Women Who Want ‘Revenge on Cancer’ May Have Better Psychological Responses

Certain personality traits are linked to higher quality of life scores in breast cancer patients who undergo breast reconstruction after mastectomy, reports a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Silvio Bellino, MD, and colleagues at the University of Turin, Italy, gave a battery of psychological tests to 57 women with breast cancer who underwent mastectomy and immediate breast reconstruction. The goal was to look at how various personality dimensions and patterns of interpersonal functioning affected quality of life after surgery.

Personalities Affect Women’s Outlook after Breast Loss and Reconstruction

After adjustment for other factors, two personality types were linked to higher quality of life scores. This included women with high scores for the temperamental characteristic of “harm avoidance” – a group that Dr. Bellino and coauthors characterize as “apprehensive and doubtful.” For these patients, they write, “Restoration of body image could help…to reduce social anxiety and insecurity.”

Patients rated as “vindictive/self-centered” on a scale of interpersonal problems also had higher quality of life scores. “Vindictive/self-centered patients are resentful and aggressive,” according to Dr. Bellino and colleagues. “Breast reconstruction could symbolize the conclusion of a reparative process and fulfill the desire of revenge on cancer.”

None of the other psychological or other factors evaluated – including the characteristics of the cancer and its treatment – were significantly related to quality of life scores. Overall, mastectomy followed by breast reconstruction yielded significant improvement in quality of life.

As survival rates improve, there is increased attention to the quality of life in breast cancer survivors. More women are undergoing breast reconstruction immediately after mastectomy, which seems to reduce the psychological impact of treatment. The new study is one of the first to look at how personality factors might affect patient satisfaction and quality of life after mastectomy and breast reconstruction.

The results suggest that some personality characteristics have an important impact on psychological recovery after breast cancer treatment. Based on their findings, “A preoperative personality assessment of patients requiring breast reconstruction will be useful to identify predictive factors of better subjective quality of life after surgery,” Dr. Bellino and colleagues believe. Such an assessment could help to identify women who could benefit from a brief course of psychotherapy during the period after reconstruction, with the goals of “preventing depressive symptoms and improving interpersonal relations.”

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If you’re considering breast augmentation, it is important to be an active participant in the process. The ASPS has developed the following list of questions to ask during your consultation:

  • Are you certified by the American Board of Plastic Surgery?
  • Were you trained specifically in the field of plastic surgery?
  • How many years of plastic surgery training have you had?
  • Do you have hospital privileges to perform this procedure?
  • Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
  • Am I a good candidate for breast enhancement or breast enlargement?
  • What will be expected of me to get the best results?
  • Where and how will you perform my breast augmentation surgery?
  • What shape, size, surface texturing, incision site and placement site are recommended for me?
  • How long of a recovery period can I expect, and what kind of help will I need during my recovery?
  • What are the risks and complications associated with my procedure?
  • How many additional implant-related operations can I expect over my lifetime?
  • How will my ability to breastfeed be affected?
  • How can I expect my implanted breasts to look over time?
  • What are my options if I am dissatisfied with the cosmetic outcome of my implanted breasts?
  • How will my breasts look if I choose to have the implants removed in the future without replacement?
  • Do you have breast augmentation before-and-after photos I can look at for this procedure and what results are reasonable for me?
  • If so, at which hospitals?
  • How are complications handled?
  • After pregnancy? After breastfeeding?
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For Optimal Facial Rejuvenation, Plastic Surgeons Should Consider What’s Going on Under the Skin

What makes us look older? Wrinkles and sagging result not just from changes in the skin, but also from age-related changes in the underlying facial bones, according to a report in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

The researchers, led by Robert Shaw, Jr., MD, at the University of Rochester Medical Center, analyzed computed tomography scans of the facial bones in young (age 20 to 40), middle-aged (41 to 64), and older (65 and up) age groups. All scans were performed for medical reasons-not for planning plastic surgery.

Aging Linked to Changes in Eye Sockets, Jaw Bones, and More

Detailed measurements in three-dimensional reconstructions of the CT scans showed some important differences in the facial bone structure (or facial skeleton) between age groups. “The facial skeleton experiences morphologic change and an overall decrease in volume with increasing age,” Dr. Shaw and colleagues write.

One prominent change was an increase in the area of the “orbital aperture” – that is, the eye sockets. In both men and women, the eye sockets became wider and longer with age. Aging also affected the bones of the middle part of the face, including reductions in the glabellar (brow), pyriform (nose), and maxillary (upper jaw) angles.

The length and height of the mandible (lower jaw) decreased with age as well. Although these changes occurred in both sexes, many occurred earlier in women – between young and middle age. In men, most of the changes occurred between middle age and old age.

Plastic surgeons are experts at dealing with changes in the skin and underlying soft tissues that contribute to an aged appearance of the face. However, as the new study demonstrates, they must also understand the contribution of changes in the underlying facial bones.

“The bony components of the face are important for overall facial three-dimensional contour as they provide the framework on which the soft-tissue envelope drapes,” Dr. Shaw and coauthors write. For example, the enlarging eye socket and decreasing brow angle could contribute to frown lines on the forehead, “crow’s feet” at the corners of the eyes, and drooping of the lower eyelid.

By using materials and techniques for skeletal augmentation, plastic surgeons can improve the outcomes of facial rejuvenation, Dr. Shaw and colleagues believe. They discuss the “aesthetic implications” of changes in the facial bone structure, and outline some strategies plastic surgeons can follow to optimize the final results for patients who desire a more youthful appearance.

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