Ibrahim Ahmed Ms, Sinno Hani H, Izadpanah Ali, Vorstenbosch Joshua, Dionisopoulos Tassos, Markarian Mark K, Lee Bernard T, Lin Samuel J
Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; ; Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec.
Plast Surg (Oakv). 2015 Summer;23(2):103-7. doi: 10.4172/plastic-surgery.1000916.
Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states.
To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics.
Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant.
Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance.
For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to 'perfect health' than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema.
Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
乳房下垂可随年龄增长、体重减轻及哺乳后出现。乳房上提术是一种用于改变下垂乳房的大小、轮廓和高度而不改变乳房体积的手术。为了更深入了解因乳房下垂需行乳房切除术的健康负担，可使用经过验证的测量方法将其与其他健康状况进行比较。
量化可从乳房上提术中获益的乳房下垂患者的健康状态效用评估；并确定效用得分是否因参与者的人口统计学特征而异。
使用视觉模拟量表（VAS）、时间权衡法（TTO）和标准博弈法（SG）进行效用评估，以从普通人群和医学生样本中获取乳房下垂、单眼失明和双眼失明的效用得分。采用线性回归和学生t检验进行统计分析；P<0.05被认为具有统计学意义。
107名志愿者乳房下垂的平均（±标准差）测量值（VAS：0.80±0.14；TTO：0.87±0.18；SG：0.90±0.14）与单眼失明和双眼失明的相应测量值有显著差异（P<0.0001）。与普通人群样本相比，接受医学教育显示在不太愿意用生命年限进行权衡以及不太愿意承担乳房上提术等手术风险方面存在统计学显著差异。种族和性别不是风险接受度的统计学显著独立预测因素。
首次使用经过验证的指标（即VAS、TTO和SG）确定了因乳房下垂需手术干预的健康负担。发现乳房下垂的健康负担与乳房肥大、单侧乳房切除术、双侧乳房切除术以及唇腭裂的负担相当。此外，与单眼失明、双眼失明、需要面部移植手术的面部毁容、单侧面部瘫痪和严重下肢淋巴水肿相比，乳房下垂被认为更接近“完美健康”。
量化因乳房下垂需行乳房上提术的健康负担表明，其与其他乳房相关疾病（乳房肥大和双侧乳房切除术）相当。已为这种健康状态赋予了数值（VAS：(0.80±0.14)；TTO：(0.87±0.18)；SG：(0.90±0.14)），可用于与其他疾病状态的健康负担进行比较。
