Handedness and Laterality in Plastic Surgery and Outcome-A Retrospective, Two-Center, Evaluator-Blinded Study

Abstract

Background: Little is known about the influence of handedness on the outcome of operations in plastic surgery. Our study addresses the question of whether there is a difference between the right and left sides in the outcome of plastic surgeries in relation to the handedness of the surgeon.

Patients and methods: In this retrospective two-center study, patients undergoing plastic surgery on bilateral locations (breast reduction, mastopexy, augmentation mastopexy, blepharoplasty, mastectomy on gynecomastia, brachioplasty, thigh lift) between January 2020 and December 2023 were included. The outcome was assessed separately by an independent assessor. The Likert scale (1-10) was used as the standardized assessment method for the study data. Additionally, complications were classified as minor or major complications, depending on whether a reoperation was necessary or not.

Results: During the study period, 61 patients (four men and 57 women) were included (mean age 44 years, range 18-83 years) with a mean follow-up of 9.3 months (range 1-28 months). There was no statistically significant difference between both sides (p = 0.60) with a positive trend toward the right side. There were no major complications and 12 minor complications (19.7%) with a tendency to a higher complication rate on the right side.

Conclusion: Our results indicate that handedness may play a minor role in the outcome of plastic surgeries. Nevertheless, ergonomic measurements can be made in order to optimize the outcome. Moreover, it might be necessary to include ambiguity in handedness to improve the overall outcome.

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 .

Keywords: Comparative study; Complications; Functional laterality; Patient outcome assessment; Retrospective studies.

Fig. 1

Bar plot with Likert scores for the breast surgery group

Fig. 2

Bar plot with Likert scores for the blepharoplasty surgery group

Fig. 3

A 33-year-old woman with breast hypoplasia and involution (a–e) after pregnancy underwent bilateral submuscular breast augmentation dual plane II (320 cc (Ref.: E2SF-320Q, Motiva)). The postoperative course was uneventful. After a follow- up of six months (f–j), clinical analysis showed a window shading effect on the left side. Nevertheless, the patient was very satisfied with the overall outcome (VAS 10 on both sides). Our independent evaluation confirmed the patient’s satisfaction (Likert scale 10 on both sides), and the scar was imperceptible

Fig. 4

An 83-year-old woman underwent bilateral upper blepharoplasty with severe hooding and skin excess (a—e). The postoperative course was uneventful and there were no complications. After a follow-up of 6.3 months (f—j), clinical analysis showed a satisfactory result, which goes in line with patient satisfaction (VAS 10 on both sides). Our independent evaluation confirmed the patient’s satisfaction (Likert scale 10 on both sides), and the scar was imperceptible

Fig. 5

A 19-year-old man underwent bilateral water-assisted liposuction and pull-through technique with drains for the treatment of Grade 3 [22] gynecomastia as previously described (a—e) [13]. The postoperative course was uneventful and there were no complications. After a follow-up of 12 months, clinical analysis showed a satisfactory result (f—j) with minimal indentation on the left side which did not bother the patient. Patient satisfaction was VAS 10 for both sides. Our independent evaluation confirmed the patient’s satisfaction (Likert scale 10 on both sides), and the scar was imperceptible

Fig. 6

A 25-year-old female with macromastia (a—e) underwent bilateral breast reduction with a super-medial pedicle, circumvertical incisions and along the inframammary fold. The patient had previous radiotherapy as a child for Hodgkin lymphoma. The postoperative course was uneventful without any complications. The patient was satisfied with the result (f—j) six months after the surgery but was slightly displeased by the hypopigmented periareolar scar. Our independent evaluation showed a Likert score of 7 for the right side and a Likert score of 9 for the left side