Objective assessment of quality of life in female patients after esthetic, non-oncologic or oncologic surgery of their mammary glands--reality and perspectives.
The World Health Organisation defines health as a state of complete physical, mental and social well-being, and not merely the absence of a disease or infirmity. The female breast, surgically considered as a "troubled organ", can be affected by disorders of various types. Its normal morphology can be changed by deformities which may have a serious impact on the mental state of female patients. Assessment of these deformities is essential when doctors should define the inclusion and exclusion criteria for each breast operation that has elements of esthetic surgery in it, the breast being indisputably a symbol of female beauty. When we consider the parameters of normal breast morphology, it is only proper to take into account their dependence on race, national culture, folk psychology, etc. For Bulgarian women, P. Tepavicharova has found that the distance from fossa jugularis to the nipple-areolar complex can have the following characteristic proportions: 15.5-17 cm for a woman 155-160 cm in height and with breast circumference of 75-80 cm; 17-18.5 cm for woman 160-165 cm in height and with breast circumference of 89-95 cm; and 18-20 cm for a woman 165-170 cm in height and with breast circumference of 95-100 cm. J. Lalardie points out that breast stability is determined by three principal factors: skin and its elasticity, the condition of the underlying collagenous structure of the breast, and the firm bond between the skin and fibrous elements. RB Brinks defines the four forms of ptosis of the breast: glandular ptosis, true ptosis, parenchymal maldistribution, and pseudoptosis. According to P. Tepavicharova, the violation of breast symmetry is the major factor triggering a sequence of psychosomatic reactions.


CONCLUSIONS
The basic parameters of female breast morphology are the mammary base, mammary perimeter, the forward projection of the breast, symmetry, breast volume, and the state of the axillary extension. The major deviations from normal breast morphology that can have an impact on the quality of life are mammary ptosis, hypertrophy, asymmetry, and deformations of the breast shape as well as the operation cicatrices on the breast. An assessment of the association of the deviations from normal morphology with the correction to normal morphology (with or without dealing with a pathological process) and with the impact on the quality of life is a possible base for objective assessment of the latter parameter.
Molov
Veselin V
VV
Surgery Clinic III, Medical University-Plovdiv, Bulgaria. molovdm@abv.bg
Tepavicharova
Penka P
PP
Deenichin
George P
GP
Mitov
Franz S
FS
D001941:Breast Diseases / Q000523:psychology* / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D010347:Patient Care Planning; D017060:Patient Satisfaction; D011788:Quality of Life