Breast size in lactating women and the content of macronutrients in human milk

INTRODUCTION

Although the primary function of a woman's breast is milk synthesis, only a few studies have evaluated the relationship between breast size and human milk composition, showing equivocal results. This study aims to test if breast size during fully established lactation is related to energy density and content of macronutrients in human milk.

MATERIALS AND METHODS

Mothers of healthy, born-on-term infants at stage III of lactogenesis (N = 137) provided breast milk samples. Milk composition was analyzed using midinfrared transmission spectroscopy. The breast size index was calculated by dividing the breast by the circumference below the breast.

RESULTS

Stepwise forward linear regression showed a negative association between breast size index and lactose concentration in breast milk (β = -.242, p = .003). The final model, which includes breast size index, feeding frequency, and maternal energy intake together explained around 13% of the variance in breast milk lactose content (R2 adj = .126, p < .001). No statistically significant relationship was found between breast size index and milk's energy density, protein, and fat content.

CONCLUSION

This is the first study that shows a negative relationship between breast size during fully established lactation and lactose concentration in milk in a large sample size. No relationship between other macronutrients and breast size indicates that large breast size is not necessary for adequate milk production; however, it may contribute to an altered lactose concentration.

Integrated Case-Based Learning Session for Breast and Upper Limb Anatomy

Introduction

Medical students are frequently introduced to medical school curricula through anatomy coursework, which often includes histology and embryology content. As medical education has increasingly emphasized integration of content areas, use of activities such as case-based learning (CBL) sessions has grown. Little published work has demonstrated the effectiveness of CBL sessions in integrating anatomy, embryology, and histology on first-year medical students' ability to improve content mastery and adapt their study techniques.

Methods

We developed a CBL session that included anatomy, embryology, and histology content covering the upper extremity and breast pathology that was taught to incoming first-year medical students (N = 51) during a prematriculation program in the summers of 2022 and 2023. The session involved completion of an individual pre- and postsession quiz; group completion of clinical cases involving image interpretation, matching exercises, and construction of diagrams, flowcharts, or tables; and a postsession survey with Likert-style and free-response questions about preparation and session effectiveness.

Results

Postsession quiz scores significantly improved (p < .001). On the postsession survey (response rate: 59%), students commented that they enjoyed the real-life application and integration of the cases and that the sessions improved their understanding of the connections between content areas. Other comments demonstrated that students were evaluating and adapting their study approach in preparation for the sessions, often using techniques introduced and practiced in the sessions.

Discussion

CBL sessions can provide opportunities to incoming first-year medical students to practice, adapt, and evaluate study techniques while delivering integrated content.

Understanding Preoperative Breast Satisfaction among Patients Undergoing Mastectomy and Immediate Reconstruction: BREAST-Q Insights

BACKGROUND

This study aims to present normative values for satisfaction with breasts among preoperative breast reconstruction patients as assessed using the BREAST-Q instrument and to delineate factors associated with preoperative breast satisfaction.

METHODS

A retrospective analysis of prospectively collected data was performed examining women undergoing postmastectomy breast reconstruction at a tertiary care center who preoperatively completed the BREAST-Q from 2010 to 2017. Because breast satisfaction scores were nonnormally distributed, scores were categorized into quartiles for analysis. Patient- and treatment-level variables were tested in a multivariable ordinal logistic regression model as predictors of breast satisfaction. Preoperative satisfaction was also tested for association with choice of reconstructive modality.

RESULTS

Among 1306 postmastectomy reconstruction patients included in the study, mean preoperative Satisfaction with Breasts score was 61.8 ± 21.5 and the median score was 58.0 (interquartile range, 48 to 70). Factors associated with significantly lower preoperative satisfaction included history of psychiatric diagnosis, preoperative radiotherapy, marital status (married), and higher body mass index. Factors associated with significantly higher scores were malignancy (localized tumor), medium bra size (B to C cup), and self-identification as black. Preoperative breast satisfaction was lower among patients who elected autologous reconstruction than among those with implant reconstruction (p < 0.001).

CONCLUSIONS

Preoperative breast satisfaction is influenced by multiple factors. Understanding these factors may improve preoperative counseling and expectation management for patients who undergo postmastectomy breast reconstruction.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, III.

25 Years of Research in Human Lactation: From Discovery to Translation

Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.

BreastImplantAnalyzer: An easy-to-use, validated tool for calculating breast implant volume from MRI data

BACKGROUND

Given the prevalence of breast augmentation and prosthetic-based breast reconstruction, it is common for the plastic surgeon to see patients presenting for revisional implant surgery. A frequent issue encountered in such procedures is uncertainty of implant size, which presents numerous challenges and may lead to undesired outcomes for both the patient and the surgeon. There is currently no tool available with the purpose of measuring implant volume from magnetic resonance imaging (MRI) data. In this study, such a program was designed and tested.

METHODS

An open-source software was developed that provides volume measurement of a chosen breast implant with minimal interaction from the user, allowing for precision in the planning of breast implant revisional surgery. It was developed to be as easy to use as possible for clinicians who may not have experience with imaging analysis platforms. The program was tested on patients who underwent revisional implant surgery and had documented implant volumes and pre-operative breast MRIs. Twenty-two implants were tested in total, including saline and both smooth and textured silicone implants.

RESULTS

The software has shown to be highly accurate with an average accuracy of 98.6%. A Spearman correlation coefficient of 0.967 was obtained. The software also performed faster than previously proposed methods.

CONCLUSION

Plastic surgeons can easily calculate breast implant volume pre-operatively using BreastImplantAnalyzer, which is available to download for free from www.BreastImplantAnalyzer.com or as an extension for the popular medical imaging platform 3D Slicer.

Sports Medicine-Related Breast and Chest Conditions-Update of Current Literature

ABSTRACT

This article reviews the most up-to-date evidence-based recommendations pertaining to breast and upper chest conditions, specifically for the sports medicine physician. Because of the unique circumstances of the team physician, they can see a wide breadth of pathology. Athletes may not have a primary care physician and may prefer to present to their team physician for breast and upper chest conditions. It is often more comfortable and convenient for athletes to seek treatment in the team setting. Therefore, it is important that the medical professional be aware of not only common pathology but also of that which is rarer. Any delay in evaluation can result in unnecessary morbidity and lead to complications or extended time lost from sport. Consequently, it also is important to facilitate an atmosphere encouraging early presentation and workup.

Side of contrast injection and breast size correlate with motion artifacts grade and image quality on breast MRI

BACKGROUND

Motion is a relevant cause of artifacts in breast magnetic resonance imaging (MRI), potentially degrading image quality, even with optimized protocols.

PURPOSE

To investigate the causes of motion artifacts (MA) impacting on image quality (IQ) of contrast-enhanced breast MRI.

MATERIAL AND METHODS

Retrospective two-center study on consecutive 1.5-T contrast-enhanced breast MRI, independently reviewed by two radiologists on first subtracted and maximum intensity projection images to define the side most affected by MA. IQ was scored as 1 (optimal), 2 (reduced, but without reduction of diagnostic power), or 3 (reduced, with reduced diagnostic power). Correlations with injection side, breast size (A/B vs. C/D cups), patient age, clinical indication, and MRI scanner/protocol were assessed using χ² and Fisher's exact statistics.

RESULTS

In total, 237 examinations were included, with right injection performed in 124 (52%) and left in 113 (48%). MA were more frequent on the side ipsilateral to the injection (144/237, 61%, 95% confidence interval [CI] 54-67%) than on the contralateral (93/237, 95% CI 33-46%) (P < 0.001); IQ was scored 1 in 154/237 (65%), 2 in 63/237 (27%), and 3 in 20/237 (8%) examinations; patients with A/B cups showed higher IQ score than patients with C/D cups (scores 1, 2, and 3: 54% vs. 70%; 29% vs. 25%; 17% vs. 5%, respectively, P = 0.002). No significant correlations were found for MA (P≥0.106) or IQ (P ≥ 0.318) between ipsi- or contralateral injection and right/left injection, breast size, age, indication, or scanner/protocol.

CONCLUSION

MA were more frequent in breasts ipsilateral to contrast injection and showed a reduced IQ for small breasts.

BreastIdea Volume Estimator: A New Tool for Breast Volume Estimation-Presentation and Validation for Women

Breast volume assessment is crucial in a breast surgeon's clinical practice. The aim of this study was to present and validate a new Web application, BreastIdea Volume Estimator, a module for breast estimation of the already validated BreastIdea application. Forty breasts in 20 women were scanned using a three-dimensional scanner. They were then photographed in nonstandardized conditions, and volume estimations were calculated using BreastIdea Volume Estimator. Accuracy in addition to relative and absolute reliability of BreastIdea Volume Estimator measurements were investigated. In addition, breast volume differences were analyzed. Breast volume estimation using BreastIdea Volume Estimator yielded satisfactory accuracy and presented precision of the level of clinical measures. The mean absolute difference for both observers was 4.33 ± 3.79 cc and 6.78 ± 4.66 cc, which correspond to 1.87 ± 1.89 percent and 2.75 ± 2.05 percent errors of measurement. Similar relations were found for measurements of breast volume differences. BreastIdea Volume Estimator is a clinically oriented, reliable tool for breast volume evaluation. It provides results of appropriate accuracy regardless of chest abnormality and photograph standardization.

The impact of age and body mass index on a bra sizing system formed by anthropometric measurements of Sichuan Chinese females

Existing bra sizing systems are based only on bust and underbust girths, which do not guarantee an accurate fit or comfort for consumers. This study presents a comprehensive investigation of the impact of age and body mass index (BMI) on bra sizing systems, and the distributions of band and cup sizes based on anthropometric measurement data. The first four principal components were extracted by principal component analysis, and the factor loadings of age and BMI were found to be significant determinants of bra size along with 12 other variables. Furthermore, chi-square analysis revealed that bra size allocations were significantly influenced by age and BMI. Thus, we propose that age and BMI should be considered as auxiliary criteria for the bra sizing system. Taken together, these findings will be of value to designers and bra manufacturers in developing well-fitting bras for their target consumers, and to consumers for selecting well-fitting bras with confidence. Practitioner Summary: This study contributes to an understanding of how bra sizing systems are affected by age and BMI. This understanding is valuable to bra designers, manufacturers, and retailers, as it will enable the adjustment of bra sizes for different target markets and in turn improve consumer confidence in selecting proper fitting and comfortable bras.

Relationship between formulaic breast volume and risk of breast cancer based on linear measurements

BACKGROUND

Whether breast volume is a risk factor for breast cancer is controversial. This study aimed to evaluate whether a significant association between breast volume and risk of breast cancer, based on linear measurements, was present by applying propensity score matching (PSM).

METHODS

The study was designed as a hospital-based case-control study. Between March 2018 and May 2019, 208 cases and 340 controls were retrospectively reviewed. Information on menarche, smoking, feeding mode, oral contraceptives, reproductive history and family history was obtained through a structured questionnaire. Breast volume was calculated using a formula based on linear measurements of breast parameters. Cox regression and PSM were used to estimate odds ratios and 95% confidence intervals for breast cancer using risk factors adjusted for potential confounders.

RESULTS

There was a significant difference in breast volume between the two groups before propensity score matching (P = 0.014). Binary logistic regression showed that the risk of breast cancer was slightly higher in the case group with larger breast volumes than in the control group(P = 0.009, OR = 1.002, 95%CI:1.000 ~ 1.003). However, there was no significant statistical difference between the two groups using an independent sample Mann-Whitney U test (P = 0.438) or conditional logistic regression (P = 0.446).

CONCLUSIONS

After PSM for potential confounding factors, there is no significant difference in breast volume estimated by BREAST-V formula between the case group and the control group. The risk of breast cancer may not be related to breast volume in Chinese women.

Breast and torso characteristics of female contact football players: implications for the design of sports bras and breast protection

This study aimed to provide normative data characterising the breast size, breast position and torso size of female contact football players. 117 AFL, Rugby League, Rugby Union and Rugby 7s players attended a single testing session where a three-dimensional scan was taken of their naked breasts and torso. Dimensions relevant to the design of sports bras and breast protective equipment were then calculated from the scans. Several breast and torso characteristics of female contact football athletes differed to measurements reported for females in the general population and amongst the contact football codes. Designers and manufacturers of sports bras or breast protective equipment should consider the specific breast and torso dimensions of female contact football players to maximise the fit, comfort and efficacy of these garments. Practitioner summary: Using three-dimensional scanning, this study characterised the breast and torso size and shape of 117 female contact football players. These normative data should be used to improve the fit and comfort of sports bras and breast protective equipment for female contact football players.

The Attachments of the Breast to the Chest Wall: A Dissection Study

BACKGROUND

The anatomical descriptions of the attachments of the female breast to the chest wall vary in their structure, location, and terminology within the published literature.

METHODS

A dissection study of the attachments of the breast to the chest wall was conducted on 18 female embalmed breasts in the coronal (n = 15) and sagittal planes (n = 3).

RESULTS

Perimeter, posterior wall, and horizontal septum attachments were observed. The perimeter along its entire length was attached to the chest wall. Regional and anatomical variation was observed in this structure and location. Sharp dissection was required to remove it from the chest wall, in contrast to the blunt dissection required to remove the posterior wall and horizontal septum attachments.

CONCLUSIONS

The breast attaches to the chest wall along its entire perimeter, posterior wall, and horizontal septum, with the perimeter functioning as the primary anchor of the breast to the chest wall. The structure of the perimeter attachment is both periosteal and fascial and requires sharp dissection to remove it from the chest wall. The fascial structures of the posterior wall and horizontal septum require blunt dissection only. The structure of the perimeter has regional variation, and its location on the chest wall has anatomical variation. Detailed anatomical descriptions and illustrations are supported by photographic evidence of cadaver dissections in two planes. Clinical and anatomical terminology are linked, with clinical implications for medical anatomy education, breast modeling, and breast surgery.

The effect of breast size and bra type on comfort for UK female police officers wearing body armour

Within the Police service of England and Wales the wearing of ballistic and stab resistant body armour is common, with most police forces mandating its usage when away from the police station. Of all the serving police officers in England and Wales 29.1% are female (Hargreaves et al., 2017). A survey was developed and then distributed by the Police Federation of England and Wales to all servicing police officers up to the rank of Inspector. The survey returned 2633 responses after cleaning of the data. From the responses it was seen that the predominant bra type worn is underwired (71%) and the predominant UK bra size is 34B (9%). It was also determined that the predominant areas where the body armour either rubbed or caused discomfort were the left and right anterior mammary regions and the posterior lateral sacral region. By understanding the distribution of bra size, type of bra worn and areas of discomfort or rubbing it helps further understand the issues faced by female police officers and how body armour design could be improved.

Stereotypical and Actual Associations of Breast Size with Mating-Relevant Traits

Breast size varies substantially among women and influences perception of the woman by other people with regard to her attractiveness and other characteristics that are important in social contexts, including mating. The theory of sexual selection predicts that physical criteria of partner selection should be markers of the candidate's desirable properties, mainly biological quality. Few studies, however, have examined whether breast size really signals biological quality or its components and whether observers accurately interpret these signals. Our first study encompassed 163 young women and aimed to establish actual correlates of breast size. The aim of the second study was to determine preferences and stereotypes related to breast size: 252-265 women and men evaluated female digital figures varying in, among other characteristics, breast size. Breast size (breast circumference minus chest circumference) was negatively associated with body asymmetry and positively associated with infections of the respiratory system, but did not correlate with infections of the digestive system, openness to casual sex, and testosterone and estradiol level. Women and men perceived breasts in a similar way to each other: the bigger the breasts the higher the reproductive efficiency, lactational efficiency, sexual desire, and promiscuity attributed to the woman. Nevertheless, large breasts were not regarded more attractive than average ones, though small breasts were the least attractive. In addition, big-breasted women were perceived as less faithful and less intelligent than women with average or small breasts. We discuss our results from the perspectives of evolutionary psychology, perceptual biases, and social stereotypes.

Evaluation of average glandular dose and investigation of the relationship with compressed breast thickness in dual energy contrast enhanced digital mammography and digital breast tomosynthesis

PURPOSE

To quantitatively assess the dose of Dual energy contrast enhanced digital mammography (CEDM) and digital breast tomosynthesis (DBT) and to investigate the relationship between average absorbed glandular dose (AGD), compressed breast thickness (CBT) and compression force (CF).

MATERIALS AND METHODS

All CEDM and DBT examinations were performed in cranio-caudal (CC) and medio-lateral oblique (MLO) view. Exposure parameters of 135 mammographic procedures that using AEC (automatic exposure control) mode were recorded. AGDs were calculated. Kruskal Wallis test was performed.

RESULTS

CBT population ranged from 23 to 94 mm with a thickness median value of 52 mm in CC view and of 57 mm in MLO views. CEDM AGD median value was significatively lower than DBT AGD in each views (p << 0.01). AGD showed a positive correlation and linear regression with CBT for both CEDM and DBT while CF did not show a correlation and linear regression with AGD. The highest values were found for MLO view: R² of 0.74 for CEDM and R² of 0.61 for DBT. Kruskal Wallis test shows that there was a difference statistically significant between AGD values of CEDM and DBT in CC view respect to MLO views (p < 0.01).

CONCLUSIONS

Dose values of both techniques meet the recommendations for maximum dose in mammography. The results of the present study indicated that there was significant difference between AGD for CEDM and DBT exposure in different views (AGD in CC views had the lowest value) and that CBT could influence the AGD while CF was not correlated to AGD.

Effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity in women

PURPOSE

This study investigated the effects of obesity on breast size, thoracic spine structure and function, upper torso musculoskeletal pain and physical activity participation in women living independently in the community.

METHODS

A total of 378 women were divided into 3 groups (Not Overweight: body mass index (BMI) = 22.5 ± 0.2 kg/m² (mean ± SE); Overweight: BMI = 27.4 ± 0.3 kg/m²; Obese: BMI = 35.4 ± 0.3 kg/m²). Outcome variables of breast volume (mL), thoracic flexion torque (N·m), thoracic kyphosis (degrees), upper torso musculoskeletal pain (score) and time spent in physical activity (min) were calculated and compared among the 3 groups, adjusting for between-group differences in age.

RESULTS

There was a significant main effect of BMI on all outcome variables. Participants classified as Obese displayed significantly larger breasts, had greater thoracic flexion torques and reported less time participating in physical activity relative to the participants who were classified as Not Overweight and Overweight. Participants in the Obese group also displayed significantly more thoracic kyphosis and reported significantly more upper torso musculoskeletal pain compared to their counterparts who were classified as Not Overweight.

CONCLUSION

This study is the first to demonstrate that increased obesity levels were associated with compromised kyphosis and loading of the thoracic spine, as well as increased symptoms of upper torso musculoskeletal pain and reduced time spent in physical activity in women living in the community. We recommend further research to determine whether evidence-based interventions designed to reduce the flexion torque generated on the thoracic spine can improve these symptoms of upper torso musculoskeletal pain and the ability of women with obesity to participate in physical activity.

An audit of radiation-induced skin reactions in the inframammary fold; does breast size impact on the severity of the reaction?

INTRODUCTION

Skin toxicity is a clinically significant side effect of external beam radiation; moist desquamation is particularly prevalent for breast patients, mainly in the axilla and inframammary fold (IMF). The aim of this audit was to assess if there is a correlation between patient breast size and the presence and extent of radiotherapy skin reaction in the IMF.

METHODS

Between 22/12/2017 and 31/05/2018 forty patients undergoing standard whole breast radiotherapy using 3D planned medial and lateral tangential fields had their skin reaction recorded weekly, whilst on treatment, using the Radiotherapy Oncology Group (RTOG) scoring system. Skin reactions were also documented at three and eight weeks post radiotherapy. A measurement of the patients IMF length and bra size were also noted. Statistical analysis was carried out using IBMÒ SPSS Statistics 24.

RESULTS

Six patients presented with grade ≥2 during week three of radiotherapy. The mean IMF length of six patients with adverse reactions 6.1 cm (±3.6 cm). As the length of the IMF increases, severity of skin reactions also increases; a positive correlation was identified between the two at both week three of radiotherapy and three weeks post radiotherapy (r = 0.401, n = 34, p = 0.05 and r = 0.671, n = 29, p = 0.00 respectively). Only one patient displayed grade 2 at eight weeks post radiotherapy (IMF length 7.5 cm).

CONCLUSION

The findings from this study would suggest that larger breasted patients do present earlier, and with more severe radiation-induced skin reactions.

IMPLICATIONS FOR PRACTICE

Changes to skin care practice could be considered for patients with larger breasts. This could be in the form of more frequent check-ups during treatment or proactive side effect management rather than reactive management.

Demonstration of flat-top beam illumination in widefield multiphoton microscopy

Multiphoton microscopy provides a suitable technique for imaging biological tissues with submicrometer resolution. Usually a Gaussian beam (GB) is used for illumination, leading to a reduced power efficiency in the multiphoton response and vignetting for a square-shaped imaging area. A flat-top beam (FTB) provides a uniform spatial intensity distribution that equalizes the probability of a multiphoton effect across the imaging area. We employ a customized widefield multiphoton microscope to compare the performance of a square-shaped FTB illumination with that based on using a GB, for both two-photon fluorescence (TPF) and second-harmonic generation (SHG) imaging. The variation in signal-to-noise ratio across TPF images of fluorescent dyes spans ∼5.6  dB for the GB and ∼1.2  dB for the FTB illumination, respectively. For the GB modality, TPF images of mouse colon and Convallaria root, and SHG images of chicken tendon and human breast biopsy tissue showcase ∼20  %   area that are not imaged due to either insufficient or lack of illumination. For quantitative analysis that depends on the illuminated area, this effect can potentially lead to inaccuracies. This work emphasizes the applicability of FTB illumination to multiphoton applications.

A New Tool for Breast Anthropometric Measurements: Presentation and Validation for Women and Men

Introduction

Anthropometric measurements of breasts are crucial for planning surgical procedures; however, there are no practical solutions for their quick, digital performance. The aim of the study was to present and validate a self-designed web application BreastIdea (BI) designed for indirect breast anthropometry.

Methods

Ten male and 10 female volunteers had their chests measured directly according to the routine clinical practice. Then their chests were photographed in non-standardised conditions. Corresponding measurements were performed using BI. Accuracy and both relative and absolute reliability of BI measurements were investigated.

Results

Breast assessments using BI yielded highly accurate results and presented near-perfect precision when compared to direct anthropometric measurements of the breast. Indirect anthropometry eliminates the necessity to trace the body’s curves, which usually introduces a bias to linear measurements.

Conclusion

BI web application is a reliable tool for indirect breast measurements in a clinical setting, providing accurate results regardless of chest pathology and photograph standardisation.

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.

Poland syndrome before Alfred Poland: the oldest medical description (Paris, France, 1803)

Here, we present a description of Poland syndrome from the second session of the Anatomical Society (Paris, France) on 11 December 1803 of congenital mammary absence and muscular atrophy on the right side. This case report predates the first official description of the disease published by Alfred Poland in Guy's Hospital Reports (London, 1841). Consequently, perhaps would it be necessary to do justice to its French discoverer, and to name from now on this nosological entity the "syndrome of Marandel"?

The Occurrence, Causes and Perceived Performance Effects of Breast Injuries in Elite Female Athletes

Female breasts are vulnerable to direct blows or frictional injuries during sport; however, little research has investigated breast injuries experienced by female athletes. This study aimed to investigate the occurrence, causes and perceived performance effects of breast injuries in elite female athletes across a wide range of sports. A custom-designed survey was distributed to female athletes aged over 18 years who were competing nationally or internationally in their chosen sport. The survey included questions about breast injuries sustained during training and competition and any perceived performance effects of these injuries. 504 elite female athletes from 46 different sports completed the survey. 36% of participants (n = 182) reported experiencing breast injuries and 21% (n = 37) perceived that their breast injury negatively affected their performance. Contact breast injuries were reported by significantly more athletes involved in contact or combat sports and by athletes with larger breasts or a higher body mass index. Frictional breast injuries were reported by significantly more older athletes or those with larger breasts. Less than 10% of participants who experienced breast injuries reported their injury to a coach or medical professional and only half used any prevention strategies. Athletes, coaches and medical professionals associated with women's sport need to be made aware of the occurrence and potential negative effects of breast injuries. It is critical to normalise conversations around breast health so that athletes can be encouraged to report and, when necessary, receive treatment for breast injuries. Further research is also required to better understand factors that affect breast injuries in sport in order to develop evidence-based breast injury prevention strategies.

Preoperative breast volume evaluation of one-stage immediate breast reconstruction using three-dimensional surface imaging and a printed mold

BACKGROUND

Accurate assessment of breast volume is an essential component of preoperative planning in one-stage immediate breast reconstruction (IBR) for achieving breast symmetry and a satisfactory cosmetic outcome. In this study, we compared breast volume estimation using three-dimensional (3D) surface imaging with magnetic resonance imaging (MRI) to determine the accuracy of breast volume measurements. Further, a 3D printing mold for facilitating autologous breast reconstruction intraoperatively is described.

METHODS

Patients scheduled to therapeutic or prophylactic mastectomy with one-stage IBR, either by autologous tissue transfer or direct implant, from 2016 to 2019, were enrolled in this study. 3D surface image and MRI were performed to evaluate breast volume and shape. The results were validated by the water displacement volume of the mastectomy specimen. Finally, a 3D printing mold was designed for breast reconstruction with autologous tissue.

RESULTS

Nineteen women who were scheduled to have 20 mastectomies (18 unilateral and one bilateral) were included. There was a strong linear association between breast volume measured using the two different methods and water displacement of mastectomy specimens when a Pearson correlation was used (3D surface image: r = 0.925, p < 0.001; MRI: r = 0.915, p < 0.001). Bland-Altman plots demonstrated no proportional bias between the assessment methods. The coefficient of variation was 52.7% for 3D surface imaging and 59.9% for MRI. The volume of six breasts was evaluated by both measurements and the intraclass correlation coefficient was 0.689 for 3D surface image (p = 0.043) and 0.743 for MRI (p = 0.028).

CONCLUSION

Using 3D surface image to evaluate breast shape and volume is a quick, effective, and convenient method. The accuracy, reproducibility, and reliability of 3D surface imaging were comparable with MRI in our study. In addition, 3D-printed molds can achieve better symmetry and aesthetic outcomes in immediate autologous breast reconstructions.

Diagnosis and Treatment of Breast Cancer in Men

Breast cancer occurs in about 1% of men, but the number of men receiving a diagnosis is increasing. Data on male breast cancer (MBC) is limited, and treatment for men is based primarily on treatments used for women. However, some argue that breast cancer in men is a different disease than breast cancer in women. Multiple risk factors, including those with genetic and environmental origins, affect the likelihood of men receiving a breast cancer diagnosis. This article discusses types of MBC, risk factors, treatment options, and ethical concerns men encounter after they receive a breast cancer diagnosis.