title: Does breast reconstruction impact the decision of patients to pursue cosmetic surgery?
abstract: BACKGROUND
  Breast reconstruction is an integral component of breast cancer treatment, often aiding in restoring a patient's sense of femininity. However, many patients choose to have subsequent cosmetic surgery. The purpose of this study is to investigate the reasons that motivate patients to have cosmetic surgery after breast reconstruction.
  
  
  METHODS
  The authors performed a retrospective study examining patients who had breast reconstruction and subsequent cosmetic surgery at the University of Pennsylvania Health System between January 2005 and June 2012. This cohort received a questionnaire assessing the influences and impact of their reconstructive and cosmetic procedures.
  
  
  RESULTS
  A total of 1,214 patients had breast reconstruction, with 113 patients (9.3%) undergoing cosmetic surgery after reconstruction. Of 42 survey respondents, 35 had autologous breast reconstruction (83.3%). Fifty-two cosmetic procedures were performed in survey respondents, including liposuction (26.9%) and facelift (15.4%). The most common reason for pursuing cosmetic surgery was the desire to improve self-image (n = 26, 61.9%), with 29 (69.0%) patients feeling more self-conscious of appearance after reconstruction. Body image satisfaction was significantly higher after cosmetic surgery (P = 0.0081). Interestingly, a multivariate analysis revealed that patients who experienced an improvement in body image after breast reconstruction were more likely to experience a further improvement after a cosmetic procedure (P = 0.031, OR = 17.83). Patients who were interested in cosmetic surgery prior to reconstruction were also more likely to experience an improvement in body image after cosmetic surgery (P = 0.012, OR = 22.63).
  
  
  CONCLUSIONS
  Cosmetic surgery may improve body image satisfaction of breast reconstruction patients and help to further meet their expectations.
authors.affiliation: From the *Division of Plastic Surgery, The Perelman School of Medicine at the University of Pennsylvania; and †MD Anderson Cancer Center, Department of Plastic Surgery, Houston, TX.
authors.forename: Vivian M
authors.initials: VM
authors.lastname: Hsu
authors.forename: Youssef
authors.initials: Y
authors.lastname: Tahiri
authors.forename: Ari M
authors.initials: AM
authors.lastname: Wes
authors.forename: Chen
authors.initials: C
authors.lastname: Yan
authors.forename: Jesse C
authors.initials: JC
authors.lastname: Selber
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Nelson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Serletti
authors.forename: Liza C
authors.initials: LC
authors.lastname: Wu
mesh_terms: D001828:Body Image; D003357:Cosmetic Techniques / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods / Q000523:psychology*; D008408:Mastectomy / Q000523:psychology*; D009042:Motivation; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D010414:Pennsylvania; D012189:Retrospective Studies; D012649:Self Concept; D011795:Surveys and Questionnaires