1
|
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 .
Collapse
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.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Li XR, Zeng L, Hong WJ, Li ZH, Lin FC, Zhang YL, Luo SK. Three-dimensional Evaluation of Results After Dual-Plane Breast Augmentation with and Without Internal Suture Mastopexy. Aesthetic Plast Surg 2023; 47:1303-1311. [PMID: 36454327 DOI: 10.1007/s00266-022-03200-2] [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: 10/08/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND In patients with breast atrophy and ptosis, it is necessary to correct both problems simultaneously. This study aimed to analyze breast morphological changes with a three-dimensional (3D) scanning technique to demonstrate the improvement effect of dual-plane breast augmentation combined with internal suture mastopexy. METHODS 3D breast surface scans were performed preoperatively and postoperatively in 24 patients (n = 35 breasts) undergoing internal suture mastopexy combined with prosthetic augmentation through the periareolar approach and 24 patients (48 breasts) undergoing simple dual-plane breast augmentation. Changes in linear distance, breast volume and volume distribution, breast projection, and nipple position were analyzed to assess the breast morphology. RESULTS Compared with simple breast augmentation, augmentation combined with internal suture mastopexy was associated with a higher upper pole volume increase and greater medial and upward nipple displacement. After the surgery, the upper pole volume increased by an average of 10.6% in combined augmentation group and decreased by an average of 2.2% in the simple breast augmentation group. The measured breast projections were 24.8 ± 2.2% lower than expected in the combined group and 23.1 ± 4.1% lower than expected in the simple group, based on implant parameters recorded by the manufacturer. The nipple moved 0.2 ± 0.5 cm laterally, 1.6 ± 0.6 cm upward, and 2.8 ± 0.7 cm anteriorly in the combined group and 0.9 ± 0.5 cm laterally, 0.7 ± 0.6 cm upward, and 3.0 ± 0.6 cm anteriorly in the simple group. CONCLUSIONS Dual-plane breast augmentation in addition to internal suture mastopexy appears to reposition breast tissue from the lower pole to fill in the deficient upper breast, pull the nipple medially and superiorly, and ultimately correct mild to moderate breast ptosis. 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 .
Collapse
Affiliation(s)
- Xin-Rui Li
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Li Zeng
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Wei-Jin Hong
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhen-Hao Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
- Jinan University, Guangzhou, Guangdong, China
| | - Fu-Chuan Lin
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - You-Liang Zhang
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Sheng-Kang Luo
- Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China.
- Jinan University, Guangzhou, Guangdong, China.
| |
Collapse
|
4
|
Henseler H. Exploring natural breast symmetry in the female plastic surgical patient population. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2023; 12:Doc03. [PMID: 37577729 PMCID: PMC10413273 DOI: 10.3205/iprs000173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background Breast symmetry remains a challenging quality to measure. The question arises of how much baseline breast symmetry exists in the female plastic surgical patient population. Material and methods Several linear dimensional assessments were collected based on a retrospective analysis of objective data of women with natural breasts, who presented for an initial consultation in a plastic surgical clinic and were measured with the 3D Vectra Camera by the company Canfield Scientific Inc., U.S.A. The first 100 cases were extracted from the large database in alphabetical order. The nipple positions were examined, including the following linear dimensions: distances from the jugulum to the nipple, from the nipple to the inframammary fold, and from the nipple to midline. Furthermore, the under-breast widths were obtained. Results The objective three-dimensional imaging method determined that all patients had some degree of asymmetry. The linear distances from the jugulum and midline to the nipple revealed that the measurements were larger on the left side. However, the nipple to the inframammary fold measurements were roughly the same. In the sample of plastic surgical patients, the average distance between the jugulum and nipple was around 20 cm, the distance between the nipple and inframammary fold was around 6.5 cm, the distance between the nipple and midline was around 10 cm, and the under-breast width was around 13 cm. On average, the jugulum-nipple distance on the right side was 19.9±2.3 cm and 20.1±2.4 cm on the left side. The distance between the nipple and the inframammary fold was 6.4±1.1 cm, revealing a similar distribution on both sides. The mean distance from the nipple to the midline was much larger on the left side of the body at 10.0±1.2 cm than on the right side at 9.4±1.3 cm. The under-breast width on the right side was slightly larger than the left side, with measurements of 13.4±1.8 cm versus 13.2±1.7 cm. Conclusion Breast dimensions can be described comprehensively by an objective three-dimensional imaging process, which can detect asymmetry in all patients. The differences related to the nipple position were larger on the left side than the right regarding the distances from the jugulum and particularly the midline to the nipple, which seems to be of special importance, but not from the nipple to the inframammary fold. The linear measurements for the distances from the jugulum and the midline to the nipple are essential to accurate symmetry assessments and form an aesthetic triangle of the breast, which is a new term and the key to a simplified shape analysis.
Collapse
Affiliation(s)
- Helga Henseler
- Klinik am Rhein, Klinik für Plastische und Ästhetische Chirurgie, Düsseldorf, Germany
| |
Collapse
|
5
|
Liu Y, Zhang X, Luan J. Breast Morphological Comparison Between Anatomic and Round Implant Augmentation: A Prospective Study. Ann Plast Surg 2023; 90:19-26. [PMID: 36534096 DOI: 10.1097/sap.0000000000003353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The choice of implant shape (anatomic or round) is one of the most critical issues for breast augmentation. Determining whether there are differences in the postoperative breast morphology of the 2 implants is pivotal for surgical planning. This issue has been controversial and lacking in evidence. The aim of this study was to provide reference for implant selection by comparing breast morphology after dual-plane augmentation with anatomic and round implants using 3-dimensional scanning technology. METHODS Patients with implant volume less than 300 mL who underwent transaxillary dual-plane augmentation were included in this study and were grouped according to implant shape. Three-dimensional scans were performed preoperatively and 6 months postoperatively. Postoperative breast height (BH), breast width (BW), BH of upper pole (BHUP), BH of lower pole (BHLP), breast projection (BP), BP of upper pole (BPUP), and BP of lower pole (BPLP) were measured separately, resulting in corresponding ratios (BH/BW, BHUP/BHLP, BP/BH, BPUP/BPLP). Breast volume, and the volumes of each pole (breast volume of upper pole [BVUP], breast volume of lower pole [BVLP]) and its ratio (BVUP/BVLP) were calculated. Correlation and regression analysis on the influencing factors of breast volume were performed. RESULTS Thirty patients with anatomic implants and 26 with round implants were enrolled in this study. The mean volumes of anatomic and round implants were 260.5 ± 26.7 and 267.9 ± 21.7 mL (P = 0.192). The ratios of BH/BW in the 2 groups were 1.39 ± 0.12 and 1.37 ± 0.19, respectively (P = 0.582). The BHUP/BHLP values of 2 groups were 1.35 ± 0.22 and 1.41 ± 0.25 (P = 0.160). Two sets of BPUP/BPLP were 0.68 ± 0.19 and 0.73 ± 0.17 (P = 0.133). The ratios of BP/BH in the 2 groups were 0.39 ± 0.08 and 0.39 ± 0.06 (P = 0.830). The BVUP/BVLP ratios for both groups were 0.75 ± 0.11 and 0.77 ± 0.12 (P = 0.287). There was a volume loss rate of 13.3% ± 3.9% and 13.9% ± 5% (P = 0.489). The postoperative volume showed a positive correlation with both the preoperative volume and the implant volume. CONCLUSIONS For patients with breast dysplasia undergoing transaxillary dual-plane augmentation with anatomic or round implants less than 300 mL, the difference in postoperative breast morphology is not obvious. Using these 2 shapes of implants results in a similar degree of volume loss.
Collapse
Affiliation(s)
- Yue Liu
- From the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | | |
Collapse
|
6
|
Breast Morphological Changes after Transaxillary Dual-Plane Augmentation with Smooth Round Implants: A Prospective Study. Aesthetic Plast Surg 2022; 47:966-978. [PMID: 36216919 DOI: 10.1007/s00266-022-03130-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: 08/06/2022] [Accepted: 09/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast augmentation is the most performed cosmetic surgery in the world. Although smooth round implants are widely used, the trend in breast morphology change after dual-plane augmentation with such implants remains unclear. In this study, we analyzed the issue with the support of 3D scanning technology, which may help provide an objective basis for the evaluation of postoperative outcomes and the determination of follow-up time points. METHODS Patients undergoing dual-plane augmentation with smooth round implants were prospectively included in this study. The variation trend of postoperative breast morphology was analyzed by measuring the specified linear distance, body surface distance, breast projection, nipple position and breast volume at different follow-up time points (1st month, post-1M; 3rd month, post-3M; 6th month, post-6M; 12th month, post-12M). RESULTS A total of 18 patients were included in this study. During the postoperative follow-up period, breast height prolonged while interval of the medial border gradually widened. Breast width was maintained without significant alterations from post-1M. The N-MBB lengthened with shortening of the N-LBB, meanwhile the N-IMF was prolonged by 0.6 cm. Breast volume was gradually reduced with the decrease in breast projection. The position of the nipple gradually shifted laterally, superiorly, and posteriorly after surgery. There was no statistically significant difference between the linear distance at post-3M and post-12M, while the surface distance, breast projection, nipple position and breast volume tended to be stable at post-6M. CONCLUSIONS After dual-plane augmentation with smooth round implants, the base contour of the breast shifted outwards and downwards, and stabilized after 3 months. The remaining breast morphological parameters reached a relative steady state by post-6M, which could be regarded as the time point for objective evaluation of postoperative effect. 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 .
Collapse
|
7
|
How Do Positions of Nipple and Inframammary Fold Change After Autologous Breast Augmentation with Fat Grafting? Aesthetic Plast Surg 2022; 46:2131-2137. [PMID: 35672460 DOI: 10.1007/s00266-022-02959-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/16/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Breast augmentation with autologous fat grafting was widely used. However, it is unclear how does this kind of surgery affect the morphologic change of breast. This study aimed to explore the change of nipple and inframammary fold (IMF) levels, which are important aesthetic landmarks of breast that further explore whether this kind of surgery could correct the asymmetry of nipple and IMF. METHODS Preoperative and postoperative measurements were performed in the patients who received fat grafting with or without fasciotomy. The position levels of nipple and IMF were measured. The preoperative and postoperative discrepancies and the difference of these levels after surgery were also calculated. RESULTS As for the IMF asymmetry, in the fasciotomy plus fat grafting group, the asymmetry was significantly reduced after surgery, while there was no significant difference in the fat grafting group. As for the nipple asymmetry, fat grafting could not correct the asymmetry in both fasciotomy plus fat grafting group and fat grafting group. As for the morphological change after surgery, both nipple and IMF were descended significantly after surgery. The descending range of IMF in the preoperative higher group was larger than the preoperative lower group. On the preoperative IMF higher side, descending degree of IMF was significantly larger in the fasciotomy plus fat grafting group than fat grafting group. CONCLUSIONS Fat grafting with fasciotomy can improve IMF asymmetry but cannot improve nipple asymmetry. Both IMF and nipple were lowered somehow after surgery, which might be related to the breast enlargement. 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.
Collapse
|
8
|
Mercury O, Nores GG, Carlson GW. Symmetry of Nipple Position After Bilateral Nipple-Sparing Mastectomy and Implant-Based Reconstruction: The Impact of Reconstructive Method. Ann Plast Surg 2022; 88:S422-S426. [PMID: 35690937 DOI: 10.1097/sap.0000000000003162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Asymmetry of nipple position is common in the female population. There are scant data on the impact of bilateral nipple-sparing mastectomy (NSM) and immediate implant-based reconstruction on nipple asymmetry. METHODS A retrospective review was performed of an institutional review board approved prospective database of NSM and immediate implant-based reconstruction was performed. BCCT.core software was used to examine preoperative and postoperative nipple asymmetry. It directly calculates the quantitative differences in nipple position between the breasts expressed as breast retraction assessment (BRA). Nipple to sternal notch (N-SN) asymmetry was calculated from the collected data. RESULTS Sixty-eight patients undergoing bilateral NSM and implant reconstruction were reviewed. Reconstructive methods were tissue expander (TE) 39 (57.4%) and direct to implant (DTI) (prepectoral 13, submuscular 16) 29 (42.6%). The TE group had greater body mass index (BMI) (23.5 vs 22.1, P = 0.02), mastectomy weight (390.7 vs 243.8, P = 0.001) and higher preoperative N-SN asymmetry (TE 0.89 vs DTI 0.59, P = 0.02). Ten patients received radiation (TE group 4, DTI group 6). The TE group had larger implant size (479.1 vs 375.0, P = 0.0001). Overall, TE reconstruction resulted in an increase in nipple asymmetry (mean BRA: preoperative, 1.50 vs postoperative, 1.65), which was not significant. Direct to implant reconstruction increased nipple asymmetry: mean N-SN asymmetry preoperative 0.59 versus postoperative 0.97 (P = 0.04) and mean BRA scores 1.40 and 1.82 (P = 0.06). Both implant locations in the DTI group resulted in an increase in postoperative asymmetry but was significant for the prepectoral group: mean BRA preoperative 1.19 versus postoperative 1.85, P = 0.02 and mean N-SN asymmetry preoperative 0.48 vs postoperative 0.94, P = 0.04. Radiation impacted the final mean BRA score: radiation 2.24 versus no radiation 1.63 (P = 0.05). CONCLUSIONS Patients who underwent TE reconstruction had significantly larger breasts and greater preoperative N-SN asymmetry than the DTI group. Despite this, the TE group resulted in mild increase in nipple asymmetry. Both implant locations in DTI reconstruction resulted in increased postoperative asymmetry but was significant for the prepectoral group. Radiation therapy has a significant impact of nipple asymmetry.
Collapse
Affiliation(s)
- Oblaise Mercury
- From the Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta GA
| | | | | |
Collapse
|
9
|
Munir A, Huws AM, Khawaja S, Khan S, Holt S, Sharaiha Y. Automated Breast Volume Assessment Derived From Digital Breast Tomosynthesis Images Compared to Mastectomy Specimen Weight and Its Applications in Cosmetic Optimisation. Cureus 2021; 13:e19642. [PMID: 34926087 PMCID: PMC8673690 DOI: 10.7759/cureus.19642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/06/2022] Open
Abstract
Background: Estimating the size and volume of the breast preoperatively is an important step in surgical planning for many breast procedures such as immediate implant-based breast reconstructions and reduction mammoplasties. Breast volume estimation helps in appropriate implant selection preoperatively. Objectives: The aim of this study was to objectively evaluate the estimation of breast weight by automatic volumetric breast assessment in digital breast tomosynthesis (DBT) using Quantra™ 2.2 Breast Density Assessment Software (Hologic Inc., Marlborough, Massachusetts, United States).
Methods: Breast specimen weight after mastectomy and volume estimated by Quantra software were recorded. Results: Volume assessment obtained from Quantra software showed a high correlation with actual mastectomy specimen weight, with Pearson’s correlation coefficients of 0.952. Conclusions: The automated DBT-derived breast volume using the Quantra software is a simple and practical method to assess breast size and weight preoperatively.
Collapse
Affiliation(s)
- Asma Munir
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Anita M Huws
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Saira Khawaja
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Sohail Khan
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | - Simon Holt
- Breast Surgery, Prince Philip Hospital, Llanelli, GBR
| | | |
Collapse
|
10
|
Yang Y, Mu D, Xu B. Invited Response on: Comment on "An Intraoperative Measurement Method of Breast Symmetry Using Three-Dimensional Scanning Technique in Reduction Mammaplasty". Aesthetic Plast Surg 2021; 45:3069-3070. [PMID: 33929578 DOI: 10.1007/s00266-021-02317-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Yan Yang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shijingshan District, 33# Badachu Road, Beijing, 100144, People's Republic of China
| | - Dali Mu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shijingshan District, 33# Badachu Road, Beijing, 100144, People's Republic of China.
| | - Boyang Xu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Shijingshan District, 33# Badachu Road, Beijing, 100144, People's Republic of China
| |
Collapse
|
11
|
Moellhoff N, Kandelhardt C, Ehrl D, Kohler L, Koban K, Giunta RE, Guertler A, Mardini S, Cotofana S, Frank K. The Impact of Breast Symmetry on Eye Movement and Gaze Pattern: An Eye-Tracking Investigation. Aesthet Surg J 2021; 41:NP1512-NP1518. [PMID: 34272851 DOI: 10.1093/asj/sjab285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The objective assessment of beauty remains challenging despite ongoing research efforts. A new method of objectively determining the aesthetic appeal of body features by analyzing gaze patterns and eye movements has recently been investigated. OBJECTIVES The objective of this study was to assess, by means of objective eye-tracking technology, differences in the gaze patterns of observers presented with standardized 3-dimensional images showing different degrees of breast asymmetry. METHODS A total of 83 Caucasian study participants with a mean age of 38.60 (19.8) years were presented with 5 images depicting varying degrees of breast asymmetry. In addition to the assessment of eye movements, participants were asked to rate the aesthetic appeal and the asymmetry of the breasts on a 5-point Likert scale. RESULTS Overall, the data showed that participants' rating of the breasts' aesthetic appeal was inversely related to the level of asymmetry. The mean [standard deviation] time until fixation was shortest for the image depicting the greatest breast asymmetry (50 cc) at 0.77 [0.7] seconds (P < 0.001). In addition, the mammary region was also viewed longest in this image at 3.76 [0.5] seconds (P < 0.001). A volume difference of 35 cc between breasts deflected the observers' gaze significantly toward the larger of the asymmetric breasts (P < 0.001). CONCLUSIONS Surgeons should focus on achieving symmetric breast volume (ie, differences <35 cc between breasts) to avoid noticeable asymmetry with regard to breast size.
Collapse
Affiliation(s)
- Nicholas Moellhoff
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Chiara Kandelhardt
- 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
| | - Lukas Kohler
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Konstantin Koban
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Riccardo E Giunta
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| | - Anne Guertler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | - Samir Mardini
- Division 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
| | - Konstantin Frank
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Germany
| |
Collapse
|
12
|
Knoll B, Kotti B. Invited Discussion on: The Effect of Arm Position on Breast Volume Measurement Using Three-dimensional Imaging. Aesthetic Plast Surg 2021; 45:2015-2016. [PMID: 33564950 DOI: 10.1007/s00266-021-02164-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
|
13
|
The Effect of Arm Position on Breast Volume Measurement Using Three-dimensional Imaging. Aesthetic Plast Surg 2021; 45:2009-2014. [PMID: 33492476 DOI: 10.1007/s00266-020-02113-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/20/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Three-dimensional (3D) imaging offers an objective and quantitative way to evaluate the breast volume. In this study, we aimed to investigate whether arm position can be a factor influencing the measurement of breast volume and which arm position is more stable when using 3D breast imaging in evaluating the fat volume retention rate in autologous fat grafting for breast augmentation. METHODS Patients undergoing breast augmentation with autologous fat grafting in our department were selected for the first part of this study. Preoperative 3D breast imaging was performed at three different arm positions: at the sides, akimbo and with hands on the head. Scans on each arm position were repeated on the first day after surgery, taking six scans in total. Breast volume change (BVC) was compared before and after surgery. The patients planning to receive bilateral mammaplasty in our department were selected for the second part of this study. Two repeated 3D scans were performed at the sides, akimbo and hands on the head, and then, the breast volume change error (BVCE) was compared. RESULTS Twenty-five patients (n = 50 breasts) were included in the first part of study. For the patients who received 100-200 ml fat injection, compared with hands on the head, a statistically significant difference in the average BVC was found at the sides and akimbo (p = 0.02). For the patients receiving more than 200 ml fat injection, there was no statistically significant difference between the groups (p > 0.05). Twenty-six patients (n = 52 breasts) were enrolled in the second part. For the average BVCE, there was no significant difference between the groups (p = 0.11). CONCLUSIONS The arm position during 3D breast imaging, to some extent, affects the evaluation of BVC after breast augmentation using autologous fat grafting, particularly for patients receiving less fat grafting. The arm position should be kept consistent when using 3D breast imaging in evaluating the fat volume retention rate. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
14
|
Wang C, Luan J. Response to Invited Discussion on: The Effect of Arm Position on Breast Volume Measurement Using Three-dimensional Imaging. Aesthetic Plast Surg 2021; 45:2507-2508. [PMID: 34173023 DOI: 10.1007/s00266-021-02389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Chenglong Wang
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China
| | - Jie Luan
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 33 Ba-Da-Chu Road, Shi-Jing-Shan District, Beijing, 100144, China.
| |
Collapse
|
15
|
An Intraoperative Measurement Method of Breast Symmetry Using Three-Dimensional Scanning Technique in Reduction Mammaplasty. Aesthetic Plast Surg 2021; 45:2135-2145. [PMID: 33758977 DOI: 10.1007/s00266-021-02241-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/14/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Intraoperative symmetrical assessment plays a decisive role in the aesthetic results of reduction mammaplasty, but it depends mostly on the surgeons' experience that may be biased by individual subjective factors. This study was intended to propose an objective method based on a hand-held three-dimensional (3D) scanner to assist intraoperative symmetrical assessment, aiming to achieve better aesthetic results in reduction mammaplasty. METHODS Sixty patients were enrolled in the study from April 2018 to January 2020. Intraoperative 3D scanning was routinely performed on 29 patients (study group) to assist symmetrical adjustments during breast shaping. 3D surface scanning data of both groups were obtained at 3 months postoperatively to objectively assess breast symmetry. Postoperative symmetry scores in five aspects, including nipple-areolar complex position, inframammary-fold height, breast size, shape, and footprint, were rated by six independent observers based on anonymized photographs to subjectively evaluate pre- and postoperative breast symmetry of the two groups. RESULTS The bilateral breast volume difference of the study group was significantly smaller than the control group (39.1 vs. 113.3 cm3, p = 0.001), as well as the difference in nipple to inframammary-fold distance (2.79 vs. 7.43 mm, p = 0.01). The observer-reported results showed that breast reduction significantly improved postoperative symmetry in all five aspects compared with preoperative symmetry in the study group (P<0.001). Furthermore, postoperative symmetrical ratings of all five aspects in the study group were statistically better than the control group (P<0.05). CONCLUSIONS Intraoperative 3D scanning provided a reliable method to assist symmetry adjustments and ensure better postoperative breast symmetry in reduction mammaplasty. 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 .
Collapse
|
16
|
Balancing Nipple and Inframammary Fold in Transaxillary Augmentation Mammaplasty with Anatomical Implant: The 'NIMF' Classification and Surgical Algorithm. Aesthetic Plast Surg 2021; 45:1497-1506. [PMID: 33876287 DOI: 10.1007/s00266-021-02274-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study aims to put forward a new classification of breast asymmetry based on the relative position of the nipple and inframammary fold (IMF) and propose a surgical algorithm of determining new IMF to address breast asymmetry in patients undergoing transaxillary augmentation mammaplasty, which is named as NIMF (nipple inframammary) classification and surgical algorithm. METHODS Three hundred and forty-five patients received transaxillary augmentation mammaplasty with anatomical implants. Preoperative breast asymmetry was classified into four types. I: asymmetrical nipple with asymmetrical IMF in the same direction; II: symmetrical nipple with asymmetrical IMF; III: asymmetrical nipple with symmetrical IMF; IV: asymmetrical nipple with unapparent IMF. Surgical plans (3 plans for type I, II, IV while 5 plans for type III) to set the new IMF were provided for each patient, who chose one of them as the final surgical plan. Breast-Q and Likert scale were used to evaluate patient satisfaction and symmetry of breast preoperatively and 6 months postoperatively. RESULTS The incidence of type I, II, III, IV was 30%, 15%, 13%, and 4%, respectively. Ninety-seven percent of patients with breast asymmetry chose plan C, which aimed to balance the relative position of nipple and IMF. Postoperative Breast-Q scores showed a significant rise compared with preoperative scores, but no statistical difference between plan C V.S. other plans. Patients with symmetrical preoperative breasts (Group A) had significantly higher postoperative Breast-Q scores than patients with asymmetrical preoperative breasts (Group B). In breast symmetry assessment, Group A had a significantly higher postoperative score than Group B, but the postoperative score was significantly lowered compared with the preoperative score in both Group A and B. CONCLUSION The NIMF classification and surgical algorithm provide a systematic and scientific way to analyze and improve breast asymmetry, to achieve optimized patient satisfaction in transaxillary augmentation mammaplasty with anatomical implants. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .
Collapse
|
17
|
Prevention and Management of Double-Bubble Deformity in Augmentation Mammoplasty. Aesthetic Plast Surg 2021; 46:85-86. [PMID: 34331093 DOI: 10.1007/s00266-021-02436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
|
18
|
Abstract
Introduction Bariatric surgery is the most effective treatment option for obesity. It results in massive weight loss and improvement of obesity-related diseases. At the same time, it leads to a drastic change in body shape. These body shape changes are mainly measured by two-dimensional measurement methods, such as hip and waist circumference. These measurement methods suffer from significant measurement errors and poor reproducibility. Here, we present a three-dimensional measurement tool of the torso that can provide an objective and reproducible source for the detection of body shape changes after bariatric surgery. Material and Methods In this study, 25 bariatric patients were scanned with Artec EVA®, an optical three-dimensional mobile scanner up to 1 week before and 6 months after surgery. Data were analyzed, and the volume of the torso, the abdominal circumference and distances between specific anatomical landmarks were calculated. The results of the processed three-dimensional measurements were compared with clinical data concerning weight loss and waist circumference. Results The volume of the torso decreased after bariatric surgery. Loss of volume correlated strongly with weight loss 6 months after the operation (r = 0.6425, p = 0.0005). Weight loss and three-dimensional processed data correlated better (r = 0.6121, p = 0.0011) than weight loss and waist circumference measured with a measuring tape (r = 0.3148, p = 0.1254). Conclusion Three-dimensional imaging provides an objective and reproducible source for the detection of body shape changes after bariatric surgery. We recommend its use for the evaluation of central obesity, particularly for research issues and body imaging before and after bariatric surgery. Electronic supplementary material The online version of this article (10.1007/s11695-020-04408-4) contains supplementary material, which is available to authorized users.
Collapse
|
19
|
Hutchinson LE, Castaldo AD, Malone CH, Sommer NZ, Amalfi AN. A Pilot Study Evaluation of 3-Dimensional Imaging in Cosmetic Breast Augmentation: Results of a Single Surgeon 3.5-Year Retrospective Study Using the BREAST-Q Questionnaire. Aesthet Surg J Open Forum 2021; 3:ojab005. [PMID: 33791677 PMCID: PMC7953835 DOI: 10.1093/asjof/ojab005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Traditional methods of breast implant size selection provide limited ability to demonstrate postoperative outcomes. Three-dimensional (3D) imaging provides an opportunity for improved patient evaluation, surgical planning, and evaluation of postoperative breast appearance. OBJECTIVES The authors hypothesized that preoperative 3D imaging for patients undergoing breast augmentation would improve patient satisfaction and understanding of expected surgical outcomes. METHODS A retrospective review of patients undergoing breast augmentation by a single surgeon over a 3.5-year period was performed. Patients presenting after the VECTRA was purchased had preoperative 3D imaging, while patients presenting before this did not. Eligible patients received a BREAST-Q questionnaire designed for postoperative evaluation of breast augmentation. They also received a second survey that evaluated expected vs actual breast outcomes. RESULTS In total, 120 surveys were mailed and 61 patients (50.8%) returned the survey. The 3D imaged group had improved BREAST-Q scores regarding satisfaction with outcome, surgeon, and physical well-being compared with the group that did not. The imaged group also had higher size, shape, and overall breast correlation scores, confidence in implant size selection scores, and communication with surgeon scores. The differences between the 2 groups were not statistically significant. CONCLUSIONS Three-dimensional imaging is a valuable tool in breast surgery. Although this study showed improvement in patient satisfaction and predicted outcome scores in the 3D imaged group, the results were not statistically significant. With the majority of patients reporting that they would choose 3D imaging, it appears to instill confidence in patients regarding both surgeon and implant selection. LEVEL OF EVIDENCE 4
Collapse
Affiliation(s)
| | - Andrea D Castaldo
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Cedar H Malone
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Nicole Z Sommer
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ashley N Amalfi
- Southern Illinois University School of Medicine, Springfield, IL, USA
| |
Collapse
|
20
|
Hartmann R, Weiherer M, Schiltz D, Seitz S, Lotter L, Anker A, Palm C, Prantl L, Brébant V. A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging. Aesthetic Plast Surg 2020; 44:1980-1987. [PMID: 32405724 PMCID: PMC7683456 DOI: 10.1007/s00266-020-01749-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome's symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. METHODS Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. RESULTS Statistical analysis revealed that there is no difference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). CONCLUSION This study's findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes' optical symmetry was detected between autologous and alloplastic approaches. Level of evidence Level IV. 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 .
Collapse
Affiliation(s)
- Robin Hartmann
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Daniel Schiltz
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Luisa Lotter
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Alexandra Anker
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
- Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Lukas Prantl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| |
Collapse
|
21
|
Improved accuracy of breast volume calculation from 3D surface imaging data using statistical shape models. PLoS One 2020; 15:e0233586. [PMID: 33232326 PMCID: PMC7685503 DOI: 10.1371/journal.pone.0233586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Three-dimensional (3D) scanning is an established method of breast volume estimation. However, this method can never be entirely precise, since the thoracic wall cannot be imaged by the surface scanner. Current methods rely on interpolation of the posterior breast border from the surrounding thoracic wall. Here, we present a novel method to calculate the posterior border and increase the accuracy of the measurement. Methods Using principal component analysis, computed tomography images were used to build a statistical shape model (SSM) of the thoracic wall. The model was fitted to 3D images and the missing thoracic wall curvature interpolated (indirect volumetry). The calculations were evaluated by ordinary least squares regression between the preoperative and postoperative volume differences and the resection weights in breast reduction surgery (N = 36). Also, an SSM of the breast was developed, allowing direct volumetry. Magnetic-resonance images (MRI) and 3D scans were acquired from 5 patients in order to validate the direct 3D volumetry. Results Volumetry based on a SSM exhibited a higher determination coefficient (R2 = 0,737) than the interpolation method (R2 = 0,404). The methods were not equivalent (p = 0.75), suggesting that the methods significantly differ. There was no influence of BMI on the correlation in either method. The MRI volumetry had a strong correlation with the 3D volumetry (R2 = 0,978). Conclusion The SSM-based method of posterior breast border calculation is reliable and superior to the currently used method of interpolation. It should serve as a basis of software applications aiming at calculation of breast volume from 3D surface scanning data.
Collapse
|
22
|
Hartmann R, Weiherer M, Schiltz D, Baringer M, Noisser V, Hösl V, Eigenberger A, Seitz S, Palm C, Prantl L, Brébant V. New aspects in digital breast assessment: further refinement of a method for automated digital anthropometry. Arch Gynecol Obstet 2020; 303:721-728. [PMID: 33184690 PMCID: PMC8519833 DOI: 10.1007/s00404-020-05862-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022]
Abstract
Purpose In this trial, we used a previously developed prototype software to assess aesthetic results after reconstructive surgery for congenital breast asymmetry using automated anthropometry. To prove the consensus between the manual and automatic digital measurements, we evaluated the software by comparing the manual and automatic measurements of 46 breasts. Methods Twenty-three patients who underwent reconstructive surgery for congenital breast asymmetry at our institution were examined and underwent 3D surface imaging. Per patient, 14 manual and 14 computer-based anthropometric measurements were obtained according to a standardized protocol. Manual and automatic measurements, as well as the previously proposed Symmetry Index (SI), were compared. Results The Wilcoxon signed-rank test revealed no significant differences in six of the seven measurements between the automatic and manual assessments. The SI showed robust agreement between the automatic and manual methods. Conclusion The present trial validates our method for digital anthropometry. Despite the discrepancy in one measurement, all remaining measurements, including the SI, showed high agreement between the manual and automatic methods. The proposed data bring us one step closer to the long-term goal of establishing robust instruments to evaluate the results of breast surgery. Level of evidence: IV.
Collapse
Affiliation(s)
- Robin Hartmann
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Daniel Schiltz
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Magnus Baringer
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vivien Noisser
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Hösl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Christoph Palm
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany.,Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
| | - Lukas Prantl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| |
Collapse
|
23
|
Xu B, Liu T, Liu C. Breast Reconstruction with Perforator Flaps in Poland Syndrome: Report of a Two-Stage Strategy and Literature Review. Breast Care (Basel) 2020; 15:421-427. [PMID: 32982654 DOI: 10.1159/000503848] [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: 07/13/2019] [Accepted: 10/02/2019] [Indexed: 11/19/2022] Open
Abstract
Background Poland syndrome is a congenital deformity presenting unilateral hypoplasia of the breast, pectoralis muscle, and ipsilateral skeletal anomalies. In complex female cases, the significant amount of soft tissue needed for reconstruction continues to be a surgical challenge. Perforator flaps offer alternative methods with sufficient tissue volume, minimal donor site morbidity, and natural cosmetic outcome; however, their role in Poland syndrome breast reconstruction is seldom discussed. This study aims to present a new 2-stage strategy for esthetic restoration of the Poland syndrome chest anomaly that achieves breast symmetry while maintaining a scarless appearance. Case Presentation A 38-year-old female presented with Poland syndrome on the right side, and amastia, athelia, and absence of pectoralis major muscle were observed. We present an innovative 2-stage approach consisting of tissue expansion and, successively, a deep inferior epigastric perforator flap transfer. A pleasing breast appearance had been achieved at 6 months of follow-up. A literature review regarding the use of free perforator flaps in Poland syndrome was conducted to demonstrate the applicability of this method. Seven articles described a total of 15 cases using free perforator flaps met the inclusion criteria and were summarized. A satisfactory correction was reported in all the cases. Conclusion Perforator flaps provide reliable alternatives for Poland syndrome breast and chest-wall reconstruction. Proper patient selection and thorough assessment are vital to the success of the surgery.
Collapse
Affiliation(s)
- Boyang Xu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Tong Liu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chunjun Liu
- Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| |
Collapse
|
24
|
Prediction of the Ideal Implant Size Using 3-Dimensional Healthy Breast Volume in Unilateral Direct-to-Implant Breast Reconstruction. MEDICINA-LITHUANIA 2020; 56:medicina56100498. [PMID: 32987779 PMCID: PMC7598626 DOI: 10.3390/medicina56100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 12/02/2022]
Abstract
Background and objectives: There is no consensus regarding accurate methods for assessing the size of the implant required for achieving symmetry in direct-to-implant (DTI) breast reconstruction. The purpose of this study was to determine whether the ideal implant size could be estimated using 3D breast volume or mastectomy specimen weight, and to compare prediction performances between the two variables. Materials and Methods: Patients who underwent immediate DTI breast reconstruction from August 2017 to April 2020 were included in this study. Breast volumes were measured using 3D surface imaging preoperatively and at postoperative three months. Ideal implant size was calculated by correcting the used implant volume by the observed postoperative asymmetry in 3D surface imaging. Prediction models using mastectomy weight or 3D volume were made to predict the ideal implant volume. The prediction performance was compared between the models. Results: A total of 56 patients were included in the analysis. In correlation analysis, the volume of the implant used was significantly correlated with the mastectomy specimen weight (R2 = 0.810) and the healthy breast volume (R2 = 0.880). The mean ideal implant volume was 278 ± 123 cc. The prediction model was developed using the healthy breast volume: Implant volume (cc) = healthy breast volume × 0.78 + 26 cc (R2 = 0.900). The prediction model for the ideal implant size using the 3D volume showed better prediction performance than that of using the mastectomy specimen weight (R2 = 0.900 vs 0.759, p < 0.001). Conclusions: The 3D volume of the healthy breast is a more reliable predictor than mastectomy specimen weight to estimate the ideal implant size. The estimation formula obtained in this study may assist in the selection of the ideal implant size in unilateral DTI breast reconstruction.
Collapse
|
25
|
Patlazhan G, Shkolnaya O, Torubarov I, Gomes M. Our 10 Years' Experience in Breast Asymmetry Correction. Aesthetic Plast Surg 2020; 44:706-715. [PMID: 32157377 DOI: 10.1007/s00266-020-01632-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 01/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Breast asymmetry is a common problem in augmentation mammoplasty. The notorious different implant volume approach has been shown ineffective because of recurring breast asymmetry in course of time. A uniform approach to the correction of breast asymmetry is still unavailable. METHODS Four hundred and two patients underwent breast asymmetry correction with augmentation mammoplasty. We have described our technique providing good results in breast asymmetry correction using similar volume implants and resecting glandular tissue from the larger breast. RESULTS Good aesthetic results were reported by all patients. No additional management of asymmetry was required in 290 patients (72%). One hundred and twelve (28%) patients received an additional correction of breast asymmetry due to breast ptosis, different levels of submammary folds. No major volume correction was required, and no implant change was needed. CONCLUSION Our method of breast asymmetry correction allows using identical implants and presents good long-term results and no relapse. 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.
Collapse
|
26
|
Chen L, Sun J, Mu D, Liu C, Luan J. What Makes a Difference? Three-Dimensional Morphological Study of Parameters that Determine Breast Aesthetics. Aesthetic Plast Surg 2020; 44:315-322. [PMID: 31240336 DOI: 10.1007/s00266-019-01426-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 06/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of breast plastic surgery is to improve the shape of the breasts. The shape of the breast is determined by several parameters and proportions; however, the proportions that have the greatest impact on breast aesthetics have not been investigated. The purpose of this study is to determine which breast proportions are crucial to aesthetics and should be given priority when surgery is designed. METHODS Breasts were divided into a high-satisfaction group and a low-satisfaction group according to an aesthetic evaluation that consisted of self-evaluations and evaluations by plastic surgeons. Three-dimensional scanning and measurement of the breasts were performed. The differences in breast parameters and proportions between the two groups were analyzed, and the ROC curve of each proportion was applied to determine which index had a significant influence on satisfaction and could predict satisfaction well. RESULTS A total of 179 unilateral breasts were evaluated and measured; of these, 68 breasts were classified as high satisfaction, and 111 were classified as low satisfaction. There were no significant differences in breast width between the two groups. In the high-satisfaction group, the absolute value and the value divided by the breast width of breast projection and the lower pole length were significantly greater than those of the low-satisfaction group. The areas under the ROC for breast projection and lower pole length, as aesthetic predictive indexes, were greater than 0.7. CONCLUSIONS Breast width emerged as the benchmark of breast aesthetic assessment. Breast projection and the lower pole length had a great impact on unilateral breast aesthetics and should be given priority when improving the breast shape, and appropriate ratio of low pole length and breast projection to breast radius might bring a more satisfying outcome. 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.
Collapse
Affiliation(s)
- Lin Chen
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, People's Republic of China
| | - Jingjing Sun
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, People's Republic of China
| | - Dali Mu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, People's Republic of China
| | - Chunjun Liu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, People's Republic of China
| | - Jie Luan
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, and the Plastic Surgery Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, People's Republic of China.
| |
Collapse
|
27
|
de Vita R, Buccheri EM, Villanucci A, Ragusa LA. Breast Asymmetry, Classification, and Algorithm of Treatment: Our Experience. Aesthetic Plast Surg 2019; 43:1439-1450. [PMID: 31485764 DOI: 10.1007/s00266-019-01489-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/22/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the literature, several classifications of breast asymmetries and treatment protocols have been proposed over time, which are mainly based on etiological or morphological characteristics of the deformity. The aim of this study was to present our new classification, based on patient's self-consciousness of breast asymmetry, a simple and reliable treatment algorithm is also presented. METHODS The case series included 343 patients treated between January 2006 and January 2015. Only patients presenting with developmental breast asymmetries were included in the study. All patients underwent prior classification in three groups based on the patient's degree of awareness of their asymmetry. A specific treatment algorithm was associated with each group according to breast size, grade of ptosis, and patient's desire. At the 48-month follow-up appointment, patients completed an anonymous questionnaire that addressed satisfaction with breast shape, size, and symmetry, scar appearance, body perception, self-esteem, perceived attractiveness, intimate life, and overall feelings about their breasts. RESULTS Mean patient age was 24.6 years (range 18-57 years). Mean follow-up was 54.4 months (6 months to 9 years). At the 48-month follow-up, 66.7% of the patients completed a visual analog scale (VAS) satisfaction questionnaire. An overall satisfaction rate of 77.0% was reported, and a statistically significant difference in the distribution of the overall satisfaction between groups was found. No patient expressed complete dissatisfaction. CONCLUSIONS The proposed classification and the surgical algorithm is a simple, applicable, and reliable method to assess and treat breast asymmetries with a high satisfaction rate as confirmed from our results. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
Affiliation(s)
- Roy de Vita
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | | | - Amedeo Villanucci
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Luigi Amerigo Ragusa
- Department of Plastic and Reconstructive Surgery, IFO - "Regina Elena" National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| |
Collapse
|
28
|
Analysis of the Visual Perception of Female Breast Aesthetics and Symmetry. Plast Reconstr Surg 2019; 144:1257-1266. [DOI: 10.1097/prs.0000000000006292] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
29
|
Natural Breast Symmetry in Preoperative Breast Cancer Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2297. [PMID: 31942335 PMCID: PMC6952140 DOI: 10.1097/gox.0000000000002297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/17/2019] [Indexed: 11/25/2022]
Abstract
Plastic surgeons aim to achieve breast symmetry during cosmetic and reconstructive breast surgery. They rely on measures of breast size, position, and projection to determine and achieve breast symmetry, but normative data on symmetry in preoperative breast reconstruction patients are scarce.
Collapse
|
30
|
Yasunaga Y, Tsuchiya A, Nakajima Y, Kondoh S, Noguchi M, Yuzuriha S. Three-Dimensional Simulation for Breast Augmentation of Female Asymmetric Pectus Excavatum: A Case Report. Aesthet Surg J Open Forum 2019; 1:ojz010. [PMID: 33791606 PMCID: PMC7671236 DOI: 10.1093/asjof/ojz010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Breast augmentation for women with asymmetric pectus excavatum (PE) has a characteristic problem in that surgeons need to select implants while considering the left-right difference in breast volume, contour, and position. We herein report a 33-year-old woman with severe asymmetric PE who presented with residual breast asymmetry after chest wall correction using the Nuss procedure. Her right breast appeared hypoplastic and the right anterior chest wall remained depressed. Augmentation of the right breast with a silicone implant was performed, selecting the inserted implant preoperatively with the assistance of three-dimensional (3D) simulation. The breast asymmetry and anterior chest wall depression were improved to a natural appearance. Three-dimensional simulation represents an advantageous way to preoperatively select optimal implants for breast augmentation in asymmetric PE women with breast asymmetry. Level of Evidence: 5
Collapse
Affiliation(s)
- Yoshichika Yasunaga
- Director of the Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan
| | - Aya Tsuchiya
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Nakajima
- Director of the Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan
| | - Shoji Kondoh
- Director of the Division of Plastic and Aesthetic Surgery, Ina Central Hospital, Ina, Japan
| | - Masahiko Noguchi
- Director of the Division of Plastic Surgery, Nagano Children's Hospital, Azumino, Japan
| | - Shunsuke Yuzuriha
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| |
Collapse
|
31
|
Estimation of implant size based on mammograms in immediate breast reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-018-1473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
32
|
Beamer LC. Novel measurements for radiodermatitis research and clinical care: A pilot and feasibility study. Eur J Oncol Nurs 2019; 39:62-69. [PMID: 30850140 DOI: 10.1016/j.ejon.2019.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/12/2018] [Accepted: 01/14/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The role of clinician-measured breast length and bra cup size in the development of radiodermatitis over time and the efficacy of using multiple measurements of skin toxicity during radiotherapy were piloted. The feasibility of measures to be used in a larger future study was assessed. METHODS AND MATERIALS Participants included women receiving normofractionated or accelerated external breast radiotherapy provided in the supine position using 3-dimensional conformal techniques at a US community cancer center. Acute skin toxicity was assessed using the RTOG scale in 7 areas within the treatment field across 6 timepoints. The total score for the 7 areas was calculated each week. Breast length was measured, examined as an acute radiodermatitis risk factor, and compared against reported bra cup size. RM-ANOVAs examined radiodermatitis using maximum skin toxicity and 7 sites in the radiotherapy field over 6 timepoints. Correlation was implemented to explore the relationship between study variables. RESULTS Forty women consented to this study. Increase in breast length significantly correlated with increase in maximum RTOG score (p = .04); increased RTOG score in the upper medial breast quadrant (p = .04), upper lateral quadrant (p = .02), lower lateral quadrant (p = .02), inframammary fold (p = .001); with increasing BMI (p = .002) and bra cup size (p = .0003). The clinician-measured breast lengths and participant-reported bra cup sizes were discordant. Participants completed all measures and measurements including breast length. CONCLUSIONS Our results suggest that measuring breast length and assessing radiodermatitis in multiple areas of the treatment field is feasible. These measures may increase the sensitivity of skin toxicity assessment.
Collapse
Affiliation(s)
- Laura Curr Beamer
- School of Nursing, Northern Illinois University, DeKalb, IL, USA; College of Nursing, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
33
|
Wang C, Luan J, Cheng H, Chen L, Li Z, Panayi AC, Liu C. Menstrual Cycle-Related Fluctuations in Breast Volume Measured Using Three-Dimensional Imaging: Implications for Volumetric Evaluation in Breast Augmentation. Aesthetic Plast Surg 2019; 43:1-6. [PMID: 30276455 DOI: 10.1007/s00266-018-1243-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/16/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Breast volume is a key parameter of breast measurement in breast augmentation. However, the correlation between menstrual cycle phases and variation in breast volume has not been well studied. METHODS Young female patients with regular menstrual cycles underwent eight three-dimensional imaging scans during a single menstrual cycle from November 2017 to January 2018. Breast volumetric difference at each timepoint and basic breast volume were measured for each subject. Preovulatory phase and postovulatory phase values were compared using an unpaired t test. A Pearson's linear correlated analysis was performed to identify the correlation between the basic breast volume and maximum range of breast volumetric difference during the menstrual cycle. RESULTS Thirteen patients (26 breasts) met the inclusion criteria. During the menstrual cycle, the breast volumetric difference showed first a rising trend followed by a fall. A significant difference in the breast volumetric difference between the preovulatory phase and postovulatory phase (- 19.6 ± 2.1 ml pre-ovulation vs. - 6.9 ± 3.3 ml post-ovulation, p = 0.002) was noted. There was a positive linear association between breast volume and maximum range of breast volumetric difference when a Pearson correlation was used (r = 0.45, p = 0.021). CONCLUSIONS The breast volume fluctuates during the menstrual cycle, and there is a significant difference between the preovulatory phase and postovulatory phase for breast volumetric change. The influence of the menstrual cycle on breast volume should be taken into consideration by plastic surgeons performing breast augmentation. 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 .
Collapse
|
34
|
Wang C, Liu C, Giatsidis G, Cheng H, Chen L, Kang D, Panayi AC, Luan J. The Effect of Respiration on Breast Measurement Using Three-dimensional Breast Imaging. Aesthetic Plast Surg 2019; 43:53-58. [PMID: 30242460 DOI: 10.1007/s00266-018-1231-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Three-dimensional (3D) imaging offers new opportunities to enable objective and quantitative analysis of the breast. Unlike scanning of rigid objects, respiration may be one of the factors that can influence the measurement of breast when using 3D imaging. In this study, we aimed to investigate how the different respiratory phases affect 3D morphologic and volumetric evaluations of the breast. METHODS We performed preoperative 3D breast imaging at the end of expiration (EE) and the end of inspiration (EI). We repeated scans on each respiratory phase, taking four scans in total (EE1, EE2 and EI1, EI2). Using Geomagic Studio 12 software, measurements from the different respiratory phases (EE1 and EI1) were compared for differences in the linear distances of breast. Breast volumetric change error (BVCE) was measured between EE1 and EE2 (R1) and between EI1 and EI2 (R2). A multilevel model was used to analyze the difference of linear-distances parameters between EE1 and EI1 and a paired sample t-test was used to analyze the difference between R1 and R2. RESULTS Our study included 13 Chinese women (26 breasts) with a mean age of 32.6 ± 6.3 years. Compared with EI, EE showed a longer sternal notch to the level of the inframammary fold and shorter nipple to midline (p < 0.05). During EI, breast projection increased by 0.23 cm (95% CI - 0.39, - 0.08) and breast base width increased by 0.27 cm (95% CI - 0.46, - 0.09). The position of the nipple moved by 0.18 cm (95% CI - 0.34, - 0.03) laterally, 0.41 cm (95% CI 0.18, 0.64) cranially, and 0.71 cm (95% CI - 0.92, - 0.51) anteriorly. Although there was no significant difference in BVCE between EE and EI, the result seen with EE appeared to be more consistent. CONCLUSIONS The results of this study demonstrate that there was no difference in breast volume results when patients are in the expiratory or inspiratory state during 3D breast imaging. This study, however, holds potential benefits to both surgical practice as well as the 3D imaging industry. 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 .
Collapse
|
35
|
O'Connell RL, Khabra K, Bamber JC, deSouza N, Meybodi F, Barry PA, Rusby JE. Validation of the Vectra XT three-dimensional imaging system for measuring breast volume and symmetry following oncological reconstruction. Breast Cancer Res Treat 2018; 171:391-398. [PMID: 29872939 PMCID: PMC6096875 DOI: 10.1007/s10549-018-4843-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/29/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE Three-dimensional surface imaging (3D-SI) of the breasts enables the measurement of breast volume and shape symmetry. If these measurements were sufficiently accurate and repeatable, they could be used in planning oncological breast surgery and as an objective measure of aesthetic outcome. The aim of this study was to validate the measurements of breast volume and symmetry provided by the Vectra XT imaging system. METHODS To validate measurements, breast phantom models of true volume between 100 and 1000 cm3 were constructed and varying amounts removed to mimic breast tissue 'resections'. The volumes of the phantoms were measured using 3D-SI by two observers and compared to a gold standard. For intra-observer repeatability and inter-observer reproducibility in vivo, 16 patients who had undergone oncological breast surgery had breast volume and symmetry measured three times by two observers. RESULTS A mean relative difference of 2.17 and 2.28% for observer 1 and 2 respectively was seen in the phantom measurements compared to the gold standard (n = 45, Bland Altman agreement). Intra-observer variation over ten repeated measurements demonstrated mean coefficients of variation (CV) of 0.58 and 0.49%, respectively. The inter-observer variation demonstrated a mean relative difference of 0.11% between the two observers. In patients, intra-observer variation over three repeated volume measurements for each observer was 3.9 and 3.8% (mean CV); the mean relative difference between observers was 5.78%. For three repeated shape symmetry measurements using RMS projection difference between the two breasts, the intra-observer variations were 8 and 14% (mean CV), the mean relative difference between observers was 0.43 mm for average symmetry values that ranged from about 3.5 to 15.5 mm. CONCLUSION This first validation of breast volume and shape symmetry measurements using the Vectra XT 3D-SI system suggests that these measurements have the potential to assist in pre-operative planning and also as a measure of aesthetic outcome.
Collapse
Affiliation(s)
- Rachel L O'Connell
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Komel Khabra
- Department of Statistics, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Jeffrey C Bamber
- Joint Department of Physics and Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Nandita deSouza
- Cancer Research UK Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Farid Meybodi
- Westmead Breast Cancer Institute, Westmead, NSW, 2145, Australia
| | - Peter A Barry
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - Jennifer E Rusby
- Department of Breast Surgery, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| |
Collapse
|
36
|
Zimman OA, Butto CD, Rostagno R, Rostagno C. Volumetric Mammogram Assessment: A Helpful Tool in the Treatment of Breast Asymmetries. Aesthetic Plast Surg 2017; 41:1261-1274. [PMID: 28779406 DOI: 10.1007/s00266-017-0940-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022]
Abstract
The surgical approach to breast asymmetry depends on several factors, including the surgeon's experience, the anatomy of the patient, and several methods that may help to choose a technique and define the size of the implant or the amount of breast tissue to be excised. The aim of this study is to assist in evaluation of breast volumes with the Quantra™ software application, intended for use with Hologic™ digital mammography systems. Twenty-eight women were studied with full-field digital mammography (FFDM) with the Quantra™ software application, for use with Hologic™ digital mammography systems preoperatively. The case diagnoses were as follows: breast hypertrophy, ptosis, hypoplasia, and reconstruction, and the surgeries included breast reduction, mastopexy, mastopexy and breast reduction, mastoplasty and breast augmentation, breast augmentation, and immediate or delayed breast reconstruction. Patients were evaluated from 6 to 18 months after surgery. Volumetric mammogram studies help to decide the amount of tissue to be excised, the size of the implants, and the combination of both. The results of this study were evaluated by surgeons and patients and found to be highly satisfactory. The use of full-field digital mammography with adequate software should be considered as another tool to assist in making decisions regarding the correction of breast asymmetries. 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 .
Collapse
Affiliation(s)
- Oscar A Zimman
- Centro Zimman de Cirugía Plástica and Division of Plastic Surgery, Hospital de Clínicas, University of Buenos Aires, Juncal 2437, 1A, (1425), Buenos Aires, Argentina.
| | - Carlos D Butto
- Division of Plastic Surgery, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina
| | | | | |
Collapse
|
37
|
Assessment of Breast Asymmetry in Adolescent Idiopathic Scoliosis Using an Automated 3D Body Surface Measurement Technique. Spine Deform 2017; 5:152-158. [PMID: 28449957 DOI: 10.1016/j.jspd.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 12/28/2016] [Accepted: 01/02/2017] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To assess breast asymmetry (BA) directly with 3D surface imaging and to validate it using MRI values from a cohort of 30 patients with significant adolescent idiopathic scoliosis (AIS). Also, to study the influence of posture (prone vs standing) on BA using the automated method on both modalities. SUMMARY OF BACKGROUND DATA BA is a common concern in young female patients with AIS. In a previous study using MRI, we found that the majority of patients with significant AIS experienced BA of up to 21% in addition to their chest wall deformity. MRI is costly and not always readily available. 3D surface topography, which offers fast and reliable breast acquisitions without radiation or distortion of the body surface, is an alternative method in the clinical setting. METHODS Thirty patients with AIS were enrolled in the study on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception of their BA. Each patient underwent two imaging studies of their torso: a 3D trunk surface topography and a breast MRI. An automated breast volume measuring method was proposed using a program developed with Matlab programming. RESULTS Strong correlations were obtained when comparing the proposed method to the MRI on the left breast volumes (LBV) (r = 0.747), the right breast volumes (RBV) (r = 0.805) and the BA (r = 0.614). Using the same method on both imaging modalities also yielded strong correlation coefficients on the LBV (r = 0.896), the RBV (r = 0.939) and the BA (r = 0.709). CONCLUSIONS The proposed 3D body surface automated measurement technique is feasible clinically and correlates very well with breast volumes measured using MRI. Additionally, breast volumes remain comparable despite being measured in different body positions (standing and prone) in a young cohort of AIS patients. LEVEL OF EVIDENCE Level IV.
Collapse
|
38
|
Egu OE, Forouzanpour F. Mild Nipple Asymmetry: Using a Supra-Areola Incision With Crescent Nipple-Areola Complex Lift to Address This Problem in Primary Breast Augmentations. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/0748806816685067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Breast augmentation mammoplasty is one of the most commonly performed cosmetic procedures in the United States. Currently, the common access incisions employed to perform the procedure are periareolar, inframammary, transaxillary, (TUBA) transumbilical, and (TABA) transabdominal (a technique that places breast prosthesis through existing abdominal scars or during the performance of an abdominoplasty). Asymmetries of the breast and chest wall are a common occurrence that is faced by aesthetic surgeons who perform breast augmentations. We aim to describe how our experience with using the supra-areola incision, for a primary breast augmentation procedure, has the added advantage of allowing us to address this problem. This article is a retrospective review of primary breast augmentation cases that were performed in our General Cosmetic Surgical Group and Fellowship Training Program from January 1, 2007, to June 30, 2015. The review addresses the incidence of nipple asymmetry in our primary breast augmentation patients and how we are able to address this problem by performing a crescent nipple-areola complex (NAC) lift via a supra-areola incision. From January 1, 2007, to June 30, 2015, 281 primary breast augmentations were performed, of which 184 (65.8%) had an NAC lift to address subjective and objective mild nipple asymmetry (~1 cm). There were no intraoperative complications. At follow-up, more than 92% of patients report satisfaction with their aesthetic outcome, 98% admitted to resolution or improvement of nipple asymmetry, 99% admitted to adequate postoperative nipple sensation, while 8% had secondary/revision breast surgery in the form of capsulectomies, scar revisions, and implant change revisions. Supra-areola incision approach should be strongly considered as a first-line approach in patients undergoing a primary breast augmentation procedure with adequately sized NAC and have evidence of mild (maximum study average = 0.95 cm) nipple asymmetry.
Collapse
|
39
|
Chae MP, Rozen WM, Spychal RT, Hunter-Smith DJ. Breast volumetric analysis for aesthetic planning in breast reconstruction: a literature review of techniques. Gland Surg 2016; 5:212-26. [PMID: 27047788 DOI: 10.3978/j.issn.2227-684x.2015.10.03] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Accurate volumetric analysis is an essential component of preoperative planning in both reconstructive and aesthetic breast procedures towards achieving symmetrization and patient-satisfactory outcome. Numerous comparative studies and reviews of individual techniques have been reported. However, a unifying review of all techniques comparing their accuracy, reliability, and practicality has been lacking. METHODS A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE, was undertaken. RESULTS Since Bouman's first description of water displacement method, a range of volumetric assessment techniques have been described: thermoplastic casting, direct anthropomorphic measurement, two-dimensional (2D) imaging, and computed tomography (CT)/magnetic resonance imaging (MRI) scans. However, most have been unreliable, difficult to execute and demonstrate limited practicability. Introduction of 3D surface imaging has revolutionized the field due to its ease of use, fast speed, accuracy, and reliability. However, its widespread use has been limited by its high cost and lack of high level of evidence. Recent developments have unveiled the first web-based 3D surface imaging program, 4D imaging, and 3D printing. CONCLUSIONS Despite its importance, an accurate, reliable, and simple breast volumetric analysis tool has been elusive until the introduction of 3D surface imaging technology. However, its high cost has limited its wide usage. Novel adjunct technologies, such as web-based 3D surface imaging program, 4D imaging, and 3D printing, appear promising.
Collapse
Affiliation(s)
- Michael P Chae
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - Warren Matthew Rozen
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - Robert T Spychal
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - David J Hunter-Smith
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| |
Collapse
|
40
|
Yeslev M, Braun SA, Maxwell GP. Asymmetry of Inframammary Folds in Patients Undergoing Augmentation Mammaplasty. Aesthet Surg J 2016; 36:156-66. [PMID: 26353799 DOI: 10.1093/asj/sjv174] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Variation in the anatomical position of the inframammary fold (IMF) in women remains poorly studied. OBJECTIVES The purpose of this study was to evaluate the incidence of asymmetry between IMF locations on the chest wall of women undergoing breast augmentation and to determine breast measurements associated with IMF asymmetry. METHODS Three-dimensional imaging analysis of the breasts was performed in 111 women with micromastia, using the Vectra Imaging System(TM). The following measurements were recorded: vertical distance between right and left IMF (inter-fold distance), vertical distance between nipples (inter-nipple distance), and difference between projection of right and left breasts in anterior-posterior direction. RESULTS Asymmetry between the right and left IMF positions was found in the majority of patients (95.4%), with symmetry only found in 5 patients (4.6%). In the majority of patients (60.3%), the right IMF was located inferior to the left IMF with median inter-fold distance 0.4 cm (range, 0.1, 2.1 cm). In 39 patients (35.1%), the left IMF was located inferior to the right with median inter-fold distance 0.4 cm (range, 0.1, 1.7 cm). There was strong correlation between the degree of asymmetry of IMF and asymmetry of nipple areola complex (NAC) positions (r = 0.687, P < .01). CONCLUSIONS The majority of women with micromastia demonstrate asymmetry of the IMF, which correlates with asymmetry of NAC location. The authors propose a classification system based on most commonly observed IMF locations as types I (right IMF inferior to left), type II (left IMF inferior to right) and type III (both IMF located on the same level). LEVEL OF EVIDENCE 4: Diagnostic.
Collapse
Affiliation(s)
- Max Yeslev
- From the Department of Plastic Surgery, Vanderbilt University, Nashville, TN
| | - Stephane A Braun
- From the Department of Plastic Surgery, Vanderbilt University, Nashville, TN
| | - G Patrick Maxwell
- From the Department of Plastic Surgery, Vanderbilt University, Nashville, TN
| |
Collapse
|
41
|
Yang J, Zhang R, Shen J, Hu Y, Lv Q. The Three-Dimensional Techniques in the Objective Measurement of Breast Aesthetics. Aesthetic Plast Surg 2015; 39:910-5. [PMID: 26395095 DOI: 10.1007/s00266-015-0560-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/18/2015] [Indexed: 02/04/2023]
Abstract
UNLABELLED Breast symmetry, size, and shape are key components of aesthetic outcomes of augmentation mammoplasty, reduction, and reconstruction. Many have claimed that the 3D scanning technique, which measures breast volumes directly and assesses the asymmetry of the chest and breast on a 3D model, is superior to anthropometric measuring in accuracy, precision, and reproducibility. The documented methods of 3D body surface imaging include laser scanning, stereo photography and so on. To achieve ideal aesthetic results, individualized surgery planning based on a reliable virtual model of the prospective surgery outcome could be of considerable value in decision making and assisting in guidance for the surgery procedure. Additionally, the 3D scanning technique is applicable in postoperative monitoring of morphological change, notably, in a dynamic way. Another distinguishing feature is that it enables virtual division of breast volume, thus surgeons could virtually divide the breast volumes into portions using 3D scanning during the programming and evaluation of surgery plans. However, because 3D surface scanning cannot look through the breast substances and reach the interspace between the chest and posterior border of the breast/dorsal limit of the breast, the inframammary fold in larger breasts cannot be correctly imaged, leaving the preoperative inframammary fold reference lacking. Therefore, 3D scanning is thought to be inaccurate in large and/or ptotic breasts. Another fact that prevents 3D scanning from wide application is its high cost and lack of access. 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.
Collapse
Affiliation(s)
- Jiqiao Yang
- Department of Breast Surgery, West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Run Zhang
- West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Jiani Shen
- West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Yuanyuan Hu
- West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China.
| |
Collapse
|
42
|
Epstein MD, Scheflan M. Three-dimensional Imaging and Simulation in Breast Augmentation. Clin Plast Surg 2015; 42:437-50. [DOI: 10.1016/j.cps.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
43
|
Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery. Breast 2015; 24:331-42. [DOI: 10.1016/j.breast.2015.03.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/18/2015] [Accepted: 03/22/2015] [Indexed: 11/22/2022] Open
|
44
|
Somogyi RB, Stavrou D, Southwick G. Correction of small volume breast asymmetry using deep parenchymal resection and identical silicone implants: an early experience. Aesthet Surg J 2015; 35:394-401. [PMID: 25908698 DOI: 10.1093/asj/sju058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Virtually all patients presenting for augmentation mammaplasty will exhibit some degree of asymmetry. The use of asymmetric implants to address small- volume breast asymmetry introduces uncontrolled variables into the longevity of postoperative results. OBJECTIVES We described a novel method of addressing small-volume asymmetry using deep parenchymal resection (DPR) to achieve symmetry prior to insertion of identical implants. We also compared our results with this technique to a cohort of standard augmentation mammaplasty patients. METHODS All patients underwent 3-dimensional (3D) imaging during consultation. In patients with small-volume breast asymmetry, a uniform disk of deep parenchymal tissue was resected from the base of the larger breast cone through an inframammary incision. A standard submuscular augmentation was then completed. Five patients (DPR group) with appreciable small-volume asymmetry underwent DPR in the larger breast prior to insertion of identical implants. Fifty-six consecutive patients with no appreciable volume asymmetry (standard group) underwent standard submuscular breast augmentation. RESULTS Using 3D imaging preoperatively, DPR-group patients had an estimated breast volume asymmetry of 86 ± 58 g and had 55 ± 27 g excised from the larger breast intraoperatively, allowing for insertion of identical implants in each patient. Complications in the standard group included 1 case of rippling and 2 cases of malposition. One case of malposition was noted in the DPR group. No other complications were recorded in either group over 6 months. CONCLUSIONS Our novel method of addressing small-volume breast asymmetry allows for the use of identical implants and presents no increase in early complications.
Collapse
Affiliation(s)
- Ron Barry Somogyi
- Dr Somogyi was a Clinical Fellow at a private plastic surgery practice in Melbourne, Australia, at the time of this study and is now a plastic surgeon in private practice in Toronto, Canada. Dr Stavrou was a Clinical Fellow at a private plastic surgery practice in Melbourne, Australia, at the time of this study and is now a plastic surgeon in private practice in Cyprus, Greece. Dr Southwick is a plastic surgeon in private practice in Melbourne, Australia
| | - Demetris Stavrou
- Dr Somogyi was a Clinical Fellow at a private plastic surgery practice in Melbourne, Australia, at the time of this study and is now a plastic surgeon in private practice in Toronto, Canada. Dr Stavrou was a Clinical Fellow at a private plastic surgery practice in Melbourne, Australia, at the time of this study and is now a plastic surgeon in private practice in Cyprus, Greece. Dr Southwick is a plastic surgeon in private practice in Melbourne, Australia
| | - Graeme Southwick
- Dr Somogyi was a Clinical Fellow at a private plastic surgery practice in Melbourne, Australia, at the time of this study and is now a plastic surgeon in private practice in Toronto, Canada. Dr Stavrou was a Clinical Fellow at a private plastic surgery practice in Melbourne, Australia, at the time of this study and is now a plastic surgeon in private practice in Cyprus, Greece. Dr Southwick is a plastic surgeon in private practice in Melbourne, Australia
| |
Collapse
|
45
|
|
46
|
3D surface imaging of the human female torso in upright to supine positions. Med Eng Phys 2015; 37:375-83. [PMID: 25703742 PMCID: PMC4380553 DOI: 10.1016/j.medengphy.2015.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 01/09/2015] [Accepted: 01/18/2015] [Indexed: 11/20/2022]
Abstract
Three-dimensional (3D) surface imaging of breasts is usually done with the patient in an upright position, which does not permit comparison of changes in breast morphology with changes in position of the torso. In theory, these limitations may be eliminated if the 3D camera system could remain fixed relative to the woman’s torso as she is tilted from 0 to 90 degrees. We mounted a 3dMDtorso imaging system onto a bariatric tilt table to image breasts at different tilt angles. The images were validated using a rigid plastic mannequin and the metrics compared to breast metrics obtained from 5 subjects with diverse morphology. The differences between distances between the same fiducial marks differed between the supine and upright positions by less than one percent for the mannequin, whereas the differences for distances between the same fiducial marks on the breasts of the 5 subjects differed significantly and could be correlated with body mass index and brassiere cup size for each position change. We show that a tilt table - 3D imaging system can be used to determine quantitative changes in the morphology of ptotic breasts when the subject is tilted to various angles.
Collapse
|
47
|
Yip JM, Watson DI, Tiggemann M, Hsia S, Smallman AE, Dean NR. Determinants of breast reconstruction outcome: How important is volume symmetry? J Plast Reconstr Aesthet Surg 2015; 68:679-85. [PMID: 25731778 DOI: 10.1016/j.bjps.2014.12.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/23/2014] [Accepted: 12/31/2014] [Indexed: 11/30/2022]
Abstract
Breast reconstruction has established psychosocial benefit compared to mastectomy alone. Evaluation of determinants of breast reconstruction outcome has previously been limited by lack of high quality, condition-specific, patient-reported outcomes measures. The BREAST-Q is such a measure and is well suited to comparison against objective measurements of reconstructed breasts such as volume and volume symmetry. A cohort of patients who had undergone breast reconstruction over a 14 year period underwent assessment of their breast reconstructions using a 3D laser scanning technique and at the same time completed the BREAST-Q patient reported outcomes measure. The objective data derived from the 3D laser scans were then compared to the quantitative data from the patient-reported outcomes measure. Internal comparisons between domains of the BREAST-Q were also examined. 119 patients completed the study. No correlation was found between objectively measured post-operative volume symmetry and patient reported satisfaction with breasts. Examination of a specific question of the BREAST-Q established that patients did notice if they had breast asymmetry but that this did not translate into dissatisfaction with the breasts overall. Patients who had second stage surgery to correct asymmetry, however, did have a statistically significant increase in satisfaction with breasts between pre and post-symmetrization measures. The strongest correlation for a high level of satisfaction with the reconstructed breast(s) was high level of satisfaction with pre-operative information given. Although symmetrization procedures are valuable for increasing satisfaction with breasts, breast volume symmetry is not a major determinant of outcome in breast reconstruction. The breast reconstruction 'process' is more important in determining patients' post-operative well-being and satisfaction with their overall outcome than the actual final 'product' of their reconstruction.
Collapse
Affiliation(s)
- Jia Miin Yip
- Department of Plastic & Reconstructive Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia; Flinders University, Bedford Park, SA 5042, Australia.
| | | | | | - Shawn Hsia
- Department of Plastic & Reconstructive Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Andrea E Smallman
- Department of Plastic & Reconstructive Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia
| | - Nicola R Dean
- Department of Plastic & Reconstructive Surgery, Flinders Medical Centre, Bedford Park, SA 5042, Australia; Flinders University, Bedford Park, SA 5042, Australia
| |
Collapse
|
48
|
Objective breast volume, shape and surface area assessment: a systematic review of breast measurement methods. Aesthetic Plast Surg 2014; 38:1116-30. [PMID: 25338712 DOI: 10.1007/s00266-014-0412-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are many methods of measuring the breast and their clinical applications are well described in the literature. However, there has been no attempt to compare these various methods to allow the user to have a broad overview of the subject. The authors have attempted to summarise all the available methods to measure the breast in this article to provide a useful reference for all. METHODS A comprehensive literature search of PubMed was performed, and the resulting articles were screened and reviewed. The data regarding the methods' mechanism, reliability, time and cost were evaluated and compared. RESULTS A total of 74 articles dating from 1970 to 2013 were included in this study. All of the methods can be classified into those that measure (1) volume, (2) shape and (3) surface area. Each category consists of several methods that work through different mechanisms and they vary in their reliability and feasibility. Based on their mechanism, the volume measurement methods were further grouped into the natural shape methods, the stereological method, the geometrical methods and the mathematical modelling method. CONCLUSIONS More objective breast evaluation can be achieved if all three dimensions (volume, shape and surface area) are considered. In the volume measurements, 3D modelling and the MRI are the most reliable tools. Linear measurement (geometry) and mathematical modelling are less accurate but are more economical. In the shape measurements, besides the traditional linear measurement, 3D methods that can deliver colour-coded maps and Swanson's 2D photographic measurement system are capable of depicting and tracking breast shape changes after surgery. Although the surface area metric has not been used extensively, it has potential in clinical and research applications. 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.
Collapse
|
49
|
Ramsay J, Joncas J, Gilbert G, Trop I, Cheriet F, Labelle H, Parent S. Is Breast Asymmetry Present in Girls with Adolescent Idiopathic Scoliosis? Spine Deform 2014; 2:374-379. [PMID: 27927335 DOI: 10.1016/j.jspd.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/11/2014] [Accepted: 05/24/2014] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Cross-sectional descriptive study. OBJECTIVES To characterize breast asymmetry (BA), as defined by breast volume difference, in girls with significant adolescent idiopathic scoliosis (AIS), using magnetic resonance imaging (MRI). SUMMARY AND BACKGROUND BA is a frequent concern among girls with AIS. It is commonly believed that this results from chest wall deformity. Although many women exhibit physiological BA, the prevalence is not known in adolescents and it remains unclear if it is more frequent in AIS. Breasts vary in shape and size and many ways of measuring them have been explored. MRI shows the highest precision at defining breast tissue. METHODS Thirty patients were enrolled on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception on their BA. MRI acquisitions were performed in prone with a 1.5-Tesla system using a 16-channel breast coil. Segmentation was achieved using the ITK-SNAP 2.4.0 software and subsequently manually refined. RESULTS The mean left breast volume (528.32 ± 205.96 cc) was greater compared with the mean right breast volume (495.18 ± 170.16 cc) with a significant difference between them. The mean BA was found to be 8.32% ± 6.43% (p < .0001). A weak positive correlation was observed between BA and thoracic Cobb angle (0.177, p = .349) as well as thoracic gibbosity angle (0.289, p = .122). The left breast was consistently larger in 65.5% of the patients. Twenty patients (66.7%) displayed BA ≥5%. CONCLUSIONS We have described BA in patients with significant AIS using MRI. This method is feasible, objective, and very precise. The majority of patients had a larger left breast, which could compound the apparent BA secondary to trunk rotation. In many cases, BA is present independently of thoracic deformity. This knowledge will assist in counseling AIS patients in regards to their concerns with BA.
Collapse
Affiliation(s)
- Joyce Ramsay
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; University of Montreal, 2910 Edouard-Montpetit Blvd, Montreal, Quebec H3C 3J7, Canada
| | - Julie Joncas
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare, 281 Hillmount Road, Markham, Ontario L6C 2S3, Canada; Hôtel-Dieu University of Montreal Hospital Center, 3840 Saint Urbain Street, Montreal, Quebec H2W 1T8 Canada
| | - Isabelle Trop
- Hôtel-Dieu University of Montreal Hospital Center, 3840 Saint Urbain Street, Montreal, Quebec H2W 1T8 Canada
| | - Farida Cheriet
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec, H3T 1J4 Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Stefan Parent
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; University of Montreal, 2910 Edouard-Montpetit Blvd, Montreal, Quebec H3C 3J7, Canada.
| |
Collapse
|
50
|
Wheat J, Choppin S, Goyal A. Development and assessment of a Microsoft Kinect based system for imaging the breast in three dimensions. Med Eng Phys 2014; 36:732-8. [PMID: 24507690 DOI: 10.1016/j.medengphy.2013.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 12/06/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
|