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Frank K, Zeng R, Sedlbauer S, Prantl L, Giunta R, Cotofana S, Moellhoff N, Alfertshofer M, Kaye K, Brébant V. The Influence of Scar Patterns After Reduction Mammoplasty on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation. Aesthetic Plast Surg 2024; 48:250-258. [PMID: 37853080 PMCID: PMC10917861 DOI: 10.1007/s00266-023-03689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Given that scars are acknowledged as the primary cause of postoperative dissatisfaction following reduction mammoplasty, it is imperative to comprehend the patient's visual perception of different scar patterns in order to enhance patient satisfaction. To achieve this, eye-tracking technology provides an unbiased method of evaluating how observers assess breast scars. METHODS 58 participants (32 females and 26 males) between the ages of 19 and 82 years (mean age of 29.47 ± 10.98 years) were shown 18 color photographs, taken at 3 viewing angles (right 45° oblique, frontal and frontal view with arms raised), from 6 patients undergone reduction mammoplasty with the inverted T-scar technique (3 patients) or no-vertical-scar technique (3 patients). The images were presented to every participant for a fixed duration of 5 s each. Eye-tracking device was used to collect and analyze the gaze data of viewers. RESULTS The nipple-areola complex (NAC) and the periareolar scar captured observers' gaze faster, had longer duration and more count of eye fixation than all other parts of breast scars, regardless of the viewing angle and scar pattern. Moreover, the scar region in the inverted T-scar pattern received greater and faster visual attraction of observer's gaze than the no-vertical-scar pattern. CONCLUSION The NAC and the periareolar scar seem to be perceived as the most important regions for breast aesthetics. The findings can be helpful to assist plastic surgeons in determining the most appropriate technique for reduction mammoplasty, meanwhile underlining the importance of a fine periareolar scar and symmetric NAC for excellent aesthetic outcomes. This is to our best knowledge the first study using eye-tracking technology in evaluating reduction mammoplasty outcomes. This study explored the influence of different scar patterns after reduction mammoplasty on eye movements and gaze patterns among observers. The study have validated the significance of the NAC and the periareolar scar for breast aesthetics and revealed that the scar region in the inverted T-scar pattern may be judged less visually attractive than the no-vertical-scar pattern. LEVEL OF EVIDENCE V 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)
| | - Rui Zeng
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephanie Sedlbauer
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Riccardo Giunta
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sebastian Cotofana
- Department of Dermatology, Erasmus Hospital, Rotterdam, The Netherlands
- Centre for Cutaneous Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Nicholas Moellhoff
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Alfertshofer
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Vanessa Brébant
- Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Stahl S, Dannehl D, Daigeler A, Jorge C, Brendlin A, Hagen F, Santos Stahl A, Feng YS, Nikolaou K, Estler A. Definitions of Abnormal Breast Size and Asymmetry: A Cohort Study of 400 Women. Aesthetic Plast Surg 2023; 47:2242-2252. [PMID: 37253846 DOI: 10.1007/s00266-023-03400-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/23/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Macromastia, micromastia and breast asymmetry have an impact on health and quality of life. However, there is scarce information addressing breast size and asymmetry frequency distribution in reference populations. OBJECTIVE The current study aims to identify factors that influence breast size and symmetry and classifies abnormal breast sizes and breast asymmetries in an adult German population. METHODS Breast base dimensions, breast volume, symmetry, and other breast anthropometric parameters of 400 German female patients were determined in a retrospective review of the MRI archives at our institution. Professional medical MRI-segmentation software was used for volume measurement. RESULTS A total of 400 Patients were retrospectively enrolled. The patients had a mean age of 50 ± 12 years (min: 24; max: 82), mean BMI of 25.0 ± 5.0 (min: 14.7, max: 45.6), and a mean total breast volume of 976 ml (right: 973 ml, min: 64, max: 4777; left: 979 ml, min: 55, max: 4670). The strongest correlation of breast volume was observed with BMI (r = 0.834, p < 0.001), followed by breast base width (r = 0.799, p < 0.001). Smaller breasts have higher breast volume asymmetry ratios (r = - 0.124, p < 0.014). For a BMI between 18.5 and 24.9 kg/m2, micromastia is defined by breast volumes below 250 ml (5th percentile) and macromastia by volumes above 1250 ml (95th percentile). Abnormal breast volume asymmetry (< 5th and > 95th percentile) is equivalent to an absolute difference of approximately 25% relative to the smallest side (bidirectional asymmetry ratio 5th percentile - 19%; 95th percentile 26%). CONCLUSION This study provides normative data of German women, as well as selected size-for-BMI percentiles and asymmetry ratio percentiles. The normative data may help to establish transparent and objective coverage criteria for health insurances. 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)
- Stéphane Stahl
- CenterPlast Private Practice, Bahnhofstr. 36, 66111, Saarbrücken, Germany
| | - Dominik Dannehl
- Department of Women's Health, University Hospital Tübingen, Calwerstr 7/6, 72076, Tübingen, Germany
| | - Adrien Daigeler
- Department of Plastic Hand and Reconstructive Surgery, BG Trauma Center Tübingen, Schnarrenbergstr 95, 72076, Tübingen, Germany
| | - Cristina Jorge
- Department of General-, Visceral-, Vascular-, and Pediatric Surgery, Saarland University Medical Center, Kirrberger Straße, 66421, Homburg, Saar, Germany
| | - Andreas Brendlin
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Florian Hagen
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | | | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biometrics, Medical University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Arne Estler
- Department of Diagnostic and Interventional Neuroradiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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Xu B, Chen L, Liu C, Luan J. A Computerized Recognition System to Assess Breast Asymmetry after Augmentation Mammaplasty. Plast Reconstr Surg 2023; 152:1203-1210. [PMID: 36883810 DOI: 10.1097/prs.0000000000010371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Breast augmentation patients are often unaware of their preexisting breast asymmetry before surgery but discover it afterward, which leads to postoperative dissatisfaction and increases the reoperation rate. However, elaboration on how patients subjectively analyze breast asymmetry and the recognition thresholds were limited. METHODS Two hundred female participants, including 100 patients 6 months postoperatively for primary augmentation mammaplasty and 100 preoperative patients, were recruited as two study groups. Self-assessments of breast asymmetry and objective measurements were taken. A computerized recognition experiment was constructed based on standardized three-dimensional models with different nipple-areola complex (NAC) and inframammary fold (IMF) asymmetry combinations. One hundred twenty-one three-dimensional models were generated and shown in random sequence. Participants responded whether they discovered breast asymmetry in each model. The recognition rate and 50% recognition thresholds of the asymmetry in NAC, IMF, lower pole length, volume, and their interrelations were calculated. RESULTS Self-assessment of the postaugmentation group showed more precise distinguishing of NAC, IMF, and lower pole distance asymmetry than in the preaugmentation group. The 50% recognition thresholds of NAC and IMF level discrepancies were approximately 0.75 cm, with the IMF asymmetry identified with higher accuracy. When the NAC level discrepancy ranged from 0.0 to 1.25 cm, adjusting the IMF level discrepancy from 0.0 to 0.5 cm in the same direction lowered participants' recognition rates of breast asymmetry. CONCLUSIONS Patients recognize their breast asymmetry issue more accurately after augmentation operations, despite improved parameters. In addition, adjusting the new IMF level, aligning with NAC discrepancy within 0.5 cm when treating mild NAC asymmetry, improved symmetric outcomes.
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Affiliation(s)
- Boyang Xu
- From the Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute
| | - Lin Chen
- From the Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute
| | - Chunjun Liu
- From the Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute
| | - Jie Luan
- From the Chinese Academy of Medical Sciences and Peking Union Medical College Plastic Surgery Hospital and Institute
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Atiyeh B, Emsieh S, Hakim C, Chalhoub R, Habal M. A Narrative Review of Eye-Tracking Assessment of Esthetic Endpoints in Plastic, Reconstructive, and Craniofacial Surgery. J Craniofac Surg 2023; 34:2137-2141. [PMID: 37590000 DOI: 10.1097/scs.0000000000009578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023] Open
Abstract
ABSTRACT Reporting of esthetic outcomes in plastic surgery relies classically on ill-defined endpoints and subjective measures very often from the patients' and/or providers' perspectives that are notoriously characterized by subjectivity and questionable solid scientific validation. With the recent trend of increasing demand for all types of esthetic medical and surgical interventions, there is an urgent need for reliable and objective outcome measures to quantitate esthetic outcomes and determine the efficacy of these interventions. The current review is intended to analyze available evidence regarding advantages as well as limitations of eye-tracking (ET) technology in objectively documenting esthetic outcomes of plastic, reconstructive, and craniofacial interventions. Although gaze pattern analysis is gaining more attention, ET data should be interpreted with caution; how a specific visual stimulus directly influences one's sense of esthetics is still not clear. Furthermore, despite its great potentials, it is still too early to confirm or deny ET usefulness. Nevertheless, patient-reported outcomes being most indicative of an esthetic intervention success, measurement of patients' satisfaction by ET technology could offer a major breakthrough in objective assessment of esthetic outcomes that need further in-depth investigation. EVIDENCE LEVEL Level III.
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Affiliation(s)
- Bishara Atiyeh
- American University of Beirut Medical Center, Beirut, Lebanon
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Frank K, Ehrl D, Bernardini F, Walbrun A, Moellhoff N, Alfertshofer M, Davidovic K, Mardini S, Gotkin RH, Cotofana S. How We Look At Mature Faces-An Eye-Tracking Investigation Into the Perception of Age. Aesthet Surg J 2023; 43:115-122. [PMID: 36099471 DOI: 10.1093/asj/sjac251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/06/2022] [Accepted: 09/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND It is still unclear which facial region contributes most to the perception of an aged face when evaluated by eye-tracking analyses. OBJECTIVES The authors sought to apply eye-tracking technology to identify whether mature faces require longer fixation durations than young faces and which facial region contributes most to the perception of a mature face. METHODS Eye-tracking analyses were conducted in 74 volunteers (37 males, 37 females; 43 ≤ 40 years, 31 > 40 years) evaluating their gaze pattern and the fixation durations for the entire face and 9 facial subregions. Frontal facial images of 16 younger (<40 years) and older (>40 years) gender-matched individuals were presented in a standardized setting. RESULTS Independent of age or gender of the observer, a younger stimulus image was viewed shorter than an older stimulus image with 0.82 (0.63) seconds vs 1.06 (0.73) seconds with P < 0.001. There was no statistically significant difference in their duration of a stable eye fixation when observers inspected a male vs a female stimulus image [0.94 (0.70) seconds vs 0.94 (0.68) seconds; P = 0.657] independent of the observer's age or gender. The facial image that captured the most attention of the observer (rank 9) was the perioral region with 1.61 (0.73) seconds for younger observers and 1.57 (0.73) seconds for older observers. CONCLUSIONS It was revealed that the perioral region attracts the most attention of observers and contributes most to an aged facial appearance. Practitioners should be mindful of the importance of the perioral region when designing an aesthetic treatment plan.
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Affiliation(s)
- Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Denis Ehrl
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | | | - Alina Walbrun
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Kristina Davidovic
- Department of Radiology and Medical School, University of Belgrade, Belgrade, Serbia
| | - Samir Mardini
- Department of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sebastian Cotofana
- Department of Clinical Anatomy, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Brebant V, Lemonnier L, Georgieva M, Anker A, Heine N, Seitz S, Frank K, Prantl L, Eigenberger A. Comparison of analog and digitally evaluated volume of the female breast in reconstructive breast surgery. Validation of a noninvasive measurement method with 3D camera1. Clin Hemorheol Microcirc 2023; 85:277-287. [PMID: 36502309 DOI: 10.3233/ch-229101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Reconstructive surgery is established as a standard treatment option after mastectomy due to cancer. It is crucial to patients to achieve a natural and symmetric looking breast through reconstruction. Anthropometric measurements are used to assess the objective symmetry of the breast, which are prone to errors and difficult to reproduce. OBJECTIVE The aim of this work is to validate breast volumetry using three-dimensional surface imaging. METHODS We compared preoperatively analog and digitally evaluated volume of the breast with our gold standard, direct water displacement measurement of the mastectomy specimen. We examined 34 breast specimens in total. RESULTS Each measurement method (Breast Sculptor, VAM, Breast-V) for breast volume/mass determination demonstrates acceptable agreement ranges when compared with resected volumes and masses. The strongest volumetry instrument is Breast Sculptor (digital), the weakest is Breast-V (analog). CONCLUSIONS 3D surface imaging is a quick, effective, and convenient method to evaluate breast shape and volume. The accuracy, reproducibility, and reliability of 3D surface imaging were comparable with MRI in our study.This takes us a step closer to the long-term goal of establishing robust instruments to plan breast reconstructive surgery, achieve better surgical results, and contribute to quality assurance in breast surgery.
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Affiliation(s)
- V Brebant
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - L Lemonnier
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - M Georgieva
- University Medical Center Regensburg, Department of Radiology, Regensburg, Germany
| | - A Anker
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - N Heine
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - S Seitz
- University Medical Center Regensburg, Department of Gynecology and Obstetrics, Caritas Hospital St. Josef, Regensburg, Germany
| | - K Frank
- Division of Hand-, Plastic- and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - L Prantl
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
| | - A Eigenberger
- University Medical Center Regensburg. Center for Plastic, Reconstructive, Aesthetic and Hand Surgery, Regensburg, Germany
- Medical Device Lab, Regensburg Center of Biomedical Engineering (RCBE), Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
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Kantelhardt C, Frank K, Kohler L, Cotofana S, Alfertshofer M, Hagen CS, Walbrun A, Karcz K, Giunta RE, Möllhoff N. [Change of Gaze Pattern depending on the Stage of DIEP Flap Breast Reconstruction: a Preliminary Eye-Tracking Investigation]. HANDCHIR MIKROCHIR P 2022; 54:356-362. [PMID: 35944538 DOI: 10.1055/a-1794-5951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Breast reconstruction using autologous tissue is an integral part of breast cancer treatment. While many studies have elucidated the impact of breast reconstruction on patients' quality of life, self-esteem, sexuality and more, there is a lack of objective data regarding the effects on external observers. Aim of this study was to investigate the change in gaze pattern of independent observers depending on the stage of DIEP-flap breast reconstruction. MATERIALS AND METHODS Eye-tracking technology was utilized to analyze the eye movements of 58 study participants while viewing 2 D photographs of a patient after mastectomy and different stages of DIEP-flap breast reconstruction. Time until first fixation and total time of fixation were recorded and con- secutively analyzed for the right and left breast on each image. RESULTS Overall, the total time of fixation of the operated breast decreased significantly over the different stages of breast reconstruction, with p<0.001. At the same time, there was no statistically significant change in total time of fixation of the non-operated breast, with p=0.174. The time until first fixation showed a significant increase over the different stages of reconstruction for the reconstructed breast, with p<0.001, while no significant differences were found for the opposite breast, with p=0.344. CONCLUSION Mastectomy and the individual steps of breast reconstruction alter the perception of breast cancer patients. Over the course of breast reconstruction, the deviation of gaze in the direction of the affected breast is reversed.
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Affiliation(s)
- Chiara Kantelhardt
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
| | - Konstantin Frank
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
| | - Lukas Kohler
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
| | - Sebastian Cotofana
- Mayo Clinic College of Medicine and Science, Department of Clinical Anatomy
| | - Michael Alfertshofer
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
| | - Christine Sophie Hagen
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
| | - Alina Walbrun
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
| | - Konrad Karcz
- Klinikum der Universität München, Klinik für Allgemeine-, Viszeral-, und Transplantationschirurgie
| | - Riccardo E Giunta
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
| | - Nicholas Möllhoff
- Klinikum der Universität München, LMU München Abteilung für Hand-, Plastische und Ästhetische Chirurgie
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Effect of Surgical versus Nonsurgical Rhinoplasty on Perception of the Patient. Facial Plast Surg Clin North Am 2022; 30:175-181. [DOI: 10.1016/j.fsc.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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9
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Letter-to-the-editor: Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results. Arch Gynecol Obstet 2022; 305:1497-1498. [PMID: 35212767 DOI: 10.1007/s00404-021-06386-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022]
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Pietruski P. Commentary on: The Impact of Breast Symmetry on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation. Aesthet Surg J 2021; 41:NP1519-NP1520. [PMID: 34351384 DOI: 10.1093/asj/sjab309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Piotr Pietruski
- Centre of Postgraduate Medical Education, Gruca Teaching Hospital, Otwock, Poland
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