Maria José Azevedo de Brito

Abdominoplasty and its effect on body image, self-esteem, and mental health.

The impact of abdominoplasty on the quality of life of abdominoplasty patients was assessed 1- and 6-months postoperatively. Forty women aged 25 to 60 years were divided into study group (25 patients who underwent abdominoplasty) and waiting-list control group (15 patients). Three questionnaires (Body Shape Questionnaire [BSQ], Rosenberg Self-Esteem Scale [RSE/UNIFESP], and Short Form 36 Health Survey Questionnaire [SF-36]) were administered to the study group (preoperatively, 1- and 6-months postoperatively) and control group (on 2 occasions 6 months apart). A significant positive impact on body image, self-esteem, and mental health was found 1- and 6-months postoperatively. Significant differences were observed in role physical, role emotional, and vitality 1-month postoperatively. In the control group, significant differences were found for vitality. There was a significant improvement in Comparative perception of body image (6-month assessment) in the study group compared with controls. Abdominoplasty improved body image, self-esteem, and mental health.

Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery. BDD is also a challenge for plastic surgeons because it is still an underdiagnosed mental disorder. The aims of this study were to prospectively investigate whether patients with mild to moderate BDD are suitable for rhinoplasty, and to assess BDD severity and patient satisfaction with the surgical outcome 1 year after the intervention. All women (n = 116) seeking rhinoplasty at a university hospital between September 2009 and August 2010 were recruited for the study and assessed for BDD. The final sample consisted of 31 patients aged 32 (standard deviation (SD), 10) years with mild to moderate BDD who underwent rhinoplasty. The participants were assessed preoperatively (baseline) and 1 year postoperatively with the Body Dysmorphic Disorder Examination (BDDE). Most patients (22/31, 71%) were of African descent. Socio-demographic variables and the extent of the nasal deformities had no effect on the severity of BDD symptoms and patient satisfaction with surgery outcome. At the 1-year postoperative follow-up, there was a significant decrease from baseline in BDDE scores and time spent by patients worrying about their appearance; 25 (25/31, 81%) patients experienced complete remission from BDD and 28 (28/31, 90%) were satisfied with the results of surgery. Rhinoplasty may be indicated in the treatment of female patients with mild to moderate BDD.

The Increasing Growth of Plastic Surgery Lawsuits in Brazil

Medical lawsuits have reached endemic proportions in many countries [1, 2]. The value of financial compensation also has increased [3], causing harm to patients and physicians [1, 2]. Very commonly, plastic surgeons access lawsuits through nonmedical media. Objective data and actual numbers about the growth of medical lawsuits should be evaluated by professional societies. These societies should be responsible for collecting and analyzing the numbers, displaying the findings to the plastic surgeons, and developing ethical strategies aimed at reducing the number of lawsuits, thus preventing losses for plastic surgeons and patients. Our group searched the data for all final sentences of lawsuits between patients and physicians to evaluate the number of lawsuits that evolved from plastic surgeries from January 2000 to December 2008 at the Court of Justice of the Brazilian State of Rio Grande do Sul. The type of surgery on which the patient based the lawsuit and the costs (pecuniary reimbursement to the successful party for the expenses of litigation) paid by the physician sued, even if considered not guilty, also were evaluated. A total of 98 lawsuits involving plastic surgery were evaluated. From these, 59 lawsuits were excluded because they were lawsuits against health medical organizations, and the data on the reviewed court’s database system were incomplete. As a result, 39 lawsuits were analyzed. Two periods were compared: period 1 (January 2000 to June 2004) and period 2 (July 2004 to December 2008) (Fig. 1). Cosmetic surgery was involved in 91% of the cases. Abdominoplasty, rhynoplasty, and liposuction were associated most frequently with litigation. The number of lawsuits increased during period 2. The average number of lawsuits per year was 2.44 in period 1 and 6.22 in period 2. The average costs and expenses of each lawsuit per year totaled R

The Impact of Venous Leg Ulcers on Body Image and Self-esteem.

10,256.12 (US

Fulminant myocarditis associated with pandemic H1N1 influenza A virus

5,997.73) in period 1 and R

Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty

12.312,87 (US

Burn Sexuality Questionnaire: Brazilian translation, validation and cultural adaptation

7,200.51) in period 2. The greatest proportion of plastic surgery lawsuits involved cosmetic surgeries; a high number of patients, who were undergone cosmetic surgery and were disappointed, sued the plastic surgeon [3–5]. When patients search for cosmetic surgery, they want to change the way they think, feel, and behave regarding some discordant feature [6]. However, this condition can hide an unreal expectation of damaged self-perception and psychosexual issues that reach far beyond plastic surgery [7–9]. Thus, the plastic surgeon, in addition to selecting the best surgical technique, must know how to identify this condition [9]. The surgeon should be aware of the most litigated procedures in this study, namely, abdominoplasty, rhynoplasty, and liposuction. It is important to remember that food intake disorders and corporal dismorphic disorders are very prevalent among candidates for these operations [10]. A comparison of the two periods showed that the growth in the number of lawsuits has more than doubled, similar to what has happened in different fields of medicine [3]. An even more important result was found. The average cost of lawsuits increased in period 2, which may stimulate patients to sue their physicians. Every physician sued, even those considered not guilty, had to spend a considerable amount of money in costs and expenses generated by the lawsuits. D. B. Vila-Nova da Silva F. X. Nahas (&) R. A. Bussolaro M. J. A. de Brito L. M. Ferreira Plastic Surgery Postgraduation Program, Federal University of São Paulo, Rua Napoleão de Barros, 715, 4o Andar, Vila Clementino, CEP: 04024-002 São Paulo, Brazil e-mail: fabionahas@uol.com.br

Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS): Brazilian Portuguese translation, cultural adaptation and validation

OBJECTIVE:To evaluate self-esteem and body image in patients with venous leg ulcers (VLUs). DESIGN:A multicenter, prospective, descriptive, analytical, clinical study. SETTINGS:A nursing care and education center of a university hospital, a health center, and an outpatient wound care clinic in Brazil. PATIENTS:Fifty-nine consecutive adult patients with VLUs and Doppler ankle-brachial index ranging from 0.8 to 1.0 were recruited for the study. Exclusion criteria were mixed ulcers, arterial ulcers, and diabetic foot ulcers. MAIN OUTCOME MEASURES:A questionnaire assessing sociodemographic and clinical characteristics of patients, the Brazilian version of the Body Investment Scale, and the Rosenberg Self-esteem (RSE)/UNIFESP-EPM (São Paulo da Universidade Federal de São Paulo–Escola Paulista de Medicina) scale were administered to all patients. MAIN RESULTS:Most participants were women, aged between 60 and 70 years, and smokers; 33 (56%) were divorced, widowed, or single, and 26 (44%) were married. The patients had the ulcer for a mean of 5.42 years. Exudate and foul odor were present in most cases. Twenty-one ulcers (36%) measured 29 cm2 or less in surface area, and 17 (29%) ulcers measured between 30 and 49 cm2 (mean, 3.39 cm2). The mean RSE score was 22.66, indicating low self-esteem. The mean Body Investment Scale total score was 27.49, and the scores on the body image and body touch subscales were also low, indicating negative feelings about the body. CONCLUSION:Patients with VLUs had low self-esteem and negative feelings about their bodies.

Validation of the Brazilian version of the Burn Specific Health Scale-Brief (BSHS-B-Br).

Fulminant myocarditis associated with influenza A virus is exceedingly rare, with only a few cases reported in the literature. We describe a previously healthy 10-year-old boy, with a three-day history of flu-like symptoms without antiviral treatment. He was hospitalized with dehydration and hypothermia in the context of persistent vomiting, when he suddenly developed heart failure secondary to fulminant myocarditis. Despite aggressive management, including circulatory support and cardiopulmonary resuscitation measures, the patient died of cardiogenic shock. The postmortem histopathology was compatible with a multisystem viral infection with myocarditis and pulmonary involvement, and H1N1v polymerase chain reaction was positive. The prevalence of influenza-associated fulminant myocarditis remains unknown. Findings reported in the literature raise the possibility that the novel H1N1 influenza A virus is more commonly associated with a severe form of myocarditis than previously encountered influenza strains.

Body Dysmorphic Symptoms Scale for patients seeking esthetic surgery: cross-cultural validation study

BACKGROUND Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery, and body contouring surgery is most frequently sought by patients with BDD. OBJECTIVES To estimate the prevalence and severity of BDD symptoms in patients seeking abdominoplasty. METHODS Ninety patients of both sexes were preoperatively divided into two groups: patients with BDD symptoms (n = 51) and those without BDD symptoms (n = 39) based both on the Body Dysmorphic Disorder Examination (BDDE) and clinical assessment. Patients in the BDD group were classified as having mild to moderate or severe symptoms, according to the BDDE. Body weight and shape concerns were assessed using the Body Shape Questionnaire (BSQ). RESULTS The prevalence of BDD symptoms was 57%. There were significant associations between BDD symptoms and degree of body dissatisfaction, level of preoccupation with physical appearance, and avoidance behaviors. Mild to moderate and severe symptoms of BDD were present in 41% and 59% of patients, respectively, in the BDD group. It was found that the more severe the symptoms of BDD, the higher the level of concern with body weight and shape (P < .001). Patients having distorted self-perception of body shape, or distorted comparative perception of body image were respectively 3.67 or 5.93 times more likely to show more severe symptoms of BDD than those with a more accurate perception. CONCLUSIONS Candidates for abdominoplasty had a high prevalence of BDD symptoms, and body weight and shape concerns were associated with increased symptom severity.