ORIGINAL ARTICLE Changes in Body Image and Health-Related Quality of Life Following Breast Reduction Surgery in German Macromastia Patients A New Tool for Measuring Body Image Changes Ada Borkenhagen, PhD,* Frank Ro ¨hricht, MD, MRCPsych,† Simone Preiß,‡ Wolfgang Schneider,‡ and Elmar Bra ¨hler* Abstract: Health insurance funds in Germany are increasingly reluctant to fund the cost for reduction mammaplasty. However, several studies have already demonstrated the beneficial effects of breast reduction on symptom relief and health-related quality of life. More specifically, the psychologic and social consequences of breast reduction surgery were also recently evaluated. Relating to the contemporary debate on financial restraint, the present article de- scribes a follow-up study conducted in a sample of 40 patients undergoing reduction mammaplasty. The purpose of the investiga- tion was to assess indicators of health-related quality of life follow- ing reduction mammaplasty. Furthermore, the study aimed to assess body image changes and to test a new assessment instrument, Digital-Body-Photo-Test (DBPT), in comparison with a well-vali- dated body image measure (Color-a-Person Body Dissatisfaction Test, CAPT) (concurrent validity). As hypothesized, the findings indicate significant improvements in health-related quality-of-life measures and body-image characteristics. The substantial improve- ment of body-image satisfaction of all body areas suggests a gen- eralized positive effect of reduction mammaplasty on overall body image. The strong association between the DBPT and the CAPT scores in this study indicates that DBPT is an efficient and valid new tool for measuring body-image changes relating to patients’ evalu- ations of their average satisfaction of specific body parts or areas and their overall appearance acceptance. Key Words: body image, reduction mammaplasty, health-related quality of life, self-esteem, surgery outcomes (Ann Plast Surg 2007;58: 000 – 000) R eduction mammaplasty is one of the most common pro- cedures in plastic surgery. In contrast to the United States, there is no valid information about the number of breast reductions performed in Germany. Experts guess that about 30,000 breast reductions were performed in Germany per year. Unfortunately, rejection of insurance coverage and policy exclusions for breast reduction are becoming increas- ingly common in Germany. 1 More often, reduction mamma- plasty is seen as a purely cosmetic operation by the German health insurance funds. According to the definition of recon- structive surgery by the American Society of Plastic Surgeons (ASPS), reduction mammaplasty is considered reconstructive in nature. Women who seek reduction mammaplasty are primarily interested in having average-sized breasts that are proportional to the rest of their bodies. 2 The improved phys- ical and psychosocial functioning that leads to an enhanced quality of life has to be seen as an additional benefit of reduction mammaplasty. Accordingly, several studies in re- cent years revealed positive changes in body image and increase in self-esteem in patients following reduction mam- maplasty. 2 But studies investigating the outcome and the implications on psychosocial functioning of German women undergoing reduction mammaplasty are very rare. 3 Health-Related Quality of Life, Mood, Complaints, and Body Image in Patients With Macromastia The majority of reduction mammaplasty patients present with physical complaints ranging from neck, shoul- der, and upper back pain to the inability to perform daily or work-related activities. Most empirical studies describe a high satisfaction rate after reduction mammaplasty. Signifi- cant improvements in emotional, psychologic, and physical well-being 2,4 –13 were reported by patients who underwent bilateral breast reduction. In a meta-analysis of published studies, Chadbourne et al 13 reported that current evidence suggests that women undergoing reduction mammaplasty have significant postoperative improvement of symptoms and quality of life. Jones and Bain 11 found in their review of studies 14 –18 on the benefits of reduction mammaplasty consistent im- Received March 22, 2006, and accepted for publication, after revision, July 21, 2006. From the *Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany; †Queen Mary University of London, Newham Centre for Mental Health, London, UK; and the ‡Clinic of Plastic and Reconstructive Surgery, Otto-von-Guericke-Uni- versity of Magdeburg, Magdeburg, Germany. Reprints: Ada Borkenhagen, PhD, University of Leipzig, Department of Medical Psychology and Medical Sociology, Stephanstr. 11, 04103 Leipzig, Germany. E-mail: Dr.Borkenhagen@web.de. Copyright © 2007 by Lippincott Williams & Wilkins ISSN: 0148-7043/07/5804-0001 DOI: 10.1097/01.sap.0000239840.62931.52 balt5/zps-aps/zps-aps/zps00407/zps4213-07z xppws S1 12/30/06 9:56 Art: SAP200537 Annals of Plastic Surgery • Volume 58, Number 4, April 2007 1 AQ: 1 AQ: 7