title: Chinese women's preferences and concerns regarding incision location for breast augmentation surgery: a survey of 216 patients.
abstract: BACKGROUND
  The axillary approach is the dominant incision used in China for breast augmentation. Systematic preoperative education regarding incision locations for breast augmentation is scarce in China. In this study, we surveyed Chinese patients to ascertain their preferences and concerns for incision location based on a comprehensive understanding of different incisions.
  
  
  METHODS
  We used a literature review, patient interviews, and expert panels to develop the preoperative education material and questionnaire regarding different incision locations. The respondents were requested to choose one incision location before and after they received the preoperative education. Their initial choices and final decisions as well as the reasons for these choices were recorded and analyzed. Multinomial logistic regression was preformed to analyze the affecting factors on the incision choice.
  
  
  RESULTS
  A total of 216 Chinese women participated in the study between 2012.5 and 2014.1. Initially, 176 (81.48%) women chose axillary incision, 27 (12.50%) chose periareolar incision, and 13 (6.02%) chose inframammary fold (IMF) incision. After they received preoperative education on incisions, the axillary and periareolar approaches decreased to 117 (54.17%) and 13 (6.02%), respectively, while IMF increased to 86 (39.81%). The easily hidden scar (43.98%), lower capsular contracture rate (23.15%), and lower possibility of injury to the breast parenchyma (17.13%) ranked as the top 3 reasons for the incision choice. Patients with a preoperative cup size of AA were 12.316 times more likely to choose the axillary approach relative to the IMF approach compared with those with a B cup (P = 0.044; 95% confidence interval [CI] 1.069-141.923). For each one-unit increase in BMI, the odds that a patient would choose the axillary versus the periareolar approach decreased by 32.4% (P = 0.049; 95% CI 0.457-0.999).
  
  
  CONCLUSIONS
  The systematic and objective preoperative education material and questionnaire regarding different incision locations helped the Chinese patients make truly informed decisions and express their personal requirements. The axillary approach was the first option for more than half of Chinese women mainly because an easily hidden scar was considered the primary concern during the decision-making process. The patients with a low BMI and a small preoperative breast cup size were more likely to choose an axillary incision. However, a considerable number of Chinese women would choose the IMF incision and value its superiority in terms of a lower capsular contracture rate, less tissue trauma, and lower possibility of injury to the breast parenchyma.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
authors.affiliation: Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, 100144, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Sun
authors.forename: Chunjun
authors.initials: C
authors.lastname: Liu
authors.forename: Dali
authors.initials: D
authors.lastname: Mu
authors.forename: Keming
authors.initials: K
authors.lastname: Wang
authors.forename: Sainan
authors.initials: S
authors.lastname: Zhu
authors.forename: Yi
authors.initials: Y
authors.lastname: He
authors.forename: Jie
authors.initials: J
authors.lastname: Luan
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002681:China; D002921:Cicatrix / Q000517:prevention & control; D005260:Female; D006801:Humans; D016015:Logistic Models; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D055815:Young Adult