title: Contemporary decision making and perception in patients undergoing cosmetic breast augmentation.
abstract: BACKGROUND
  Today's breast augmentation (BA) patient obtains information from a variety of sources that may positively or negatively influence her decision.
  
  
  OBJECTIVE
  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).
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Lenox Hill Hospital/Manhattan Eye, Ear, and Throat Institute, 50 East 71st Street, New York, NY 10021, USA. drjenniferwalden@hotmail.com
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Walden
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulous
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Shrader
mesh_terms: D000328:Adult; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods / Q000523:psychology*; D018427:Breast Implants / Q000523:psychology*; D003625:Data Collection; D003657:Decision Making; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D008875:Middle Aged; D011183:Postoperative Complications / Q000523:psychology; D055815:Young Adult