title: Mastopexy for breast ptosis: Utility outcomes of population preferences.
abstract: BACKGROUND
  Breast ptosis can occur with aging, and after weight loss and breastfeeding. Mastopexy is a procedure used to modify the size, contour and elevation of sagging breasts without changing breast volume. To gain more knowledge on the health burden of living with breast ptosis requiring mastectomy, validated measures can be used to compare it with other health states.
  
  
  OBJECTIVE
  To quantify the health state utility assessment of individuals living with breast ptosis who could benefit from a mastopexy procedure; and to determine whether utility scores vary according to participant demographics.
  
  
  METHODS
  Utility assessments using a visual analogue scale (VAS), time trade-off (TTO) and standard gamble (SG) methods were used to obtain utility scores for breast ptosis, monocular blindness and binocular blindness from a sample of the general population and medical students. Linear regression and the Student's t test were used for statistical analysis; P<0.05 was considered to be statistically significant.
  
  
  RESULTS
  Mean (± SD) measures for breast ptosis in the 107 volunteers (VAS: 0.80±0.14; TTO: 0.87±0.18; SG: 0.90±0.14) were significantly different (P<0.0001) from the corresponding measures for monocular blindness and binocular blindness. When compared with a sample of the general population, having a medical education demonstrated a statistically significant difference in being less likely to trade years of life and less likely to gamble risk of a procedure such as a mastopexy. Race and sex were not statistically significant independent predictors of risk acceptance.
  
  
  CONCLUSIONS
  For the first time, the burden of living with breast ptosis requiring surgical intervention was determined using validated metrics (ie, VAS, TTO and SG). The health burden of living with breast ptosis was found to be comparable with that of breast hypertrophy, unilateral mastectomy, bilateral mastectomy, and cleft lip and palate. Furthermore, breast ptosis was considered to be closer to 'perfect health' than monocular blindness, binocular blindness, facial disfigurement requiring face transplantation surgery, unilateral facial paralysis and severe lower extremity lymphedema.
  
  
  CONCLUSIONS
  Quantifying the health burden of living with breast ptosis requiring mastopexy indicated that is comparable with other breast-related conditions (breast hypertrophy and bilateral mastectomy). Numerical values have been assigned to this health state (VAS: 0.80±0.14; TTO: 0.87±0.18; and SG: 0.90±0.14), which can be used to form comparisons with the health burden of living with other disease states.
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
authors.forename: Ahmed Ms
authors.initials: AM
authors.lastname: Ibrahim
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; ; Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Hani H
authors.initials: HH
authors.lastname: Sinno
authors.affiliation: Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Ali
authors.initials: A
authors.lastname: Izadpanah
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
authors.forename: Joshua
authors.initials: J
authors.lastname: Vorstenbosch
authors.affiliation: Division of Plastic Surgery, Jewish General Hospital, McGill University, Montreal, Quebec.
authors.forename: Tassos
authors.initials: T
authors.lastname: Dionisopoulos
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
authors.forename: Mark K
authors.initials: MK
authors.lastname: Markarian
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
authors.forename: Bernard T
authors.initials: BT
authors.lastname: Lee
authors.affiliation: Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA;
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Lin
keywords: Breast ptosis; Health state preference; Mastopexy; Utility score