Correlation analysis of resected breast tissue and implant volume after mastectomy and its association with breast density

Relationship Between Breast Density and Ptosis Degree in Direct-to-Implant Breast Reconstruction

BACKGROUND

Direct-to-implant breast reconstruction is a popular procedure since breast volume can be acquired immediately. Various evaluations have been utilized to achieve symmetry. We measured the weight and volume of mastectomy specimens and calculated the relationship between breast density and ptosis degree.

METHODS

We conducted a retrospective chart review of patients who had undergone direct-to-implant breast reconstruction. Clinical data from 155 patients were reviewed, and they were classified based on breast density (weight/volume) (Group 1: density < 0.9 g/mL [n=17], Group 2: 0.9 g/mL ≤ density <1.1 g/mL [n=59], and Group 3: density ≥ 1.1 g/mL [n=79]). The relationship between breast density and ptosis degree was analyzed using the Cochran-Armitage test for trend. Adequate suture and anchoring techniques were applied to achieve symmetric breasts. Postoperative outcomes were assessed by measuring the discrepancy in nipple height.

RESULTS

A statistically significant relationship was found between higher breast density and a greater degree of ptosis. The outcome showed a significant trend across Group 1, 2 and 3 (p<0.05). In postoperative analysis, the nipple level discrepancy was less than 10 mm as follows: 100% in Group 1, 89.8% in Group 2, and 70.9% in Group 3, showing a progressive decreasing trend from Group 1 to Group 3 (p<0.05).

CONCLUSION

Direct-to-implant breast reconstruction is an attractive technique, offering predictable outcomes based on adequate measurements. The relationship between breast density and the degree of ptosis is a significant indicator in making intraoperative decisions. Breast density is an adjunctive index for achieving patients' expectations of symmetrical breasts.

LEVEL OF EVIDENCE IV

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Comparison of the Preoperative MRI Evaluation of Glandular Tissue in Subcutaneous Mastectomy and its Influence on the Implant Volume

Background/Aim

This study examined the influence of preoperative MRI on the choice of implant volume in patients undergoing subcutaneous mastectomy with immediate breast reconstruction. It was postulated that preoperative MRI scans can adequately estimate glandular tissue, which in turn correlates with implant size.

Patients and Methods

Preoperative and postoperative MRI scans were used in oncological and prophylactical subcutaneous mastectomy scenarios in 67 cases at the Department of Gynaecology, Breast Cancer Center, University of Cologne, Germany. The preoperative MRI was used to estimate the resected tissue and the postoperative MRI was used to scan for residual glandular tissue. In addition, a correlation found by Malter et al. in 2021 was evaluated with the available data.

Results

Preoperative MRIs result in an adequate estimation of resected tissue. This in turn correlates with implant volume. The correlation by Malter et al. also holds when estimating implant volume. The likelihood of residual gland was low if the preoperatively estimate volume was removed.

Conclusion

Our results indicate that the use of preoperative and postoperative MRI scans for subcutaneous mastectomies is advantageous. We suggest a routine estimation of glandular tissue, especially for small breasts.

Weight to volume conversion: an easy and practical breast volume estimation

Background

Accurate breast volume estimation is essential for symmetrical breast reconstruction. Easy conversion of the weight of the resected breast tissue to volume could result in precise volume measurements. This study aimed to introduce the use of a mathematical constant (k) to estimate the breast volume from the weight.

Methods

Eighty-nine female patients with breast cancer who underwent surgery at King Chulalongkorn Memorial Hospital between September 2010 and February 2011 were enrolled in this prospective study. The mammographic density of each patient was classified according to the breast imaging reporting and data system (BI-RADS) into groups a, b, c, and d. The breast density number and mathematical constant (k) were calculated, and the data matched. This technique was validated by comparing the measured and calculated volumes.

Results

Sixty-six, 22, and 1 patients underwent total mastectomies (TMs), skin-sparing mastectomies (SSMs), and nipple-sparing mastectomies (NSMs), respectively. The breast densities were 1.0629, 1.1545, and 1.2233 g/mL, and the constant number (k) was 0.9409, 0.8662, and 0.8175 for BI-RADS a, combined BI-RADS b and c, and BI-RADS d, respectively. The validation process showed no significant differences between the measured and calculated volumes [95% confidence interval (95% CI)]. The correlation coefficient (r) was 0.984.

Conclusions

Accurate breast volume estimation is a key factor in achieving symmetry in breast reconstruction. Combining existing data, including the weight of the resected breast tissue and mammographic density findings, an easy and accurate method to calculate the resected breast volume was introduced.

Patient Self-reported Breast Cup Size and Resultant Mastectomy Specimen Weight: Implications for Reconstructive Breast Surgery

Breast cup sizing irregularities exist due to discrepancy between garment manufacturers and patient reported measurements making it difficult to assess true preoperative and definitive postoperative breast cup size. This study aims to evaluate the association between patient self-reported breast cup size and mastectomy specimen weight as a way to determine postreconstruction breast cup size.

METHODS

This is a retrospective study that evaluated patients who underwent bilateral mastectomy at an academic center between 2019-2021. Cup size and mastectomy weight were our only independent and dependent variables, respectively. Covariates that were assessed included chest circumference, surgical oncologist, BMI, race, and age.

RESULTS

243 patients were evaluated as a part of this study who underwent either total-simple (TS; 29), skin-sparing (SS; 146), or nipple-sparing (NS; 68) bilateral mastectomy. There were positively weak correlations using nonparametric correlation analysis for breast cup size to mastectomy weight in patients who underwent TS (r = 0.375; p = 0.004), SS (r = 0.353; p <0.001), and NS (r = 0.246; p = 0.004) mastectomy. The multivariate linear regression for TS (R₂=0.520; p < 0.001), SS (R₂=0.573; p < 0.001) and NS (R2=0.396; p < 0.001) mastectomy were significant. Covariates assessed in the regression showed BMI significant for all types, age for TS type, and SS type for breast surgeon and chest circumference.

CONCLUSIONS

There is a positively weak correlation between preoperative breast cup size and mastectomy weight, providing evidence for the difficulty of estimating postoperative breast cup size. Thus, the conversation with the patient should focus on breast appearance and quality of life rather than postreconstruction breast size.

A Prospective Investigation of Predictive Parameters for Preoperative Volume Assessment in Breast Reconstruction

Preoperative breast volume estimation is very important for the success of the breast surgery. In this study four different breast volume determination methods were compared. The end-point of this prospective study was to evaluate the concordance between different modalities of breast volume assessment (MRI, BREAST-V, mastectomy specimen weight, conversion from weight to volume of mastectomy specimen) and the breast prosthetic volume implanted. The study enrolled 64 patients between 2017 and 2019, who had all been treated by the same surgeons for monolateral nipple–areola complex-sparing mastectomy and implant breast reconstruction. Only patients who had a breast reconstruction classified as “excellent” from an objective (BCCT.core software) and subjective (questionnaire) point of view at the 6-month interval after the operation were included in the study. Data analysis highlighted a strong correlation between the volumes of the chosen prostheses and the weights of mastectomy converted into volume, especially for patients with grades B and C parenchymal density. The values of the agreement between the volumes of the chosen prostheses and the assessments from MRI and BREAST -V proved to be lower than expected from the literature. None of the four studied methods presented any strong correlation with the initial breast width. Our results suggest that conversion from weight to volume of mastectomy specimen should be used to assist in determining the volume of the breast implant to be implanted. This method would help the reconstructive surgeon guide the choice of the most appropriate implant preoperatively.