16%). On a graded scale of 10 factors ranking importance (1 = not at all and 5 = extremely), 52% said that their plastic surgeon's Web site very much or extremely influenced their decision. Of respondents, 82% had silicone implants (18% saline). The most influential factor in choosing implant filler was the feel of the silicone versus saline implants (for 41%), followed by the plastic surgeon's explanation of the difference (29%) and recent FDA approval (13%). Primary sources of information for possible complications were the plastic surgeon and BA portal sites. When asked what the worst complication could be, patients reported capsular contracture (37%), implant rupture or leak (22%), and infection (20%). The most powerful influence on choice of surgeon for BA was the plastic surgeon's Web site (49%); meeting the doctor in consultation was next (14%), followed by BA portal sites (9%). Thirty-six percent of respondents consulted with a psychiatrist or psychologist at some point in their lives, with depression, anxiety, and stress management as top-ranked reasons (in that order).
The Internet (specifically Google, the plastic surgeon's Web site, and portal Web sites) is very important to patients ages 20 to 50 in their search for information on BA. Educational and reality TV may have less influence on this particular group than was previously thought. Patients are well educated, are part of the workforce, and seem to be independent and private thinkers when it comes to their decision making. Referral sources such as the PCP assume a much smaller role in the search for information than in days past.
如今，接受隆胸（BA）的患者可以从各种渠道获取信息，这些信息可能会对她们的决策产生积极或消极的影响。
作者评估接受 BA 的患者的决策过程，包括她们如何获取有关手术、潜在并发症、医疗器械本身、推荐来源和（或）外科医生的信息。
作者针对该研究设计了一份 36 项的书面匿名调查问卷，并在作者（JW）于其所在的大都市私人执业机构进行的为期 12 个月的美学初次 BA 中对所有患者进行了调查。只有在获得食品和药物管理局批准硅胶植入物后接受手术且至少随访 4 个月的患者才被纳入研究。如果患者接受了重建、修复、隆胸/乳房提升或植入物更换，则被排除在外。数据采用描述性统计进行分析；利用 SPSS（版本 16）计算了应答频率。
共邮寄了 153 份调查问卷，其中 100 份（65%）回收了完成的问卷。平均年龄为 30 岁（范围：20-50 岁）。88 名患者在职，8 名是学生，3 名是家庭主妇。33%的患者完成了一些研究生课程或拥有研究生学位，41%的患者拥有大学学位。在开始信息搜索方面，41%的患者首先使用 Google，18%的患者首先使用 BA 门户网站，1%的患者通过初级保健提供者（PCP）/妇产科医生进行推荐。患者决定接受 BA 的主要原因是自身改变外貌的愿望（36%），其次是她们的整形外科医生的网站（16%）。在对 10 个因素的重要性进行 10 级评分（1=毫不重要，5=极其重要）时，52%的患者表示他们的整形外科医生的网站对他们的决策非常有影响或极其有影响。在受访者中，82%的患者选择了硅胶植入物（18%的患者选择了盐水植入物）。选择植入物填充物的最主要因素是硅胶与盐水植入物的触感（对 41%的患者来说），其次是整形外科医生对差异的解释（29%）和最近的 FDA 批准（13%）。可能的并发症的主要信息来源是整形外科医生和 BA 门户网站。当被问及最坏的并发症是什么时，患者报告了包膜挛缩（37%）、植入物破裂或泄漏（22%）和感染（20%）。对 BA 外科医生选择影响最大的因素是整形外科医生的网站（49%）；其次是在咨询中与医生见面（14%），然后是 BA 门户网站（9%）。36%的受访者在生活中的某个时刻咨询过精神科医生或心理学家，排名最高的原因是抑郁、焦虑和压力管理（依次排列）。
20 至 50 岁的患者在搜索 BA 信息时非常依赖互联网（尤其是 Google、整形外科医生的网站和门户网站）。教育和真人秀电视对这一特定群体的影响可能不如以前认为的那么大。患者接受过良好的教育，在职场工作，并且在决策方面似乎是独立和隐私意识强的思考者。与过去相比，推荐来源（如 PCP）在信息搜索中的作用要小得多。
