Download Appendix A. Database Template for Asian Breast Augmentation

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Appendix A. Database Template for Asian Breast Augmentation Series 1
Demographic data
Date of surgery:
Implant Details
Age at time of surgery:
Make
Primary or Secondary:
Model
Indication:
Shape
Operative Details
Volume
Antibiotics (length of time):
Surface texture
Plane:
Fill material
L
R
L
R
Incision:
Drains (length of time):
Smoking status
Outcomes
Date of last follow-up
Scar Appearance (overall, accounts for both breasts)
Complications
Range
2
Capsular Contracture
Visual Analogue Scale
0-10
Baker Grade
Color3
1-4
Wound dehiscence
Texture4
1-2
Unsightly scar7
Contour5
1-4
Scar revision
Distortion6
1-4
Hematoma
Modified Manchester Scar Score (MSS)
4-24
Seroma
Infection
Patient satisfaction survey
Range
Double-bubble
You are satisfied with the cosmetic result of surgery.
1-58
Symmastia
You would recommend this procedure to others.
1-5
Symmetry
Breast implants have improved your quality of life.
1-5
Asymmetry NAC diameter, mm:
The implants have improved your sexual attractiveness.
1-5
Asymmetry NAC position, mm:
Do you notice a scar? Does your partner?
9
Have you noticed changes in tactile or erogenous sensation?
10
Additional Surgery:
Overall, how would you would rate the scars:
1-511
Indication for reoperation:
1
Asymmetry IMF position, mm:
This is the template currently in use by the authors at their centers and is offered as an example
lower score, the better
31=perfect; 2=slight mismatch; 3=obvious mismatch; 4=gross mismatch
4
1=matte; 2=shiny
51=flush with surrounding skin; 2=slightly proud or indented; 3=hypertrophic; 4=keloid
61=none; 2=mild; 3=moderate; 4=severe; if periareolar or transareolar this represents areolar distortion
7as determined by MSS score
81=strongly disagree, 5=strongly agree
9we both notice; I do, my partner doesn't; my partner does, I don't
10both sides decreased; one side decreased; no change; one side increased; both sides increased
111=terrible scar in need of revision; 5= barely visible or invisible
2The
NAC = nipple-areola complex; IMF = inframammary fold
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