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In this review, we examine the use of DAS59 and DAS24 in the scientific literature and in particular how the use of these questionnaires has improved the understanding and practice of plastic and reconstructive surgery. A systematic review protocol was developed in accordance with the Preferred Reporting for Items for Systematic Review and Meta-Analys-Protocol (PRISMA-P) guide. A multi-step search of the PubMed, MEDLINE, Embase, Premedeline, Ebase, CINAHL, PsychINFO and Cochrane databases was performed to identify studies on body image using DAS59 and DAS24. The literature review yielded 28 articles with DAS59 and 32 articles with DAS24 from peer-reviewed journals met our inclusion criteria and were included in the analysis. Since its inception in 2001, the number of publications incorporating the DAS has increased each year with a total of 3.483 patients for DAS59 and 6.012 patients for DAS24. The prospective study design was the most prevalent, being used in 50% of publications (n = 30), 57% for DAS59, 43% for DAS24. The DAS59 was administered in a cross-sectional design in 21% of studies (n = 6) and DAS24 41% (n = 13). The DAS59 was administered in a retrospective design in 18% of studies (n = 5) and DAS24 9% (n = 3). We reported only one case series for DAS59 and 2 for DAS24. The DAS59 and DAS24 are versatile self-assessment tools that can be used in different medical and surgical environments. Level of evidence: not ratable.

The idea of this study stemmed to understand if sexuality can be a factor that affects the perception of one’s body and can be a feature that makes the subject more inclined to undergo esthetic surgery. A total of 51 male subjects participated in this study by filling out the Italian version of the DAS59 consisting of 59 items, which took approximately 35 min, under the supervision of a research assistant who did not interfere with the privacy of the patient. The data was entered in SAS version 8.4 (SAS Institute, Cary, NC, USA). The reliability of the scale was tested by Cronbach’s alpha coefficient and the correlation coefficient. Retest reliability was also tested using Spearman’s correlation coefficient between items and the total scale score. Analysis of variance was performed between the two groups. Differences between the homosexual and heterosexual subjects were assessed using the Mann–Whitney test of discriminant validity. Adult homosexual male patients without a personal history of esthetic procedures were recruited. We enrolled 26 adult homosexual male patients aged 18–42 years old and 25 male heterosexual adults aged 18–43 years. Any subject had personal history of esthetic procedures. We analyzed direct and indirect indicators of “esthetic concern,” the number of answers given by each subject accuracy, the attention to the questionnaire, and the effect on age on accuracy between the two groups. We confirmed that there are many differences between the two groups. Nevertheless, the greater attention to esthetics and concern for appearance is much more present in the homosexual group than in the heterosexual group, and its relationship with age in the homosexual group is a strong indication of an important and essential phenomenon in development. The absence of such a relationship in the heterosexual group leads instead to think that the esthetic concern is in this group a phenomenon of local type and much less fundamental than the personality. The DAS59, used in a homogeneous study group, has shown that esthetic sensibility may depend on emotional and psychological factors within a homogeneous social dimension that does not create a difference. This pilot study is the first to introduce the importance of the role of sexuality in the perception of the esthetics of one’s body. Level of evidence: Not ratable.

Rhinoplasty is one of the most complex procedures in plastic surgery. In patients over 65, the procedure is even more demanding because of the coexistence of multiple complicating psychological and anatomical factors. The aims of our study were to analyze the necessity of rhinoplasty in elderly patients, to analyze the perception of patients before and after procedures and compare these patients with younger population, to review all cases done in our department over the past 20 years, and to summarize all procedures. We designed a retrospective study of patients that had submitted to primary rhinoplasty by the same surgical team from 1997 to 2017. The inclusion criteria were as follows: Italian national patients of either sex over 65 years old who underwent primary rhinoplasty in our department. The exclusion criteria were as follows: psychiatric disorder, abuse of alcohol or drugs, patients who had undergone secondary rhinoplasty, or patients with previous trauma. Our final sample was 125 patients. We submitted FACE-Q rhinoplasty module to 25 patients comparing the results with a control group of younger patients. Of 1703 patients who underwent primary rhinoplasty in our Department of Plastic Surgery from 1997 to 2017, only 125 were over 65 years old. The average age was 68 years old, with 72 male and 53 female patients. From June 2016 to May 2017, the Italian version of FACE-Q rhinoplasty module was given to 25 elderly patients pre- and postoperatively and to 25 younger patients (control group), for comparison. All patients answered the postoperative module 6 months after their procedure. The most noticeable result was in tip perception, in fact in the > 65 years old group. Two surgeons reviewed and summarized all 125 cases and procedures, which were 89 open approach, 36 closed approach, 17 reduction rhinoplasty, 108 augmentation rhinoplasty, 47 dorsum grafts, 159 tip grafts, 9 alar region grafts, and 5 other grafts. The tip of the nose is the focus of attention for older patients who want to undergo this surgery and require surgical procedures for increased projection and support. Augmentation rhinoplasty plays a fundamental role in the remodeling of the nose in patients over 65 years old. Level of Evidence: Level III, risk/prognostic study.

Breast reconstruction plays an important role in improving the quality of life of patients with breast cancer. The aim of this study is to verify if there is a difference in patient’s satisfaction and in body perception following monolateral and bilateral mastectomy with breast reconstruction. The study population were 144 women who had undergone mastectomy and breast reconstruction at our hospital between 2005 and 2016. They filled out BREAST-Q post-operative module after almost 1 year from breast reconstruction. We administered the questionnaire electronically almost 1 year after surgery for each procedure. This cross-sectional study compared two cohorts in which 121 women underwent monolateral mastectomy and breast reconstruction with or without contralateral adjustment and 23 women underwent bilateral mastectomy and breast reconstruction. After reconstruction procedures, patients that underwent bilateral mastectomy were more satisfied than monolateral mastectomy group in satisfaction with appearance of breast (P

A patient's perspective is usually measured by patient-reported outcome instruments, which are becoming increasingly relevant to current research on clinical outcomes. The aims of our review were to identify studies that evaluated patient satisfaction after gynecomastia correction, analyze existing questionnaires, and summarize the development, psychometric properties and content of the questionnaires. A multistep search of the web-based PubMed database was performed. Each potential study was examined by 2 independent reviewers for adherence to inclusion/exclusion criteria. The identified studies were categorized by title, authors, date, study type, number of patients, surgical procedures, complications, mean age, mean duration of follow-up, and outcome measurements. We summarized all the questionnaires used. Our search generated a total of 711 articles; we selected 28 studies for further appraisal. Eight studies were excluded based on the content of the abstracts, and an additional 8 studies were excluded based on the content of the complete article. Thus, we performed a systematic review of the 12 remaining studies. All studies identified from the literature review were assessed to determine the type of surgery used and whether or not the questionnaire used to analyze patient satisfaction had been validated. A total of 847 patients were included in these studies, which reported more than 100 complications. The rate of patient satisfaction was high, although most studies did not use validated or quantifiable evaluation methods for assessment of satisfaction. A new self-assessment tool, which should include functional, psycho-relational, and cosmetic components, is needed to measure satisfaction and quality of life in patients who have undergone gynecomastia correction. Level of Evidence: Level III, therapeutic study