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Michalik R, Kühlmann B, Wild M, Siebers HL, Migliorini F, Eschweiler J, Betsch M. The Effect of Breast Size on Spinal Posture. Aesthetic Plast Surg 2024; 48:1331-1338. [PMID: 36280605 PMCID: PMC11035396 DOI: 10.1007/s00266-022-03141-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/01/2022] [Indexed: 11/30/2022]
Abstract
Macromastia can cause various clinical symptoms, such as low back and shoulder pain as well as sacro-iliac disorders. Because of these symptoms, some women consider breast reduction surgery. So far there does not exist a clear correlation between breast size and back pain. Purpose of this study was to evaluate if increasing breast size has a measurable effect on women's posture using radiation free surface topography.A total of 100 women were grouped according to their breast cup size into four groups (Cup Size: A, B, C, D). All female subjects were measured with a surface topography system, and their spinal posture and pelvic position were analysed accordingly.Our results showed that cup size affects kyphotic angle (p = 0.027) and surface rotation (p = 0.039) significantly. Kyphotic angle increased with cup size. Multiple linear regression analysis, however, revealed that the body mass index has the greatest influence on woman's posture, showing significant correlation to kyphotic and lordotic angle (p < 0.01), as to trunk (p < 0.01) and pelvic inclination (p = 0.02).This is the first study that evaluates the influence of increasing breast size on posture using surface topography. The results match with previous studies using different measuring techniques. However, the great influence of BMI on posture is also confirmed. Therefore, in clinical practice these factors should be taken into account and be approached. Surface topography seems to be a promising tool to further investigate the influence of breast size on posture.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 .
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Affiliation(s)
- Roman Michalik
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Britta Kühlmann
- Department of Plastic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Michael Wild
- Department of Trauma and Orthopaedic Surgery, Klinikum Darmstadt, Darmstadt, Germany
| | - Hannah Lena Siebers
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Jörg Eschweiler
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Marcel Betsch
- Department of Trauma Surgery and Orthopaedics, University Hospital Erlangen, Erlangen, Germany
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Yücel AF, Kozanoğlu E, Emekli U, Arıncı RA. Investigation of the Relationship of Functional Improvement and Body Mass Index in Breast Reduction Patients. Aesthetic Plast Surg 2024:10.1007/s00266-024-03855-z. [PMID: 38355743 DOI: 10.1007/s00266-024-03855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Due to macromastia, center of gravity changes and neck, shoulder, back pain become prominent. Macromastia and obesity separately cause pain and an increase in curves of vertebra. The aim of this study is to compare the functional benefits of reduction mammoplasty between obese and non-obese patients. MATERIALS AND METHODS Data of this retrospective study were collected from archives and include preoperative/postoperative thoracic Cobb angles, preoperative/postoperative VAS scores, BMI and resected breast tissue weight of patients who underwent reduction mammaplasty operations between August 2017 and April 2019 in Plastic, Reconstructive and Aesthetic Surgery Department. RESULTS This study shows that reduction mammoplasty enables significant decrease both in thoracic kyphosis angles and in neck, shoulder and back VAS scores. However, no significant difference was found in preoperative/postoperative values and mean amount of changes of thoracic kyphosis angles between obese and non-obese patients. Decreases in neck, shoulder and back VAS scores were not found statistically significant between two groups. The breast resection amount was not related to correction of kyphosis, but it enabled only a significant decrease in neck VAS scores. CONCLUSION Functional improvement was not related to body mass index in reduction mammoplasty patients. Functional benefits were observed similarly in both obese and non-obese patients. A precise threshold value for body weight, body mass index and amount of breast tissue could not be defined as an indication for functional reduction mammoplasty. 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 .
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Affiliation(s)
| | - Erol Kozanoğlu
- Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ufuk Emekli
- Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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Breast Hypertrophy: A Real Pain in the Back. Plast Reconstr Surg 2023; 151:498-508. [PMID: 36730482 DOI: 10.1097/prs.0000000000009906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bilateral breast hypertrophy comes with signs and symptoms ranging from mild to debilitating. Bilateral breast reduction (BBR) is one of the most frequently performed plastic surgery procedures, and its effects on parameters such as spinal balance, paraspinal muscle function, and physical performance have not been thoroughly evaluated. The objective of this study was to evaluate the effects of BBR using advanced spine imaging modalities, and pain resolution. METHODS A prospective, observational, cohort study was carried out at the McGill University Health Centre. The following measures were recorded preoperatively and postoperatively for each patient: patient questionnaires (BREAST-Q and Pain), magnetic resonance imaging, and EOS low-radiation spinal scan. RESULTS Significant postoperative pain reduction was recorded, and there was up to 148% improvement in physical tests. Improvement in all questionnaire and BREAST-Q categories was documented. Preoperative and postoperative magnetic resonance imaging did demonstrate a statistically significant absence of permanent anatomical skeletal sequelae. Postoperative improvement in thoracic kyphosis was documented. CONCLUSIONS Quality-of-life scores are uniformly improved following BBR. Key findings following BBR include significant pain reduction and no evidence of spinal skeletal change. This is a finding of major importance in view of the practice of many insurance companies/third-party payer and health care systems that use the Schnur scale. The Schnur scale associates a weight for resection with body size that is not directly predictive of pain relief. This may indicate the need for more precise or different guidelines based on these quantitative findings. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Spencer L, Fary R, McKenna L, Jacques A, Briffa K. Taking the strain: An examination of upper back musculoskeletal tissue sensitivity in relation to upper back pain and breast size. A cross-sectional study. Clin Biomech (Bristol, Avon) 2022; 92:105571. [PMID: 35051837 DOI: 10.1016/j.clinbiomech.2022.105571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 12/23/2021] [Accepted: 01/04/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The physiological basis for upper back pain experienced by women with large breasts is unclear but could relate to sensitivity of musculoskeletal tissues strained from the postural adaptations to large breasts. The aim of this cross-sectional study was to examine if upper back pain and breast size were associated with greater localised sensitivity of upper back musculoskeletal tissues. METHODS 119 healthy postmenopausal women (mean age 61 years) had their upper back pain (numerical rating scale), breast size (breast size score), and upper back tissue sensitivity (pressure pain thresholds (digital algometry, kPa)) assessed. The pressure pain thresholds of six skeletal sites (T2, T4, T6, T8, T10 and T12) and six muscular sites (pectoralis major, levator scapulae, sternocleidomastoid, and upper, middle, and lower trapezius muscles) were examined. Linear mixed models with random subject effects were used to evaluate differences in sensitivity at each anatomical site between participants grouped by upper back pain (nil-mild, moderate-severe) and breast size (small, large). FINDINGS For most sites, the differences in sensitivity between upper back pain groups were highly significant (P < 0.002) with significantly lower pressure pain thresholds (Mean difference (MD): 74.6 to 151.1 kPa) recorded for participants with moderate-severe upper back pain. There were no differences in sensitivity between breast size groups. INTERPRETATION Increased upper back musculoskeletal sensitivity is related to perceived upper back pain but not to breast size. It remains unclear if and how structural or mechanical factors related to breast size contribute to upper back pain in women with large breasts.
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Affiliation(s)
- Linda Spencer
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
| | - Robyn Fary
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
| | - Leanda McKenna
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
| | - Angela Jacques
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
| | - Kathy Briffa
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia.
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Abstract
Although half the world's population will develop breasts, there is limited research documenting breast structure or motion. Understanding breast structure and motion, however, is imperative for numerous applications, such as breast reconstruction, breast modeling to better diagnose and treat breast pathologies, and designing effective sports bras. To be impactful, future breast biomechanics research needs to fill gaps in our knowledge, particularly related to breast composition and density, and to improve methods to accurately measure the complexities of three-dimensional breast motion. These methods should then be used to investigate breast biomechanics while individuals, who represent the full spectrum of women in the population, participate in a broad range of activities of daily living and recreation.
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Affiliation(s)
- Deirdre E McGhee
- Biomechanics Research Laboratory, University of Wollongong, Wollongong, Australia
| | - Julie R Steele
- Biomechanics Research Laboratory, University of Wollongong, Wollongong, Australia
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Waltho D, McRae M, Thoma A. Patient-Reported Measurement of Breast Asymmetry Using Archimedes' Principle in Breast Reduction Mammaplasty: A Retrospective Study. Cureus 2020; 12:e6536. [PMID: 32038894 PMCID: PMC6993072 DOI: 10.7759/cureus.6536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Breast hypertrophy is a common condition that is often treated with breast reduction surgery. A large percentage of breast hypertrophy patients have notable asymmetry between breasts. Methods The purpose of this study was to investigate a method of measuring breast asymmetry, one that allows patients to determine the asymmetry of their own breasts at home with ease, and to assess its accuracy and role in a surgical practice. A retrospective chart review was conducted, wherein self-measurements of breast asymmetry using a variation of Bouman's technique were compared with the recorded intra-operative resected tissue mass. Results In total, 47 patients with asymmetry were included in the study. The difference between patient-reported measurements and resected breast tissue mass varied from 0 grams to 240 grams. Of the 47 patients, 38% were able to measure their breast difference within a remarkable 10 grams as compared to the resected breast tissue, of which four patients were accurate to less than one gram. The majority (70%) of patients accurately measured their asymmetry within 50 grams, which was determined to be a clinically significant amount based on a survey of plastic surgeons performed for the study. Conclusion The breast measurement technique presented in this study appears to be effective and accurate for most patients with suspected asymmetry undergoing reduction mammaplasty that stands to reduce pre-operative planning time. Patient-reported breast measurement may emerge as a valuable tool in clinical and research pursuits; however, further research on this topic is indicated at this time.
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Affiliation(s)
| | - Mark McRae
- Plastic Surgery, McMaster University, Hamilton, CAN
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Papanastasiou C, Ouellet JA, Lessard L. The Effects of Breast Reduction on Back Pain and Spine Measurements: A Systematic Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2324. [PMID: 31592372 PMCID: PMC6756677 DOI: 10.1097/gox.0000000000002324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/29/2019] [Indexed: 11/30/2022]
Abstract
The aim of this review article was to synthesize the literature on reduction mammaplasty and its effects on the spine. The particular focus was to find these few radiological studies and those investigating changes in spinal angles, posture, center of gravity, and back pain reduction.
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Affiliation(s)
- Constantine Papanastasiou
- Department of Surgery, Division of Plastic Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada.,Department of Orthopedic Surgery, Spine Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Jean A Ouellet
- Department of Orthopedic Surgery, Spine Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Lucie Lessard
- Department of Surgery, Division of Plastic Surgery, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
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Effect of Breast Size on Upper Torso Musculoskeletal Structure and Function. Plast Reconstr Surg 2019; 143:686-695. [DOI: 10.1097/prs.0000000000005319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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McGhee DE, Coltman KA, Riddiford-Harland DL, Steele JR. Upper torso pain and musculoskeletal structure and function in women with and without large breasts: A cross sectional study. Clin Biomech (Bristol, Avon) 2018; 51:99-104. [PMID: 29287172 DOI: 10.1016/j.clinbiomech.2017.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/14/2017] [Accepted: 12/20/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Women with large breasts frequently experience upper torso pain secondary to their breast size. Evidence is lacking on the underlying causes of this pain. This study investigated whether upper torso pain and musculoskeletal structure and function differed between women with large breasts and women with small breasts. METHODS A linear regression, adjusting for body mass, compared the upper torso pain, thoracic flexion torque due to breast mass, thoracic kyphosis, shoulder active range-of-motion, and scapular retraction muscle strength of 27 women with large breasts (bilateral breast volume>1200ml, age 45.9y SD 9.9y, BMI 29.0kg/m2 SD 3.8kg/m2) and 26 women with small breasts (bilateral breast volume <800ml, age 43.8y SD10.9y, BMI 23.3kg/m2 SD 2.9kg/m2). FINDINGS Women with large breasts reported a higher upper torso pain score (46.6, 95%CI 33.3-58.0 versus 24.1, 95%CI 12.5-37.8), accompanied by a larger flexion torque (5.9Nm, 95%CI 4.5-5.8Nm versus 0.9Nm, 95%CI 0.8-2.4Nm), greater thoracic kyphosis (34°, 95%CI 31-38° versus 27°, 95% CI 24-31°), decreased shoulder elevation range-of-motion (160°, 95%CI 158-163° versus 169°, 95%CI 166-172°), and decreased scapular retraction endurance-strength (511.4s, 95%CI 362.2-691.3s versus 875.8s, 95%CI 691.5-1028.4s) compared to the women with small breasts. INTERPRETATION Differences in the upper torso posture, range-of-motion, and muscle strength of women with large breasts provides insight into underlying causes of their musculoskeletal pain. This information can be used to develop evidence-based assessment and treatment strategies to relieve and prevent symptom progression.
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Affiliation(s)
- Deirdre E McGhee
- Biomechanics Research Laboratory, University of Wollongong, NSW, Australia.
| | - Karly A Coltman
- Biomechanics Research Laboratory, University of Wollongong, NSW, Australia
| | | | - Julie R Steele
- Biomechanics Research Laboratory, University of Wollongong, NSW, Australia
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Coltman CE, Steele JR, McGhee DE. Breast volume is affected by body mass index but not age. ERGONOMICS 2017; 60:1576-1585. [PMID: 28532249 DOI: 10.1080/00140139.2017.1330968] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND This study aimed to establish normative breast volume data for women of varying ages, body masses and breast sizes, and to determine the effect of age and body mass index (BMI) on breast volume. METHODS The breast volume of 356 women (age range: 18.1-83.7 years; BMI range: 18.4-54.5 kg/m²) was measured using three-dimensional scanning in a prone position. RESULTS Breast volumes ranged from 48 to 3100 mL. Although breast volume was not significantly affected by age, it was significantly affected by BMI, with the breast volume of overweight and obese women being two-to-three times greater than women with normal BMI's. CONCLUSION It is recommended that bra cups must be designed to support the wide range and increasing magnitude of breast volumes exhibited by women. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the range of breast volumes of women and the significant effect of BMI on breast volume. Bra cups need to be designed to support the wide range and increasing magnitude of breast volumes exhibited by women.
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Affiliation(s)
- Celeste E Coltman
- a Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health , University of Wollongong , Wollongong , Australia
| | - Julie R Steele
- a Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health , University of Wollongong , Wollongong , Australia
| | - Deirdre E McGhee
- a Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health , University of Wollongong , Wollongong , Australia
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The filling proportion of bone cement affects recollapse of vertebrae after percutaneous vertebral augmentation: A retrospective cohort study. Int J Surg 2017; 47:33-38. [PMID: 28935530 DOI: 10.1016/j.ijsu.2017.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/27/2017] [Accepted: 09/13/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the relationship between filling proportion of bone cement in the vertical direction and incidence of recollapse in the augmented vertebrae after vertebral augmentation. METHODS Fifty-one patients (51 vertebrae) who had operations between January 2014 and July 2016 with a mean age of 78.10 years were included. All patients in our department of spine surgery were advised to have follow-up care every 6 months. Patients characteristics, radiographic outcomes were evaluated. RESULTS The recollapse of augmented vertebral body occurred in 10 of 51 vertebrae (20%). CONCLUSION Patients with a high proportion rate of bone cement in the middle vertical direction have a low incidence of experiencing recollapse.
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Sanal B, Korkmaz M, Nas OF, Can F, Hacikurt K. The effect of gigantomasty on vertebral degeneration: A computed tomography study. J Back Musculoskelet Rehabil 2017; 30:1031-1035. [PMID: 28582838 DOI: 10.3233/bmr-169600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The main reason for waist and back pain in patients with gigantomasty is increased thoracic kyphosis and lumber lordosis. These symptoms and abnormal spinal angulations regress after reduction mammoplasty operations. However, the effect of chronic mechanical stress caused by gigantomasty on the spinal degenerative process is not clear yet. In this study with computed tomography it is shown that degenerative spondylosis is more widespread and severe in patients with large breasts.
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Affiliation(s)
- Bekir Sanal
- Zafertepe District, Dogal Street, Kutahya, Turkey
| | - Mehmet Korkmaz
- Department of Radiology, Dumlupinar University, Faculty of Medicine, Kutahya, Turkey
| | - Omer Fatih Nas
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Fatma Can
- Department of Radiology, Dumlupinar University, Faculty of Medicine, Kutahya, Turkey
| | - Kadir Hacikurt
- Department of Radiology, Uludag University Faculty of Medicine, Bursa, Turkey
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Temel M, Berberoğlu Ö, Türkmen A. Response to Comment on ''Effects of Reduction Mammaplasty Operations on the Spinal Column: Clinical and Radiological Response''. Aesthetic Plast Surg 2016; 40:517-8. [PMID: 27178569 DOI: 10.1007/s00266-016-0609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 01/08/2016] [Indexed: 11/28/2022]
Abstract
NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .".
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Affiliation(s)
- Metin Temel
- Department of Plastic and Reconstructive Surgery, School of Medicine, Mustafa Kemal University, Hatay, Turkey.
| | | | - Arif Türkmen
- Department of Plastic and Reconstructive Surgery, School of Medicine, İstanbul University, İstanbul, Turkey
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Sağlam İ, Karabekmez FE, Yavuz Ş. Comment on "Effects of Reduction Mammaplasty Operations on the Spinal Column: Clinical and Radiological Response". Aesthetic Plast Surg 2016; 40:182-3. [PMID: 26560104 DOI: 10.1007/s00266-015-0579-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
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