title: Scar Assessment After Breast Augmentation Surgery with Axillary Incision versus Inframammary Fold Incision: Long-Term Follow-Up in Chinese Patients.
abstract: BACKGROUND
  The inframammary fold (IMF) incision is widely used in Western countries for breast augmentation surgery, whereas the axillary incision is the dominant approach used in China, because many Chinese surgeons believe that the Asian population has a higher risk of developing hypertrophic scars. However, comparative data of scar assessment through different incisions in Chinese patients are scarce. The aims of the study were as follows: (1) to evaluate the outcomes of scar assessment using the Vancouver scar scale (VSS), combined with patient satisfaction scoring, in the scar assessment after breast augmentation surgery; (2) to compare the long-term cosmetic effects of surgical scars between axillary and IMF incisions.
  
  
  METHODS
  Consecutive patients coming to our department for follow-up care at least 1 year after primary breast augmentation surgeries with axillary and IMF incisions between January 1, 2014 and December 31, 2014 were included in the research. Internal consistency, inter-rater reliability, and convergent validity were examined for the VSS and patient satisfaction scoring. The baseline characteristics and scar scores were tested using the Mann-Whitney U-test and Student's t test between the two groups.
  
  
  RESULTS
  Sixty-one patients underwent implantation surgeries through the axillary incisions, and 17 patients through the IMF incisions. There were no significant differences in age, follow-up time, body mass index, implant volume, or implant projection between groups. Reliability and validity of the VSS and patient satisfaction scoring were satisfactory. The scores of pigmentation were higher in the IMF group than those in the axilla group with statistical significance (P < 0.05). The scores of other subscales, overall VSS scores, and patient satisfaction were not statistically significant. The scars were significantly longer in the axilla group compared with the IMF group (P < 0.05).
  
  
  CONCLUSIONS
  The VSS combined with patient satisfaction scoring constitutes an effective tool to evaluate incision scars after augmentation mammaplasty. Scars in the axilla and IMF can achieve comparable cosmetic effects and patient satisfaction in Chinese women. Chinese patients with proper indications can receive breast augmentation surgery through the IMF incision, with fewer risks and less trauma, and get satisfactory scar appearance as through the axillary incision.
  
  
  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, Beijing, 100144, People's Republic of China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Sun
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, Beijing, 100144, People's Republic of China.
authors.forename: Dali
authors.initials: D
authors.lastname: Mu
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, Beijing, 100144, People's Republic of China.
authors.forename: Chunjun
authors.initials: C
authors.lastname: Liu
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, Beijing, 100144, People's Republic of China.
authors.forename: Kai
authors.initials: K
authors.lastname: Ji
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, Beijing, 100144, People's Republic of China.
authors.forename: Lin
authors.initials: L
authors.lastname: Chen
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, Beijing, 100144, People's Republic of China.
authors.forename: Wenyue
authors.initials: W
authors.lastname: Liu
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, Beijing, 100144, People's Republic of China. luanjie@psh.pumc.edu.cn.
authors.forename: Jie
authors.initials: J
authors.lastname: Luan
mesh_terms: D000328:Adult; D001365:Axilla / Q000601:surgery; D001940:Breast / Q000601:surgery; D019928:Breast Implantation / Q000009:adverse effects / Q000379:methods*; D002681:China; D002921:Cicatrix / Q000175:diagnosis*; D015331:Cohort Studies; D004954:Esthetics; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D015588:Observer Variation; D056888:Patient Positioning; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011182:Postoperative Care / Q000379:methods; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D055815:Young Adult
keywords: Breast augmentation; Chinese women; Incision location; Postsurgical scar assessment