A Comparison of 28 Published Augmentation/Mastopexy Techniques Using Photographic Measurements

How Camera-to-Subject Distance and Height Affect Breast Measurement and Follow-Up Assessment in Plastic Surgery

BACKGROUND

Due to several factors that affect photograph quality, bias is inevitably present in two-dimensional (2D) breast photography. The principal variables affecting image performance at a fixed focus length are the distance between the camera and the subjects and the photography angles.

OBJECTIVE

This study aimed to investigate the effects of camera-to-subject distances and camera height on breast measurement parameters to understand the trend of breast deformation and provide guidance for the accurate evaluation of planar follow-up.

METHODS

We enlisted 16 volunteers with various breast cup sizes (A-D). Frontal and lateral photos were obtained with a steady focus of 50 mm at distances between 1.10 m and 2.20 m and at heights between 30 cm above the nipple and 30 cm below the nipple at intervals of 10 cm. Two researchers independently evaluated each volunteer's breast aesthetic parameters, including 11 linear parameters, 3 area parameters, and 3 ratio parameters, using Vernier calipers and Photoshop.

RESULTS

The correlation coefficient of the two investigators ranged from 0.922 to 0.999. The results measured by Photoshop were 29.67 ± 5.23% greater than those of the Vernier caliper (p < 0.01). In contrast to ratio parameters, which showed no significant changes in each distance group (p = 1.00), linear parameters and area parameters significantly increased as object distance decreased (p < 0.05). The lower pole of the breast grew wider and flatter and occupied a larger proportion of the breast as height declined.

CONCLUSION

Camera-to-subject distances of 1.5-1.7 m are recommended for stabilized and uniform breast photography. Varying shooting height affects breast distortion. Quantifying the relationship between photographic conditions and breast morphology enables plastic surgeons to conduct more comprehensive and accurate assessments.

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. Bullet point list: 1. The breast morphology will get more distortion with a smaller camera-to-subject distance. 2. Camera-to-subject distances of 1.5~1.7m are recommended for stabilized and uniform breast photography. 3. Height rather than distance affects the breast proportion.

Experience and Indications for the Use of the P4HB Scaffold (GalaFLEX) in Aesthetic Breast Surgery: A 100-Case Experience

BACKGROUND

The popularity of utilizing mesh in the breast has varied over the years. It is well described, and yet there has been poor uptake of its utilization in aesthetic breast surgery. Poly-4-huydroxybutarate (P4HB; GalaFLEX, Galatea, Lexington, MA) has recently been described as a useful adjunct in supporting poor tissue quality with positive early outcomes and low complication rates.

OBJECTIVES

The authors sought to determine the outcome and range of indications of PH4B in aesthetic breast surgery to document its effectiveness in assisting with long-term outcomes in mastopexy.

METHODS

Firstly, an observational study was undertaken standardizing mastopexy techniques with P4HB included in the procedure. Photographic measurements were taken to determine the extent of lower pole descent and lower pole stretch at 3 months and 1 year postoperative to observe change over time. Secondly, other indications were explored, including the correction of secondary defects such as inferior malposition and symmastia.

RESULTS

The results of the mastopexy study were highly encouraging and comparable with those previously published in the literature, confirming sustained stability of the lower pole over time for mastopexies and implant mastopexies. In addition, the GalaFLEX was successfully employed in correcting many secondary defects.

CONCLUSIONS

P4HB is extremely versatile and easy to utilize and has low complication rates. The results have led to a change in practice, with routine incorporation of GalaFLEX for all routine mastopexies. It has also replaced the utilization of acellular dermal matrices in aesthetic breast surgery.

LEVEL OF EVIDENCE: 4

Comparison of Classic Mastopexy Method with Double-Pedicled Auto-augmentation Mastopexy with Conic-Shaped Modified Inferior Butterfly Flap

BACKGROUND

In mastopexy surgery, extra skin and a specific amount of breast tissue are resected. Resected breast tissue is not in a large amount as in reduction surgery. In this study, we have investigated the results of an auto-augmentation mastopexy technique involving use of a superior pedicled mastopexy with conic-shaped inferior butterfly flap for augmentation without implant or fat injection.

METHODS

A total of 80 patients, 40 patients in each group, were included in the study. In the first group, double-pedicled auto-augmentation mastopexy with conic-shaped modified inferior butterfly flap technique was used. In the second group, conventional superior pedicled wise-pattern mastopexy was utilized. The results were evaluated from photographic measurements performed from standardized preoperative and postoperative lateral photographs.

RESULTS

No major complications were seen such as partial or total areola necrosis or breast volume loss. None of our patients has made a return with request for revision surgery. Minor complication seen in several patients was resolved with early intervention. The preoperative and postoperative photographic measurements of breast projection, upper pole projection, nipple position and lower pole level from preoperative and postoperative standardized lateral photographs revealed no significant difference between the groups.

CONCLUSION

We obtained highly satisfactory results for our patients. Following the surgery, our patients protected the cup sizes of their bra. In spite of the fact that there was no real augmentation performed in this procedure, effective straightening and the compact breast structure patients that achieved were highly successful in creating an augmented breast image.

LEVEL OF EVIDENCE III

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 .