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RealSelf Assessment of Patient Narratives and Drivers of Dissatisfaction Following Augmentation-Mastopexy: A
Khalid Khalil1, Mahmoud Aa Kandil2, Steven Labib2
1Department of Plastic Surgery, University Hospital of North Durham, County Durham & Darlington NHS Foundation Trust, Durham, UK. Khalid.khalil@nhs.net.
Background:
Augmentation-mastopexy is a technically demanding procedure associated with high rates of dissatisfaction. Beyond complication and revision rates, less is known about the subjective drivers of dissatisfaction. This study evaluated whether negative online reviews following augmentation-mastopexy can yield insights for practice.
Methods:
A mixed-methods analysis was conducted on 327 consecutive RealSelf augmentation-mastopexy reviews rated as 'Not Worth It' or 'Not Sure' from 2015-2025. Patient-reported complications, surgeons' credentials, cost, reasons for dissatisfaction and patient-submitted photographs were analysed. Surgeon credentials were verified using national registers and compared to a comparator cohort of positive reviews over the same timeframe. A thematic analysis was performed to explore patients' subjective experiences.
Results:
The most common patient-reported complications were asymmetry (20.0%) and implant malposition/displacement (19.9%). While dissatisfaction with surgical outcome was the most cited factor (97.2%), most reviews (68.2%) highlighted multiple concerns. These included issues with bedside manner (40.7%), value for money (43.1%), and inadequate aftercare (33.9%). Three overarching themes emerged: (1) dissatisfaction driven by dismissal of patient concerns or lack of accountability, (2) negative outcomes linked to a perceived lack of planning, and (3) lack of financial transparency related to revision costs. The representation of non-certified/'cosmetic surgeons' was approximately two-fold higher in the negative review cohort (5.8% vs 2.7%). Notably, 21.7% of patient-submitted photographs showed no visible complications. Median reported cost was $10,000.
Conclusion:
Dissatisfaction following augmentation-mastopexy is multifactorial. This study highlights the need for improved patient communication, expectation management, and financial transparency in order to improve satisfaction and preserve trust when complications arise.
Level Of Evidence Iv:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .