Change in self-image pressure level before and after autologous fat breast augmentation and its effect on social adaptability

Abstract

BACKGROUND

There is an increasingly strong demand for appearance and physical beauty in social life, marriage, and other aspects with the development of society and the improvement of material living standards. An increasing number of people have improved their appearance and physical shape through aesthetic plastic surgery. The female breast plays a significant role in physical beauty, and droopy or atrophied breasts can frequently lead to psychological inferiority and lack of confidence in women. This, in turn, can affect their mental health and quality of life.

AIM

To analyze preoperative and postoperative self-image pressure-level changes of autologous fat breast augmentation patients and their impact on social adaptability.

METHODS

We selected 160 patients who underwent autologous fat breast augmentation at the First Affiliated Hospital of Xinxiang Medical University from January 2020 to December 2022 using random sampling method. The general information, self-image pressure level, and social adaptability of the patients were investigated using a basic information survey, body image self-assessment scale, and social adaptability scale. The self-image pressure-level changes and their effects on the social adaptability of patients before and after autologous fat breast augmentation were analyzed.

RESULTS

We collected 142 valid questionnaires. The single-factor analysis results showed no statistically significant difference in the self-image pressure level and social adaptability score of patients with different ages, marital status, and monthly income. However, there were significant differences in social adaptability among patients with different education levels and employment statuses. The correlation analysis results revealed a significant correlation between the self-image pressure level and social adaptability score before and after surgery. Multiple factors analysis results showed that the degree of concern caused by appearance in self-image pressure, the degree of possible behavioral intervention, the related distress caused by body image, and the influence of body image on social life influenced the social adaptability of autologous fat breast augmentation patients.

CONCLUSION

The self-image pressure on autologous fat breast augmentation patients is inversely proportional to their social adaptability.

Key Words: Autologous fat breast augmentation surgery; Self-image stress level; Social adaptability; Analysis of correlation; Structural equation model

Core Tip: We selected a random clinical sample for a questionnaire survey of patients undergoing autologous fat breast augmentation. A body image disturbance questionnaire and Self-report Psychosocial Adjustment to Illness Scale were used to evaluate the self-image stress level and social adaptability of the patients, and a validity test of the questionnaire showed that it had high reliability. The results of the questionnaire showed that the preoperative self-image stress level and social adaptability score of the patients were generally high, and there was a correlation between the two. The self-image pressure was relieved, and the social maladjustment was significantly reduced.

INTRODUCTION

With the development of society and the improvement of material living standards, individuals have increasingly strong demands for appearance and physical beauty in social life, marriage, and other aspects. An increasing number of people are improving their appearance and physical shape through aesthetic plastic surgery[1]. The breast is a sign of female physical beauty; droopy or atrophied breasts can often lead to feelings of psychological inferiority and lack of confidence, which may adversely affect mental health and quality of life. Breast augmentation surgery is a common practice in plastic and aesthetic surgery. An increasing number of women are seeking breast augmentation surgery because of breast shape problems to improve their self-confidence and meet their social and work needs[2]. As a relatively safe and natural plastic method, autologous fat breast augmentation is favored by many women who pursue a beautiful physique[3]. However, existing studies have shown that approximately 52% of patients undergoing plastic surgery have a specific degree of psychological disorder[4]. With the continuous evolution of appearance anxiety and aesthetic standards, the expectations for plastic surgery are no longer limited to external aesthetic feelings, and the popularity of aesthetic plastic surgery is accompanied by a series of social and psychological problems[5,6]. Changes in the expectations, self-perception, social adaptability, and other aspects of patients are complex and worthy of in-depth research[7].

Autologous fat breast augmentation has become a prominent cosmetic procedure that reflects the evolving landscape of aesthetic enhancements. This study fills a gap in the literature by focusing on the nuanced psychological dynamics associated with this surgery. Studies have shown that the reduction of self-image stress levels can effectively reduce emotional distress and improve interpersonal skills[8,9]. Therefore, this study mainly analyzes the self-image pressure of autologous fat breast augmentation patients and the relationship between social adaptation and plastic surgery for women to provide a more comprehensive assessment framework and personalized service for medical plastic surgery.

MATERIALS AND METHODS

General information

We selected 160 patients who underwent autologous fat breast augmentation at the First Affiliated Hospital of Xinxiang Medical University Hospital from January 2020 to December 2022 as research participants using the random sampling method. The inclusion criteria were as follows: (1) Voluntarily accepted autologous fat augmentation; (2) Above elementary school culture level and correctly understood and completed the questionnaire; and (3) Good language skills. The exclusion criteria included: (1) Age: ≥ 45 years old; (2) Patients with post-breast surgery pain and areola bag piece swelling; (3) Patients with malignant tumors, mental diseases, and other diseases that seriously affect the quality of life. Informed consent was obtained from all the patients.

Questionnaire survey

Basic information questionnaire: The basic information questionnaire was designed by the members of the investigation team, and the main statistics were the demographic data of the patients. The data included age, marital status (married with children, unmarried with children, unmarried without children, and married without children), education (primary school, junior high school, senior high school, college, bachelor’s degree, or above), and monthly income (less than 3500 yuan/month, 3500-8000 yuan/month, and more than 8000 yuan/month), employment situation (employed, unemployed, seeking employment).

Body image disturbance questionnaire: Body image disturbance questionnaire (BIDQ) is a self-report evaluation method that includes seven problems; recent reports have verified the effectiveness of the BIDQ. The BIDQ assesses the extent to which participants have concerns about their appearance and the resulting anxiety and impairment of daily life functions. The BIDQ targets healthy individuals.

Self-report Psychosocial Adjustment to Illness Scale: Self-report Psychosocial Adjustment to Illness Scale (PAIS-SR) is mainly used to assess the psychological and social adjustment of patients. It includes seven dimensions (health care, work ability, family relationship, sexual life, communication, entertainment, and psychological status) with a total of 46 items. The internal consistency was 0.81, and the inter-rater reliability was 0.86. Each item score of the PAIS-SR ranges from 0 to 3, and the total score ranges from 0 to 138. Higher scores indicate more social adjustment problems.

Survey methods

General information, BIDQ, and PAIS-SR were completed at the time of the visit. The questionnaire survey was conducted one-on-one, with voluntary participation as the principle. Six months post-operation, the patients were followed up and completed the BIDQ and PAIS-SR again.

Statistical analysis

When the data were normally distributed, the standard deviation of the mean ± SD was used to represent the measurement data, and the median (lower quartile, upper quartile) was used to represent the non-normally distributed data. T-test was used for single-factor analysis, and the homogeneity of variance test was used for multi-group data comparison. Percentage (%) represented count data, and the χ² test was used for univariate analysis. Cronbach’s coefficient reliability test was used to analyze the internal consistency of each dimension of the scale. A hypothesis was proposed to establish a structural equation model of the effect of changes in the self-image pressure levels of patients on their social adaptability. The model fitness was tested, and the null hypothesis of a path coefficient greater than zero was established. The Pearson correlation analysis was used for data conforming to a normal distribution, and the Spearman correlation analysis was used for data not conforming to a normal distribution. Linear regression analysis was used for the multivariate analysis. All patients were treated with P < 0.05, indicating that the difference was statistically significant.

RESULTS

Autologous fat breast augmentation patients’ questionnaire results

We distributed 160 questionnaires, and 142 valid questionnaires were collected, with an effective recovery rate of 88.75%. Analysis of preoperative PAIS-SR and BIDQ results across patient demographics revealed no statistically significant differences in self-image stress levels and social adaptation scores among different age groups, marital statuses, and monthly incomes (P > 0.05). However, significant differences were observed in social adaptability and self-image pressure among patients with varying education levels and employment statuses (P < 0.05), as shown in Table 1.

Table 1 Self-report Psychosocial Adjustment to Illness Scale score of patients in various demographic data (mean ± SD).

Basic data		n (%)	Preoperative PAIS-SR	F	P value	Preoperative BIDQ	F	P value
Age (yr)	18-24	24 (16.90)	56.67 ± 4.37	0.750	0.526	31.00 ± 7.40	0.255	0.858
	25-31	83 (58.45)	58.15 ± 4.29			30.81 ± 7.33
	32-38	30 (21.13)	56.63 ± 6.24			31.26 ± 7.82
	≥ 39	5 (3.52)	56.33 ± 3.51			33.33 ± 8.14
Marital status	Married childless	38 (26.76)	57.58 ± 3.74	1.622	0.190	31.92 ± 8.05	1.813	0.151
	Unmarried childless	31 (21.83)	59.26 ± 5.24			27.58 ± 7.78
	Married with child	57 (40.14)	56.39 ± 5.14			31.08 ± 6.24
	Married with children	16 (11.27)	58.10 ± 3.84			33.20 ± 7.83
Degree of education	Primary and junior high schools	29 (20.42)	58.83 ± 4.55	19.455	< 0.001	34.61 ± 5.34	2.199	0.094
	High school	35 (24.65)	57.50 ± 5.04			30.48 ± 6.69
	Specialty	40 (28.17)	56.36 ± 5.24			29.50 ± 6.41
	Bachelor’s degree or above	38 (26.76)	55.38 ± 4.13			29.46 ± 5.78
Monthly income (yuan)	≤ 3500	14 (9.86)	59.56 ± 6.77	1.440	0.243	29.78 ± 10.32	0.203	0.817
	3500-8000	77 (54.22)	56.86 ± 4.48			31.23 ± 7.00
	≥ 8000	51 (35.92)	57.94 ± 4.42			30.44 ± 7.19
Employment situation	On guard	91 (64.08)	59.46 ± 6.03	6.489	< 0.001	30.86 ± 5.73	3.666	< 0.001
	Unemployment (including unemployment)	51 (35.92)	53.10 ± 4.01			34.67 ± 5.12

PAIS-SR: Self-report Psychosocial Adjustment to Illness Scale; BIDQ: Body image disturbance questionnaire.

PAIS-SR and BIDQ reliability analysis

The factors of the self-image pressure and social adaptability of patients were measured using a questionnaire, and the data quality of the patient questionnaire measurement results was tested to ensure the significance of the subsequent analysis. Cronbach’s coefficient reliability test results showed that the internal consistency of the BIDQ, PAIS-SR, and their various dimensions had high credibility, as shown in Table 2.

Table 2 Body image disturbance questionnaire and Self-report Psychosocial Adjustment to Illness Scale reliability analysis.

Variables of interest		Cronbach’s coefficient	Number of terms
Scale		0.883	7
PAIS-SR scale	Hygiene and health	0.837	7
	Ability to work	0.829	8
	Family situation	0.842	7
	Sexual ability	0.898	4
	Situation of communication	0.865	5
	The entertainment situation	0.813	6
	BIDQ psychological status	0.821	7
	Summary table	0.861	44

PAIS-SR: Self-report Psychosocial Adjustment to Illness Scale; BIDQ: Body image disturbance questionnaire.

Self-image stress level and social adaptability structural equation model

Based on demographic data analysis, patients’ employment status was categorized into employed and unemployed. Subsequently, the following hypotheses were formulated: (1) Self-image stress levels have a positive impact on the social adaptability of patients on the job. A structural equation model was established and the χ² freedom ratio of the model was 1.323, indicating a good fit; and (2) The self-image stress level of unemployed patients has a positive impact on their social resilience. A structural equation model was established and the χ² freedom ratio of the model was 1.207, indicating a good fit. According to the path coefficient results of structural equation model, the BIDQ scale for employed patients has a standard path coefficient of 0.81 > 0 for PAIS-SR quantity, and the BIDQ scale for unemployed patients has a standard path coefficient of 0.78 > 0 for PAIS-SR quantity, both of which indicate that the hypothesis is valid. Therefore, self-image stress level has a positive impact on social adaptability (Figure 1).

Figure 1 Self-image stress level impact on the social adaptability. A: Structural equation model of the effect of self-image stress level on the social resilience of employed patients; B: Structural equation model of the influence of self-image stress level on the social resilience of unemployed patients. A1-A7 represent topics 1-7 in the dimension of health care, respectively; B1-B8 represent questions 1-8 in the dimension of working ability, respectively; C1-C7 represent questions 1-7 in the dimension of family relationship, respectively; D1-D4 refers to questions 1-4 in the sexual ability dimension, respectively; E1-E5 indicates topics 1-5 in the communication dimension, respectively. F1-F6: represent topics 1-6 in the entertainment dimension, respectively; G1-G7 represent questions 1-7 in the dimension of psychological status, respectively. H1-H7: H1 represents the degree of concern caused by appearance; H2 represents the possible degree of behavioral intervention; H3 represents body image-related distress; H4 represents social and occupational problems caused by body image; H5 represents the impact of body image on social life; H6 represents the impact of body image on learning, work, or other role functions; H7 represents body image-induced avoidance behavior. PAIS-SR: Self-report Psychosocial Adjustment to Illness Scale; BIDQ: Body image disturbance questionnaire.

Correlation between the BIDQ and PAIS-SR before and after surgery

The BIDQ preoperative score of 142 patients was 30.80 ± 7.37, and the postoperative score was 26.33 ± 6.79 (P < 0.05). The PAIS-SR score was 57.46 ± 8.51 before operation and 54.4 ± 8.13 after operation (P < 0.05). The postoperative self-image pressure of the patients decreased significantly, and the social adaptability significantly increased, as shown in Table 3.

Table 3 Patients with body image disturbance questionnaire and Self-report Psychosocial Adjustment to Illness Scale scores before and after surgery.

	Before surgery	After surgery	t	P value
Total BIDQ score	30.80 ± 7.37	26.33 ± 6.79	4.209	< 0.001
Total PAIS-SR score	57.46 ± 8.51	54.4 ± 8.13	2.450	0.015

PAIS-SR: Self-report Psychosocial Adjustment to Illness Scale; BIDQ: Body image disturbance questionnaire.

The score of each dimension of the BIDQ was 5.32 ± 1.70 before the operation and 4.67 ± 1.34 after the operation. BIDQ2 was the degree of behavioral interventions, which was 4.97 ± 1.55 before the operation and 4.07 ± 1.29 after the operation. BIDQ3 represented the body image caused by problems before the operation (3.68 ± 1.18) and after the operation (3.11 ± 1.09). BIDQ4 represented social problems caused by the body image before the operation [3.00 (2.00, 4.00)] and after the operation [3.00 (2.00, 4.00)]. BIDQ5 represented the impact of body image on social life before the operation (4.60 ± 1.27) and after the operation (4.30 ± 1.25). The effect of body image on other role functions in the BIDQ6 score was 3.00 (2.00, 4.00) before the operation and 3.00 (2.00, 4.00) after the operation. BIDQ7 represented body image caused by avoidance behavior score before the operation [2.00 (1.00, 3.00)] and after the operation [2.00 (1.00, 3.00)]. The preoperative and postoperative scores of each BIDQ dimension and PAIS-SR showed that the self-image stress levels of the patients were significantly related to social adaptability problems. The higher the stress levels in patients, the more the social adaptability problems, as shown in Tables 4 and 5.

Table 4 Correlation between the scores of body image disturbance questionnaire dimensions and Self-report Psychosocial Adjustment to Illness Scale scores of patients before surgery.

Variables of interest	r	P value
Total BIDQ score	0.773	< 0.001
BIDQ1 appearance caused attention	0.848	< 0.001
The extent to which behavioral interventions may be undertaken in BIDQ2	0.727	< 0.001
BIDQ3 body image-related distress	0.775	< 0.001
BIDQ4 social issues caused by body image	0.850	< 0.001
BIDQ5 body image’s impact on social life	0.791	< 0.001
Effect of body image on other role functioning in BIDQ6	0.765	< 0.001
BIDQ7 avoidance behaviors due to body image	0.645	< 0.001

PAIS-SR: Self-report Psychosocial Adjustment to Illness Scale; BIDQ: Body image disturbance questionnaire.

Table 5 Correlation between the scores of body image disturbance questionnaire dimensions and self-report psychosocial adjustment to illness scale scores in postoperative patients.

Variables of interest	r	P value
BIDQ1 appearance caused attention	0.714	< 0.001
The extent to which behavioral interventions may be undertaken in BIDQ2	0.663	< 0.001
BIDQ3 body image-related distress	0.652	< 0.001
BIDQ4 social issues caused by body image	0.639	< 0.001
BIDQ5 body image’s impact on social life	0.703	< 0.001
Effect of body image on other role functioning in BIDQ6	0.685	< 0.001
BIDQ7 avoidance behaviors due to body image	0.348	< 0.001
BIDQ1 appearance caused attention	0.401	< 0.001

BIDQ: Body image disturbance questionnaire.

Multivariate analysis of the preoperative and postoperative PAIS-SR scores

Multiple regression analysis was performed with each dimension of the BIDQ scale as the independent variable and the PAIS-SR score as the dependent variable. The preoperative results showed that the adjusted R² = 0.594, F = 207.244, and P < 0.001; thus, the model was successfully established. Among them, the degree of concern caused by appearance in self-image pressure, the degree of possible behavioral intervention, the related distress caused by body image, and the influence of body image on social life were significantly positive predictors of social adaptability. Postoperative results showed that the adjusted R² = 0.695, F = 46.909, and P < 0.001; thus, the model was successfully established. The degree of concern caused by appearance, the degree of possible behavioral intervention, social problems caused by body image, and the influence of avoidance behavior caused by body image on postoperative self-image pressure significantly and positively predicted the level of the social adaptability of patients. The results are presented in Tables 6 and 7.

Table 6 Multivariate analysis of preoperative Self-report Psychosocial Adjustment to Illness Scale scores.

Independent variable	b	Sb	b’	t	P value
Degree of concern caused by the appearance in BIDQ1	1.784	0.660	0.249	2.704	0.008
The extent to which behavioral interventions may be undertaken in BIDQ2	2.282	0.646	0.245	3.531	0.001
BIDQ3 body image-related distress	1.882	0.71	0.202	2.651	0.009
BIDQ4 social issues caused by body image	1.161	0.721	0.114	1.612	0.109
BIDQ5 body image’s impact on social life	1.786	0.534	0.288	3.346	0.001
Effect of body image on other role functioning in BIDQ6	0.679	0.598	0.083	1.135	0.259
BIDQ7 avoidance behaviors due to body image	0.386	0.427	0.057	0.903	0.368
Total BIDQ score	1.153	0.080	0.773	14.396	< 0.001

BIDQ: Body image disturbance questionnaire.

Table 7 Postoperatively, psychosocial adjustment to illness scale-multiple factors analysis of the self-report score.

Independent variable	b	Sb	b’	t	P value
Degree of concern caused by the appearance in BIDQ1	1.308	0.545	0.185	2.399	0.018
The extent to which behavioral interventions may be undertaken in BIDQ2	1.185	0.438	0.162	2.707	0.008
BIDQ3 body image-related distress	0.979	0.548	0.113	1.785	0.076
BIDQ4 social issues caused by body image	2.155	0.439	0.344	4.908	< 0.001
BIDQ5 body image’s impact on social life	0.984	0.528	0.131	1.863	0.065
Effect of body image on other role functioning in BIDQ6	0.279	0.372	0.041	0.751	0.454
BIDQ7 avoidance behaviors due to body image	0.698	0.325	0.118	2.148	0.034
Total BIDQ score	2.155	0.439	1.552	4.908	< 0.001

BIDQ: Body image disturbance questionnaire.

DISCUSSION

Cosmetic and plastic surgery are increasingly popular in contemporary society, and the development of social media gives the appearance a more significant role in social interaction. Individuals pay more attention to body image in terms of social interaction, marriage, and other aspects[10-13]. Autologous fat breast augmentation is becoming a popular choice for the pursuit of beauty by females; cosmetic surgery is not only a physical change but is also more involved in the psychological state and social adaptation of the patients[14,15]. Therefore, this study focused on patients undergoing autologous fat breast augmentation surgery, with an in-depth investigation of self-image changes in stress levels before and after surgery and the relationship with social adaptability.

In this study, according to the results for preoperative autologous fat breast augmentation patients, the self-image stress level is high. This may be because society’s aesthetic standards for women’s body beauty have been changing, and patients have specific stereotypes about their image and chest fullness; drooping and shrinking breasts cause psychological inferiority[16-19]. Patients may be affected by media, social networks, and other aspects, and they may have experienced excessive pressure on their chest shape[20]. The preoperative social adaptability scale score of the patients was high, indicating preoperative social adaptability problems.

This study compared the social adaptability of different populations. Significant differences existed among the different cultural degrees of patients’ social adaptability, possibly because the higher level of education and individual cognitive levels were positively related. A high degree of education indicates that the individual can analyze and solve difficulties and adapt to the new environment; further, they can cope with stress and have emotion management ability, which can help maintain a good psychological state and improve social adaptability[21,22]. In addition, there are significant differences in social adaptability and self-image stress levels between employed and unemployed patients. Unemployed patients may lack social support and recognition, prompting them to prioritize external images to obtain self-esteem and recognition. The results of structural equation model validated the theoretical hypothesis that self-image stress has a positive impact on social resilience in both employed and unemployed patients. Notably, family relationship factors have a greater impact on the social resilience of unemployed patients compared to unemployed ones. Unemployed patients may rely more heavily on family members as their main social support system, and the influence of family relationship on their social resilience and mental health may be more significant. Comparing the levels of self-image pressure and social adaptability before and after surgery revealed a significant reduction in overall postoperative self-image pressure and social maladjustment problems among patients. Compared with the preoperative self-image stress level and level of social adaptability of patients, the postoperative self-image pressure level was significantly reduced, thereby reducing social maladjustment problems. In this study, the total score and all dimensions of the self-image pressure level of patients were positively correlated with their social adaptation level; that is, the higher the self-image pressure level, the higher the social adaptation score, and the more the social maladjustment problems. Multiple factors analysis preoperative results showed that the adjusted R² was 0.594, showing that the preoperative BIDQ scale explained the 59.4% change in the PAIS-SR scale. Postoperative results showed that the adjusted R² was 0.695, showing that the postoperative BIDQ scale explained the 69.5% change in the PAIS-SR scale. The results of the study suggested that the degree of concern caused by the appearance of patients on the BIDQ scale, the degree of possible behavioral intervention, the related distress caused by body image, the influence of body image on social life, and the avoidance behavior caused by body image were closely related to the social maladjustment of patients. On the one hand, if too much attention is paid to the appearance of the patient, it may lead to social anxiety. For patients who experience low self-esteem and anxiety because of their body image, it may be difficult to show good adaptability in social occasions[23,24]. On the other hand, for patients who pay too much attention to their appearance, often taking extreme behavior interventions can increase psychological pressure. Severe cases may be avoiding social occasions, and avoiding showing their body can lead to social barriers, thereby resulting in a loss of social adaptability[25]. Moreover, a moderate amount of self-adjusting and improving the appearance of behavior can help to improve self-confidence and have a positive impact on the patient’s social adaptation[26].

For patients with autologous fat breast augmentation, a lack of confidence in their body and body shape and high self-image concern lead to high self-image pressure. Medical staff can help patients learn to face the pressure of their image in a reasonable way of thinking, pay attention to their values, and establish a new identity model through psychological counseling.

CONCLUSION

The self-image pressure of patients undergoing autologous fat breast augmentation is closely related to their social adaptability. The higher the self-image pressure of the patients, the lower their level of social adaptability. The self-image stress level of the patients was reduced, and their social adaptability problems were reduced. Medical staff need to pay more attention to the psychological state of the patients. Future research should expand the sample size and discuss different types of plastic surgery for the long-term effect on the patient’s psychological and social adaptability, which will help to provide patients with individualized and effective plastic surgery services.