More exposure needed for cosmetic breast enhancement risks

Complications after cosmetic breast augmentation are more common than other cosmetic plastic surgery yet many women who undergo such procedures are often in the dark about the associated risks say QUT researchers.

The authors of a new paper argue the need for more disclosure early (and in much simpler terms) of those risks and the high likelihood of revision surgery being required so when women give their consent, they have a greater understanding of what may happen.

“The Australian cosmetic surgery industry is worth billions but there are concerns inside the industry on potential issues surrounding whether patients are being fully informed,” said Dr Stephen Whyte, lead author, behavioural economist, Senior Research Fellow and Deputy Director of QUT’s Centre for Behavioural Economics, Society and Technology (BEST Centre).

“Research indicates that close to one in five women believe their pre-operative expectations did not match the experience and post-operative results.”

The paper, Factors impacting informed consent in cosmetic breast augmentation, published in The Breast, is co-authored by Associate Professor Laura Bray, Martin Brumpton, Dr Ben (Ho Fai) Chan, Dr Timothy S Peltz (UNSW), Manisha Tamar, Professor Uwe Dulleck, and Distinguished Professor Dietmar W Hutmacher

The researchers conducted a randomised video-recorded experiment with 178 women aged 18-40 engaged in a hypothetical ‘first consultation’ with two actual Australian-based, experienced breast surgeons.

Questions asked of the participants included their age, height and weight, perception of their breast size, marital status, education level and whether they had children. Researchers also measured their socio-sexual orientation using the socio-sexual orientation inventory, a self-reported survey scale used to measure individual differences in sexual liberalism.

They found women who consider themselves healthier, are in some form of committed relationship, emotionally stable, and with higher levels of education are more inclined to understand the risks associated with cosmetic breast augmentation and less likely to undertake or recommend it to a friend.

Minor risks from breast augmentation can include bleeding during or after surgery, infection, interference with future mammograms, fluid collection around the implant, and a change in nipple and breast sensation. Higher risks can include rupture and deflation of the implant, capsular contracture, and secondary surgery with new often large direct financial costs.

“For patients who undergo breast augmentation surgery at a relatively young age such as in their mid-20s, the likelihood of revision surgery over their lifetime is close to 100 per cent,” Dr Whyte said.

“There is a growing consensus amongst plastic surgeons that during the consent phases of patient/doctor consultation, there exists a potential issue surrounding whether patients are being fully informed about the short-term and long-term risks, be it medical or financial.

“There are strict legal documents that explicitly point out all potential risks, but these documents can be vague, complicated, or insufficient in explicitly illustrating the likelihood of such events occurring for potential patients. So potential patients may be irrationally attaching very small probabilities to negative surgical outcomes.

“Some of the documentation is difficult even for medically trained experts to interpret and communicate. Our findings highlight a need for clearer pre-operative disclosure and consent forms composed in simpler language.

“Previous studies have suggested that consent forms be written to only a Year 6 level of language because patients may not understand or would likely forget much of the information disclosed to them by their medical expert.”

The full paper is available online: Factors impacting informed consent in cosmetic breast augmentation