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    Implant candidate? Exploring Web-based self-evaluation tools for breast augmentation

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    Dr. Erhardt
    Prospective breast augmentation patients can go on the Internet, type in a few key words and bring up Web sites featuring interactive patient questionnaires that purport to help determine whether an individual is a good candidate for implant surgery.

    While the sites often provide sound information and can be a beneficial element of prospective patients' information gathering, some experts note that they also hold potential for bias. Some are run by implant manufacturers; others appear primarily to be vehicles for cosmetic surgeons of varying qualifications to promote their breast augmentation business.

    THE UPSIDE In his opinion, these Web sites can enhance the doctor-patient relationship, states Walter L. Erhardt, Jr., M.D., a plastic surgeon in Albany, Ga., past president of the American Society of Plastic Surgeons (ASPS) and past chair of ASPS's Public Education Committee. In fact, Dr. Erhardt serves on the board of one such site: yourplasticsurgeryguide.com. He is among a group of board-certified plastic surgeons that reviews the site's content — a service for which he receives no compensation. Rather, he views his efforts as a contribution toward credible patient education.

    "I think it's important to have folks who are out practicing evaluate the information that goes up on these sites. You have to be a board-certified plastic surgeon to be on this site."

    Dr. Erhardt accepted the post at yourplasticsurgeryguide.com specifically because he liked the approach of Ceatus Media Group, the online health media company that publishes the Web site.

    "Basically, all the content that goes up is reviewed by plastic surgeons," Dr. Erhardt tells Cosmetic Surgery Times.

    "Certainly, patients are clamoring for information. I can tell you...the vast majority of my breast augmentation patients have done their homework and most of that is done on the Internet," he says.

    On the site, visitors can take a two-minute quiz composed of 11 questions about their breasts, general health and willingness to accept typical risks of breast implant surgery. In addition to listing some possible complications, the site asks if potential patients are willing to accept that implants are not meant to last a lifetime and may need to be replaced, notes that implants might interfere with mammography, and so on. The site then generates a "personalized" report based on the answers provided, suggesting whether the test taker might be a good candidate for implants.

    In Dr. Erhardt's experience, patients who utilize such Web-based decision support tools are serious about having breast augmentation surgery, and they tend to be more aware of the potential downsides of surgery. He believes that the research they do can enhance the quality of the patient-doctor consultation.

    "I find that patients who have actually gone to Web sites or gotten questions or checklists are at a more sophisticated level. [As a result] our dialogue is at a higher level," Dr. Erhardt relates. "For me, a well-informed, well-educated patient is the best kind of patient."

    BIAS OR BENEFIT? In the opinion of Edward Pechter, M.D., a plastic surgeon in Valencia, Calif., and assistant clinical professor of plastic surgery at UCLA, patient-screening Web sites sponsored by implant manufacturers have the most room for bias. However, according to Dr. Erhardt, corporate-sponsored Web sites aren't necessarily a bad thing. He says that those like Allergan's natrelle.com, named after the company's breast implant line, offer helpful information.

    "I actually went through the site, [took the quiz] and think that it's a good evaluator. It parallels very closely to those questions that we, as plastic surgeons, ask in the office," Dr. Erhardt points out.

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    Lisette Hilton
    Lisette Hilton is a writer in Boca Raton, Fla., who heads up her company, Words Come Alive.

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