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Pu LLQ. A Simple and Effective Intraoperative Technique for Correction of Severe Congenital Breast Asymmetry. Ann Plast Surg 2023; 90:S135-S138. [PMID: 36921337 DOI: 10.1097/sap.0000000000003442] [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: 03/17/2023]
Abstract
BACKGROUND One severe type of congenital breast asymmetry, with a hypoplastic breast on one side and a hyperplastic breast on the other side, has been recognized in the author's practice. Although breast augmentation, mastopexy, and breast reduction used separately or in combination are the most common procedures performed to correct congenital asymmetrical breasts, an effective approach for the correction of such a congenital breast asymmetry has not been established in the literature. In this article, a simple and effective intraoperative approach is described for correction of severe congenital breast asymmetry. METHOD Breast augmentation with an implant for the hypoplastic side and mastopexy or small breast reduction for the hyperplastic side were performed. Symmetry was achieved intraoperatively by an implant for breast augmentation on the hypoplastic side and mastopexy or small reduction, determined by a tailor-tacking technique, on the hyperplastic side. RESULTS In the past 2 years, a total of 4 patients with severe congenital breast asymmetry was operated on by the author with this established approach. All patients were pleased about their symmetry and cosmetic outcome without any surgical complications. The resulted breast scars are minimal and well tolerated by patients. No revision or subsequent surgery has even been needed during follow-op. CONCLUSION Correction of severe congenital breast asymmetry is not an easy task and can be difficult. This simple and effective intraoperative approach provides a relatively easy and logical way as a 1-stage procedure for this subgroup of patients with symmetrical and cosmetically pleasing outcome.
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Affiliation(s)
- Lee L Q Pu
- From the Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA
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2
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Stern C, Kim LN, Plotsker E, Boyce L, Dayan J, Nelson JA. An updated systematic review of esthetic grading tools in postmastectomy breast reconstruction. J Surg Oncol 2023; 127:782-790. [PMID: 36594965 PMCID: PMC10006367 DOI: 10.1002/jso.27186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/04/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES We ascertained whether a validated esthetic grading tool for breast reconstruction had been developed and widely adopted since the last published systematic review on the topic from 2015. METHODS We performed a systematic review identifying all studies using a grading tool to assess breast reconstruction, using search terms associated with all types of breast surgery and outcomes research. Articles were assessed for patient number, validated scale use, assessor type and training, assessor blinding, assessment method, scoring system type, type and timing of reconstruction, and usage of corroborating scales. RESULTS Of 2809 articles screened, 148 met the criteria. Only 3 used a validated tool, the Esthetic Items Scale. Most used study-only tools (n = 111) or unvalidated tools (n = 28). The most used unvalidated tool was the Garbay/Lowery 5-subscale rubric. Unanchored Likert scales were the most common subjective tool; two-dimensional images were the most used medium. Surgeons, patients, and nurses were the most common assessors. Twenty percent of studies used corroborating scales. CONCLUSIONS In the absence of a validated esthetic grading tool for breast reconstruction, researchers continue to rely on unvalidated scales. The only validated scale available is used infrequently and only validated among physicians. A validated, reliable, simple grading tool with clinical and scholastic relevance is needed.
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Affiliation(s)
- Carrie Stern
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Leslie N. Kim
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ethan Plotsker
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lindsay Boyce
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joseph Dayan
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonas A. Nelson
- Department of Surgery, Plastic and Reconstructive Surgery Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Quieregatto PR, Sabino Neto M, Furtado F, Quieregatto ADA, Trigo Junior TW, Ferreira LM. JPEG and raw image files compared to direct measurement of the breast region. Acta Cir Bras 2020; 35:e202001008. [PMID: 33263608 PMCID: PMC7709897 DOI: 10.1590/s0102-865020200100000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/22/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: To compare JPEG and RAW image file extensions to direct measurement of the breast region. Methods: Points were marked on the breasts and arms of 40 female volunteers. The joining of these points in each hemibody formed seven linear segments, one angular segment and one median segment common to both hemibodies. Volunteers were photographed in a standardized fashion and evaluated by three raters using the software Adobe Photoshop CS6® and three image file extensions (RAW, high resolution JPEG and low resolution JPEG); values were compared to direct anthropometry. Results: All variables had interclass correlation coefficient higher than 0.8 (ICC>0.8). On average, all variables in all methods showed differences (p<0.05) when compared to direct measurement. A formula was created for each segment and each image file extension in comparison with the direct measurement. Conclusion: Measurements were similar among the correlated JPEG and RAW image file extensions but differed from the actual breast measurement obtained with a caliper.
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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 .
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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.
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Anthropometric Aspects in the Breast Augmentation. Aesthetic Plast Surg 2020; 44:1498-1507. [PMID: 32728763 DOI: 10.1007/s00266-020-01853-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/19/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Studies have demonstrated the importance of anthropometric measurements of the breasts, based on linear measurements for the selection of the volume of breast implants, their positioning, and surgical planning. OBJECTIVES The objective of this study is to evaluate the main changes in anthropometric measurements in breast augmentation. METHODS A prospective, randomized clinical study with 74 female candidates for breast augmentation. All the individuals were split into five groups, according to the implant volume. The implants used were of different textures, from three different brands (LifeSil, Politech, and Silimed). The following measures were taken: distance from the nipple to the inframammary fold (N-IMF), inter-nipple-areolar complex distance (N-N), distance from the Sternal notch to the Nipple (SN-N), areola diameter, and breast projection. RESULTS The most significant breast anthropometric alteration after mammoplasty was the N-IMF distance; that is, an expansion of the lower pole of the breast, followed by an increase in the areolar diameter. Mostly of measurements showed stability between 3rd and 6th months after the surgery. The projection was the most interesting measure due to presenting two patterns of behavior according to the analysis criteria performed. When comparing the implant projection and the final breast projection, it was observed that the implant profile represented a 27% increase in the final breast projection. CONCLUSIONS This study provides an essential comparative analysis between anthropometric changes in breast augmentations and serves as a predictive tool in the preoperative evaluation of the patient during surgical planning. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Vairavan R, Abdullah O, Retnasamy PB, Sauli Z, Shahimin MM, Retnasamy V. A Brief Review on Breast Carcinoma and Deliberation on Current Non Invasive Imaging Techniques for Detection. Curr Med Imaging 2020; 15:85-121. [PMID: 31975658 DOI: 10.2174/1573405613666170912115617] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Breast carcinoma is a life threatening disease that accounts for 25.1% of all carcinoma among women worldwide. Early detection of the disease enhances the chance for survival. DISCUSSION This paper presents comprehensive report on breast carcinoma disease and its modalities available for detection and diagnosis, as it delves into the screening and detection modalities with special focus placed on the non-invasive techniques and its recent advancement work done, as well as a proposal on a novel method for the application of early breast carcinoma detection. CONCLUSION This paper aims to serve as a foundation guidance for the reader to attain bird's eye understanding on breast carcinoma disease and its current non-invasive modalities.
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Affiliation(s)
- Rajendaran Vairavan
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
| | - Othman Abdullah
- Hospital Sultan Abdul Halim, 08000 Sg. Petani, Kedah, Malaysia
| | | | - Zaliman Sauli
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
| | - Mukhzeer Mohamad Shahimin
- Department of Electrical and Electronic Engineering, Faculty of Engineering, National Defence University of Malaysia (UPNM), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia
| | - Vithyacharan Retnasamy
- School of Microelectronic Engineering, Universiti Malaysia Perlis, Pauh Putra Campus, 02600 Arau, Perlis, Malaysia
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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.
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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
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Ron O, Inbal A, Arad E, Zaretski A, Leshem D, Yanko R, Gur E, Barnea Y. Superomedial Pedicle Vertical Scar Breast Reduction: Objective and Subjective Assessment of Breast Symmetry and Aesthetics. Aesthetic Plast Surg 2018; 42:639-647. [PMID: 29218474 DOI: 10.1007/s00266-017-1015-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 10/20/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The superomedial vertical scar breast reduction (SVBR) described by Hall-Findlay is gaining popularity among surgeons worldwide. The aim of this study was to evaluate its long-term aesthetic outcome, the extent of quality of life improvement and the factors that influence patient satisfaction and reviewers' evaluation of aesthetic/surgical outcome. METHODS In this historical prospective study, we included women who underwent SVBR at least one year prior to enrollment and responded to a quality of life questionnaire. Their breasts were photographed, measured and evaluated by the plastic surgery staff. RESULTS A total of 40 patients responded to the questionnaire, and the breasts of 31 of them were measured and photographed. All 31 patients had good breast symmetry according to objective breast measurements. There was a clear correlation between the patients' and the reviewers' scores of breast symmetry, scar appearance and breast shape (r = 0.4-0.65, r = 0.432-0.495 and r = 0.335-0.403, respectively). The factor that most influenced reviewers' and patients' satisfaction with the overall aesthetic outcome was the breast-to-body proportion. CONCLUSIONS The proportions between the breast size and the patient's body habitus are pivotal to patient satisfaction and should be taken into consideration when planning a reduction mammaplasty. The SVBR technique for breast reduction provided good cosmetic outcome and symmetry over a long-term follow-up. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Ofir Ron
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Amir Inbal
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Ehud Arad
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Arik Zaretski
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - David Leshem
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Ravit Yanko
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Eyal Gur
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel
| | - Yoav Barnea
- Breast Reconstruction Unit, Department of Plastic and Reconstructive Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann St, 6423906, Tel-Aviv, Israel.
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9
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Matkowski R, Szynglarewicz B, Kasprzak P, Forgacz J, Skalik R, Zietek M, Kornafel D. Batwing Mastopexy as Oncoplastic Surgical Approach to Periareolar Tumors in Upper Quadrants. TUMORI JOURNAL 2018; 98:421-7. [DOI: 10.1177/030089161209800404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background Batwing mastopexy (BWM) is an oncoplastic technique most commonly used in the treatment of 12 o'clock periareolar tumors. The aim of this study was to assess the early cosmetic results of BWM performed for periareolar lesions located in the upper quadrants, i.e. from 10 to 2 o'clock position. Methods and study design A prospective analysis of a preliminary group of 35 women with periareolar intraductal or invasive breast cancer in the upper quadrants was done. All patients underwent wide lumpectomy with clear margins followed by BWM in order to obtain favorable cosmesis. For invasive cancers axillary biopsy or dissection was performed by separate incision. Cosmetic outcome was assessed 4 weeks after surgery by the patient with reference to breast shape, nipple-areola complex (NAC) position and scar arrangement. The result was rated as poor, medium or good for each parameter. Results There were no poor ratings of cosmetic outcome. The result was rated as medium by 5 women (14%) regarding breast shape and by 3 regarding NAC position (9%). The remaining women evaluated these parameters as good (86% and 91%, respectively). In contrast, scar arrangement was assessed as good by 26 patients (74%), medium by 8 (23%), and poor by 1 (3%). All women rating scar arrangement as other than good had a lesion located in the upper lateral quadrant. Considering the reasons for the relatively low scar acceptance by these women, the only important cause of disappointment was the placement of one of the radial parts of the scar in the area of decolletage in the upper medial quadrant. Conclusions BWM allows to achieve favorable breast shape and NAC position for lesions located in the upper quadrants regardless of the medial or lateral side. However, when performed in the lateral quadrant it produces a scar that can be hard to accept for some women.
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Affiliation(s)
- Rafal Matkowski
- Department of Oncology and Division of Oncological Surgery, Wroclaw Medical University, Wroclaw
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Bartlomiej Szynglarewicz
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Piotr Kasprzak
- Breast Imaging and Minimally Invasive Biopsy Service, Lower Silesian Oncology Center-Regional Comprehensive Cancer Center, Wroclaw
| | - Jozef Forgacz
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Robert Skalik
- Department of Physiology, Wroclaw Medical University, Wroclaw
| | - Marcin Zietek
- Second Department of Surgical Oncology, Lower Silesian Oncology Center–Regional Comprehensive Cancer Center, Wroclaw
| | - Danuta Kornafel
- Department of Anthropology, Faculty of Biological Sciences, University of Wroclaw, Wroclaw, Poland
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10
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Lee YK, Lee JH, Kang SY. Gynecomastia: glandular-liposculpture through a single transaxillary one hole incision. J Plast Surg Hand Surg 2017; 52:117-125. [DOI: 10.1080/2000656x.2017.1360318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Yung Ki Lee
- Department of Plastic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Jun Hee Lee
- Department of Plastic Surgery, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Sang Yoon Kang
- Department of Plastic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
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11
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Hameeteman M, Verhulst AC, Maal TJJ, Ulrich DJO. An analysis of pose in 3D stereophotogrammetry of the breast. J Plast Reconstr Aesthet Surg 2016; 69:1609-1613. [PMID: 27693271 DOI: 10.1016/j.bjps.2016.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/17/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Volume of the breast can be objectively measured by three-dimensional (3D) photographs. This study describes the analysis of three different positions of the patient in image acquisition, in order to find the best pose for reproducible 3D photographs of the breasts. METHOD Twenty-four patients were included between February and September 2014 in a consecutive way. Data were collected prospectively. 3D photographs were acquired using a stereophotogrammetry system. Images were taken twice in three different positions (arms behind the back, arms placed on the hips and arms horizontally placed). Surface based matching was applied and the absolute mean distance between the surfaces of both 3D models of the same position was calculated. This difference measure represents the similarity of the photographs. RESULTS Univariate ANOVA showed a significant difference in distance between the three positions (sum of squares 1.12, p < 0.001). The horizontal position presented the lowest absolute mean distance (0.45 mm). Additional post hoc multiple comparisons analysis revealed a statistically significant difference between the distances of horizontal and back position (-0.22 mm, p < 0.001) and of back and hip position (0.13 mm, p = 0.009), with better results of the horizontal and hip positions, respectively. CONCLUSION Standardization of 3D acquisition in pre- and postoperative breast imaging could improve imaging reproducibility. Based on the results of this study, we recommend a pose with the arms in a horizontal position.
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Affiliation(s)
- Marijn Hameeteman
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
| | - Arico C Verhulst
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Nijmegen, Medical Centre, Nijmegen, The Netherlands
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12
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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.
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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
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Quieregatto PR, Hochman B, Furtado F, Ferrara SF, Machado AFP, Sabino Neto M, Ferreira LM. Photographs for anthropometric measurements of the breast region. Are there limitations? Acta Cir Bras 2015; 30:509-16. [PMID: 26270144 DOI: 10.1590/s0102-8650201500700000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 06/10/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To determine the limitations of the photographs used to obtain the anthropometric measurements of the breast region. METHODS Five women, between the ages of 18 to 60 years, were evaluated. Photographs of the frontal and left and right profile views of their breasts were taken. Based on the current literature, the most commonly used anthropometric and anatomic landmarks for breast measurement were marked in their different positions. The different points were used to evaluate if the direct anthropometry was possible in a standardized way and determine how the points and the positions can to be used in any breast measurements. RESULTS There were some limitations to the use of defining points of the breast fold, as well as of its lower portion and lateral extension positions in both profiles. CONCLUSION The defining points of the breast fold and the profile photographs have some limitations and we suggested how the points and positions can be used for breasts measurements.
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Affiliation(s)
| | - Bernardo Hochman
- Department of Surgery, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | - Fabianne Furtado
- Department of Surgery, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
| | | | | | - Miguel Sabino Neto
- Department of Surgery, Universidade Federal de São Paulo, Sao Paulo, SP, Brazil
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Multi-view stereophotogrammetry for post-mastectomy breast reconstruction. Med Biol Eng Comput 2015; 54:475-84. [PMID: 26133282 DOI: 10.1007/s11517-015-1334-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
A multi-view three-dimensional stereophotogrammetry system was developed to capture 3D shape of breasts for breast cancer patients. The patients had received immediate unilateral breast reconstruction after mastectomy by the extended latissimus dorsi flap and without contralateral surgery. In order to capture the whole breast shape including the inframammary fold, the patients were introduced to the imaging room and leaned over the imaging rig to open up the inframammary fold and to expose the entire area of each breast. The imaging system consisted of eight high-resolution ([Formula: see text] pixels) digital cameras and four flash units. The cameras were arranged in four stereo pairs from four different view angles to cover the whole surface of the breasts. The system calibration was carried out ahead of every capture session, and the stereo images were matched to generate four range images to be integrated using an elastic model proposed. A watertight breast mesh model was reconstructed to measure the volume of the breast captured. The accuracy of using the developed multi-view stereophotogrammetry system for breast volume measurement was 11.12cc with SEM 7.74cc, comparing to the measurements of the water displacement method. It was concluded that the 3D stereophotogrammetry image system developed was more reliable than the method of water displacement.
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Quieregatto PR, Hochman B, Furtado F, Machado AFP, Sabino Neto M, Ferreira LM. Image analysis software versus direct anthropometry for breast measurements. Acta Cir Bras 2015; 29:688-95. [PMID: 25318002 DOI: 10.1590/s0102-8650201400160010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/22/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare breast measurements performed using the software packages ImageTool(r), AutoCAD(r) and Adobe Photoshop(r) with direct anthropometric measurements. METHODS Points were marked on the breasts and arms of 40 volunteer women aged between 18 and 60 years. When connecting the points, seven linear segments and one angular measurement on each half of the body, and one medial segment common to both body halves were defined. The volunteers were photographed in a standardized manner. Photogrammetric measurements were performed by three independent observers using the three software packages and compared to direct anthropometric measurements made with calipers and a protractor. RESULTS Measurements obtained with AutoCAD(r) were the most reproducible and those made with ImageTool(r) were the most similar to direct anthropometry, while measurements with Adobe Photoshop(r) showed the largest differences. Except for angular measurements, significant differences were found between measurements of line segments made using the three software packages and those obtained by direct anthropometry. CONCLUSION AutoCAD(r) provided the highest precision and intermediate accuracy; ImageTool(r) had the highest accuracy and lowest precision; and Adobe Photoshop(r) showed intermediate precision and the worst accuracy among the three software packages.
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Quieregatto PR, Hochman B, Ferrara SF, Furtado F, Liebano RE, Sabino Neto M, Ferreira LM. Anthropometry of the breast region: how to measure? Aesthetic Plast Surg 2014; 38:344-9. [PMID: 24610111 DOI: 10.1007/s00266-014-0291-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/31/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast region measurements are important for research, but they may also become significant in the legal field as a quantitative tool for preoperative and postoperative evaluation. Direct anthropometric measurements can be taken in clinical practice. The aim of this study was to compare direct breast anthropometric measurements taken with a tape measure and a compass. METHODS Forty women, aged 18-60 years, were evaluated. They had 14 anatomical landmarks marked on the breast region and arms. The union of these points formed eight linear segments and one angle for each side of the body. The volunteers were evaluated by direct anthropometry in a standardized way, using a tape measure and a compass. RESULTS Differences were found between the tape measure and the compass measurements for all segments analyzed (p>0.05). CONCLUSION Measurements obtained by tape measure and compass are not identical. Therefore, once the measurement tool is chosen, it should be used for the pre- and postoperative measurements in a standardized way. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Paulo R Quieregatto
- Plastic Surgery Division, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 715, 4° andar, Vila Clementino, São Paulo, SP, 04023-002, Brazil
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Henseler H, Ju X, Ayoub A, Ray AK. The importance of the pose in three-dimensional imaging of the ptotic breast. J Plast Reconstr Aesthet Surg 2013; 66:1551-6. [DOI: 10.1016/j.bjps.2013.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/16/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022]
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Subjective versus objective assessment of breast reconstruction. J Plast Reconstr Aesthet Surg 2013; 66:634-9. [DOI: 10.1016/j.bjps.2013.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/29/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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Investigation into variation and errors of a three-dimensional breast imaging system using multiple stereo cameras. J Plast Reconstr Aesthet Surg 2012; 65:e332-7. [DOI: 10.1016/j.bjps.2012.05.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 02/25/2012] [Accepted: 05/31/2012] [Indexed: 11/19/2022]
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Brown N, Scurr J. The need for a standardised anthropometric protocol for objective assessment of pre- and postoperative breast surgery. Gland Surg 2012; 1:142-5. [PMID: 25083437 DOI: 10.3978/j.issn.2227-684x.2012.10.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/10/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Nicola Brown
- 1 School of Sport, Health & Applied Science, St Mary's University College, Waldegrave Rd, Twickenham, TW1 4SX, UK ; 2 Department of Sport & Exercise Science, University of Portsmouth, Cambridge Rd, Portsmouth, PO1 2ER, UK
| | - Joanna Scurr
- 1 School of Sport, Health & Applied Science, St Mary's University College, Waldegrave Rd, Twickenham, TW1 4SX, UK ; 2 Department of Sport & Exercise Science, University of Portsmouth, Cambridge Rd, Portsmouth, PO1 2ER, UK
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Henseler H, Smith J, Bowman A, Khambay BS, Ju X, Ayoub A, Ray AK. Objective evaluation of the latissimus dorsi flap for breast reconstruction using three-dimensional imaging. J Plast Reconstr Aesthet Surg 2012; 65:1209-15. [DOI: 10.1016/j.bjps.2012.03.043] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/24/2012] [Accepted: 03/27/2012] [Indexed: 11/25/2022]
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Mazzocchi M, Dessy LA, Gagliardi D, Martano A, Scuderi N. Preliminary report on the use of the Spectra™ implant for the correction of hypoplastic breasts with small-volume asymmetry. J Plast Reconstr Aesthet Surg 2012; 65:312-9. [DOI: 10.1016/j.bjps.2011.08.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 07/30/2011] [Accepted: 08/21/2011] [Indexed: 10/16/2022]
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Creasman CN, Mordaunt D, Liolios T, Chiu C, Gabriel A, Maxwell GP. Four-dimensional breast imaging, part I: introduction of a technology-driven, evidence-based approach to breast augmentation planning. Aesthet Surg J 2011; 31:914-24. [PMID: 22006995 DOI: 10.1177/1090820x11423916] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although there are many three-dimensional imaging systems currently available on the market, all of them require a high degree of interaction on the part of the user, making them clinically impractical. Moreover, though claims have been made regarding the validity of these systems for imaging the breast form, there have been no previous reports validating any commercially-available implant simulation models in the plastic surgery literature. In this article, the authors describe the development and evaluate the efficacy of a novel four-dimensional (automated three-dimensional) breast imaging system, validating it as an evidence-based simulation tool for patient consultation, surgical planning, and outcomes analysis in cosmetic breast augmentation. This report, based on a series of longitudinal correlation studies with several patient cohorts, found a highly statistically significant degree of correlation and reliability between the automated measurements obtained with the four-dimensional system and manual measurements.
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Objective breast symmetry evaluation using 3-D surface imaging. Breast 2011; 21:152-8. [PMID: 21849246 DOI: 10.1016/j.breast.2011.07.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Revised: 07/04/2011] [Accepted: 07/22/2011] [Indexed: 11/23/2022] Open
Abstract
This study develops an objective breast symmetry evaluation using 3-D surface imaging (Konica-Minolta V910(®) scanner) by superimposing the mirrored left breast over the right and objectively determining the mean 3-D contour difference between the 2 breast surfaces. 3 observers analyzed the evaluation protocol precision using 2 dummy models (n = 60), 10 test subjects (n = 300), clinically tested it on 30 patients (n = 900) and compared it to established 2-D measurements on 23 breast reconstructive patients using the BCCT.core software (n = 690). Mean 3-D evaluation precision, expressed as the coefficient of variation (VC), was 3.54 ± 0.18 for all human subjects without significant intra- and inter-observer differences (p > 0.05). The 3-D breast symmetry evaluation is observer independent, significantly more precise (p < 0.001) than the BCCT.core software (VC = 6.92 ± 0.88) and may play a part in an objective surgical outcome analysis after incorporation into clinical practice.
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Investigation into accuracy and reproducibility of a 3D breast imaging system using multiple stereo cameras. J Plast Reconstr Aesthet Surg 2011; 64:577-82. [DOI: 10.1016/j.bjps.2010.08.044] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Revised: 08/29/2010] [Accepted: 08/31/2010] [Indexed: 11/20/2022]
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Avşar DK, Aygit AC, Benlier E, Top H, Taşkinalp O. Anthropometric breast measurement: a study of 385 Turkish female students. Aesthet Surg J 2010; 30:44-50. [PMID: 20442074 DOI: 10.1177/1090820x09358078] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anthropometric measurements and proportions of the human body have made a significant contribution to the science of aesthetic and reconstructive plastic surgery. OBJECTIVE The present study was performed to measure anthropometric breast values in Turkish female students and compare them with those of women in other nations. METHODS The study included 385 female undergraduate student volunteers between the ages of 18 and 26 years with no physical or developmental deformity and with a body mass index between 20 and 26. A total of 19 parameters were measured in a standing position. The parameters measured were body weight, height, shoulder width, upper chest width, middle chest width, lower chest width, waist width, hip width, clavicle-nipple length, sternal notch-nipple length, nipple-nipple length, upper arm length, medial mammary radius, lateral mammary radius, nipple-inframammary fold length, nipple diameter, areola diameter, nipple projection, and mammary projection. Breast volume, breast ptosis, and retracted nipple rates were also assessed. RESULTS The mean breast volume was determined to be 407.2 +/- 263.6 cc. The mean values of the right and left breast volumes were calculated as 415.2 +/- 264.5 cc and 399.1 +/- 265.5 cc, respectively; the right breast volume was significantly greater than the left breast volume (P < .001). The ideal external view of the breasts with equal volume for both sides and no ptosis was observed in 35.1% of the volunteers. The percentage of women with unilateral or bilateral retracted nipple was 2.6%. CONCLUSIONS The results of the present study will help in comparing the anthropometric breast values of young Turkish women with those of women in other countries. They may also be useful either in planning aesthetic and reconstructive breast surgery or in designing breast augmentation accessories and clothing.
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Sinna R, Garson S, Taha F, Benhaim T, Carton C, Delay E, Robbe M. Évaluation de l’imagerie tridimensionnelle acquise par une technique de projection de lumière structurée en chirurgie mammaire. ANN CHIR PLAST ESTH 2009; 54:317-30. [DOI: 10.1016/j.anplas.2009.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 02/19/2009] [Indexed: 10/20/2022]
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Meshulam-Derazon S, Barnea Y, Zaretski A, Leshem D, Miller U, Meilik B, Weiss J, Shafir R, Amir A, Gur E. Large-volume breast reduction: Long-term results. ACTA ACUST UNITED AC 2009; 43:65-70. [PMID: 19308855 DOI: 10.1080/02844310802594068] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Forty-three women had reduction mammaplasty during the period 1992-2000 and the cosmetic outcome was evaluated using subjective and objective measures. The inferior pedicle technique was used in all cases. The mean (SD) weight of resected tissue was 1121 (415) g. All objective measurements were within the ideal range except for breast volume and nipple-to-inframammary-line distance, which were more than ideal. Overall, the median difference in measurements between the two breasts of each woman was less than 10%. However, the subjective evaluations given by both clinicians and the patients for overall symmetry and for general aesthetic appearance fell below the preset threshold. The shape of the breast correlated best with the grades of symmetry and general appearance. There was no correlation between the objective and subjective evaluations of symmetry. The disappointing subjective scores, which may be attributed to the specific characteristics of our sample group, are heavy breasts and overweight patients, a double team approach, and the inevitable pseudoptosis that develops with the inferior pedicle approach. These direct us to recommend searching for an alternative operative technique and to evaluate its long term results, as well as placing the nipple-areola complex lower than the standard inframammary fold projection.
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Affiliation(s)
- Sagit Meshulam-Derazon
- Department of Plastic Surgery, Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pozzobon AV, Sabino Neto M, Veiga DF, Abla LEF, Pereira JB, Biasi TL, Ferreira LM, Yamashita LA, Kawano F, Nakano EM, Shigueoka DC. Magnetic resonance images and linear measurements in the surgical treatment of breast asymmetry. Aesthetic Plast Surg 2009; 33:196-203. [PMID: 18709409 DOI: 10.1007/s00266-008-9224-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 07/10/2008] [Indexed: 11/26/2022]
Abstract
BACKGROUND Objective evaluation of breast asymmetry surgical treatment should consider not only breast shape but also breast volume. METHODS For this study, 22 patients with primary breast asymmetry were evaluated by magnetic resonance imaging (MRI) as well as linear measurements preoperatively and 6 months postoperatively. The mean difference between the pre- and postoperative linear measurements was graduated from excellent to poor. Breast volume was estimated by MRI from axial reconstruction for three-dimensional application using the Cavalieri formula and specific software. RESULTS A strong correlation (r = 0.817) was found between the pre- and postoperative breast volumes, as increased or decreased by the surgical procedure. Patients with less postoperative volume differences tended to have the best ratings with linear measurements. When the same surgical procedure was performed bilaterally or when only one breast was treated by surgery, greater volume symmetry was observed. CONCLUSIONS Linear measurements and MRI are objective methods for evaluating postoperative symmetry, and when used in association, can help plastic surgeons to achieve favorable results in mammary asymmetry treatment.
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Affiliation(s)
- Adriana V Pozzobon
- Department of Plastic Surgery, Federal University of São Paulo, Sao Paulo, Brazil.
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Moyer HR, Carlson GW, Styblo TM, Losken A. Three-Dimensional Digital Evaluation of Breast Symmetry after Breast Conservation Therapy. J Am Coll Surg 2008; 207:227-32. [DOI: 10.1016/j.jamcollsurg.2008.02.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 02/12/2008] [Accepted: 02/12/2008] [Indexed: 11/25/2022]
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Dabeer M, Fingeret MC, Merchant F, Reece GP, Beahm EK, Markey MK. A research agenda for appearance changes due to breast cancer treatment. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2008; 2:1-3. [PMID: 21655363 PMCID: PMC3085417 DOI: 10.4137/bcbcr.s784] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor’s appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women’s perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor’s appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor’s breasts to match her preferences as much as possible.
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Affiliation(s)
- Mugdha Dabeer
- The University of Texas Department of Biomedical Engineering, Austin, TX
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Abstract
A good aesthetic outcome is an important endpoint of breast cancer treatment. Subjective ratings, direct physical measurements, measurements on photographs, and assessment by three-dimensional imaging are reviewed and future directions in aesthetic outcome measurements are discussed. Qualitative, subjective scales have frequently been used to assess aesthetic outcomes following breast cancer treatment. However, none of these scales has achieved widespread use because they are typically vague and have low intraobserver and interobserver agreement. Anthropometry is not routinely performed because conducting the large studies needed to validate anthropometric measures (i.e., studies in which several observers measure the same subjects multiple times) is impractical. Quantitative measures based on digital/digitized photographs have yielded acceptable results but have some limitations. Three-dimensional imaging has the potential to enable consistent, objective assessment of breast appearance, including properties (e.g., volume) that are not available from two-dimensional images. However, further work is needed to define three-dimensional measures of aesthetic properties and how they should be interpreted.
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DeLuca-Pytell DM, Piazza RC, Holding JC, Snyder N, Hunsicker LM, Phillips LG. The incidence of tuberous breast deformity in asymmetric and symmetric mammaplasty patients. Plast Reconstr Surg 2006; 116:1894-9; discussion 1900-1. [PMID: 16327600 DOI: 10.1097/01.prs.0000189206.94466.a9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Breast asymmetry is commonly accompanied by tuberous deformity. To date, no study has reported the incidence of this breast deformity in the presence of asymmetry. A retrospective analysis of standard preoperative photographs was performed on 375 consecutive female patients presenting for mammaplasty over a 10-year span. METHODS Women were examined for symmetry, asymmetry, and the presence of tuberous deformity. Patients were graded by the Grolleau Classification System. Patients having congenital anomalies, tumors, infection, radiation, chest wall deformities, previous breast surgery history, and incomplete chart data were excluded. RESULTS Of the 375 patients studied, 81.1 percent (n = 304) presented with asymmetry. Of these asymmetric women, 88.8 percent (n = 270) were found to have tuberous deformity. Of the 71 patients who were symmetric, 7 percent (n = 5) were tuberous. Concurrent nipple-areola complex involvement in the tuberous asymmetric patient population was present in 50 percent of the women (n = 116). Of the tuberous deformities with nipple-areola complex, 87.9 percent (n = 116) were Grolleau type III. Nipple-areola complex involvement was not found in any of the symmetric patients. Of the 275 women with tuberous deformity, 531 breasts were tuberous and 60.3 percent (n = 320) were Grolleau's type III. In total, 57.1 percent of all reduction mammaplasties (n = 92) and 83.2 percent of all augmentation mammaplasties (n = 178) had asymmetry with tuberous deformity. CONCLUSIONS This is the first published study to demonstrate that tuberous deformity is strongly associated with asymmetry in women presenting for mammaplasty. This should be evaluated in preoperative planning to ensure optimal outcome. Patients with this deformity should be educated preoperatively so their expectations of postoperative results are realistic.
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Affiliation(s)
- Danielle M DeLuca-Pytell
- Division of Plastic Surgery, Department of Surgery, The University of Texas Medical Branch, Galveston, Texas 77555, USA
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Kim MS, Reece GP, Beahm EK, Miller MJ, Atkinson EN, Markey MK. Objective assessment of aesthetic outcomes of breast cancer treatment: measuring ptosis from clinical photographs. Comput Biol Med 2006; 37:49-59. [PMID: 16438948 DOI: 10.1016/j.compbiomed.2005.10.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Revised: 08/17/2005] [Accepted: 10/10/2005] [Indexed: 11/29/2022]
Abstract
The aesthetic outcome of breast cancer treatment is an important factor in breast cancer survivors' quality of life. We investigated new quantitative, objective measurements of breast ptosis based on ratios of distances between fiducial points manually identified in oblique and lateral clinical photographs. Ptosis refers to the extent to which the nipple is lower than the inframammary fold. The new objective measures were compared to ratings made using an existing subjective scale. The variability in the objective measurements due to intra- and inter-observer variability in marking fiducial points was shown to be equivalent to less than one point on the subjective ptosis scale.
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Affiliation(s)
- Min Soon Kim
- Biomedical Engineering Department, The University of Texas at Austin, Austin, TX 78712, USA
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Losken A, Fishman I, Denson DD, Moyer HR, Carlson GW. An Objective Evaluation of Breast Symmetry and Shape Differences Using 3-Dimensional Images. Ann Plast Surg 2005; 55:571-5. [PMID: 16327452 DOI: 10.1097/01.sap.0000185459.49434.5f] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The concept of natural breast asymmetry is well known; however, actual documentation in the literature is limited. New technology is currently available which provides 3-dimensional surface images of the breast and the ability to qualitatively determine differences in breast size, shape, and contour. The purpose of this report is to objectively determine the extent to which this natural breast asymmetry exists. METHODS Eighty-seven women without a history of breast cancer or previous breast surgery were included. Images were obtained using 3dMD technology. Data points queried included age, parity, body mass index (BMI), ethnicity, and bra size. Left/right images were superimposed and the distance between the 2 surfaces, and contour was calculated. The degree of asymmetry was determined and comparisons were made. Similar differences in nipple-to-notch measurements were calculated and compared. Subjective evaluations were included for clinical relevance. RESULTS The average age was 49.6 years (range: 19-77), with an average BMI of 25 (range: 18.5-36.7). The average nipple to notch on the left was 24.3 cm and 23.8 cm on the right. The nipple-to-notch asymmetry was on average 3.2%, with the left breast measurement being greater the majority of the time (62%). The mean distance between each breast demonstrated consistent breast asymmetry, with an average measurement of +0.5 mm (left breast being larger than the right). The degree of breast asymmetry was documented by a root mean square value (RMS) of 5.93 mm. This was not related to age, parity, or ethnicity; however, it was significantly higher in those patients with larger BMI, cup size, and chest-wall circumference. Only 10% of women were found to have severe breast asymmetry on subjective evaluation, which correlated objectively with the RMS in that group being significantly higher at 9.8 mm (P < 0.05). There were no predictable patterns of asymmetry; however, the most common pattern was larger laterally and smaller medially, found in 32% of the women. CONCLUSION Natural breast asymmetry does exist, demonstrated objectively using 3-dimensional surfaces images. The left breast is on average larger than the right, with differences in size and shape being consistent but fairly unpredictable. It is important that we know baseline differences in breast symmetry prior to objectively analyzing results following esthetic and reconstructive breast surgery.
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Affiliation(s)
- Albert Losken
- Emory Division of Plastic and Reconstructive Surgery, Emory University School of Medicine, Atlanta, GA 30308, USA.
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39
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Hodgson ELB, Fruhstorfer BH, Malata CM. Ultrasonic Liposuction in the Treatment of Gynecomastia. Plast Reconstr Surg 2005; 116:646-53; discussion 654-5. [PMID: 16079704 DOI: 10.1097/01.prs.0000173441.57812.e8] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrasound-assisted liposuction is a technique that is widely used all over the body for minimal access lipectomy. Recently, it has been reported to be especially suitable for the treatment of gynecomastia. To date, however, there is only one published study that specifically addresses ultrasound-assisted liposuction as a treatment modality for gynecomastia. METHODS A review was undertaken of all the gynecomastia patients treated with ultrasound-assisted liposuction by a single surgeon over a 3-year period. Thirteen consecutive patients (aged 16 to 57 years) with bilateral, diffuse, soft to moderately firm gynecomastia were studied. RESULTS There were no early postoperative complications of hematoma, seroma, infection, or thermal injury. Similarly, there were no treatment-induced asymmetries, contour deformities, or irregularities. One patient requested "touch-up" ultrasound-assisted liposuction for "residual" breast tissue several months after an initial satisfactory correction of chest contour. None of the patients required initial open-excision or skin-reduction procedures. Patients were asked to rate their cosmetic results in four categories on linear analogue scales with a maximal score of 10. The average scores were 9.1 for overall satisfaction, 9.2 for scars, 9.2 for shape, and 8.9 for improved self confidence. CONCLUSION Ultrasound-assisted liposuction is an effective treatment modality in patients with homogenous soft to moderately firm gynecomastia, giving good cosmetic results and a high level of patient satisfaction.
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Affiliation(s)
- Elaine L B Hodgson
- Department of Plastic and Reconstructive Surgery, Addenbrooke University Hospital, Cambridge University Hospital's NHS Trust, Cambridge, United Kingdom
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Sadove AM, van Aalst JA. Congenital and Acquired Pediatric Breast Anomalies: A Review of 20 Years??? Experience. Plast Reconstr Surg 2005; 115:1039-50. [PMID: 15793443 DOI: 10.1097/01.prs.0000154214.99641.72] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this article was to review the senior author's 20 years of experience in the treatment of pediatric breast abnormalities, to propose a classification system for their treatment, and to provide a synopsis of treatment options. METHODS Congenital and acquired breast anomalies were identified in a retrospective chart review (n = 66). Breast abnormalities were classified as hyperplastic (n = 44), deformational (n = 11), or hypoplastic (n = 11). Hyperplastic abnormalities included gynecomastia, hyperplasia, polythelia, polymastia, and giant fibroadenoma. Deformational abnormalities were categorized as either iatrogenic (previous thoracostomy, thoracotomy, or tumor excision) or traumatic (thermal or penetrating injuries). Hypoplastic abnormalities included athelia, unilateral and bilateral hypoplasia, tuberous breast, and Poland syndrome. Type of surgery, age at initial operation, and number of operations were recorded for all patients. RESULTS Hyperplastic abnormalities were treated with breast reduction techniques and required the fewest operations per patient (1.14), followed by iatrogenic breast injury (2.1 per patient). The average number of procedures required for hypoplastic abnormalities was 2.45 per patient. The highest reoperation rates were seen in patients with burn injuries to the breast and patients with Poland syndrome. Mean age at initial operation was highest in the deformational group (18.5 years) and lowest in the hyperplastic group (17.4 years). CONCLUSION Classification of pediatric breast abnormalities and considerations about timing for surgery and the likely need for staged operations aid in anticipating and optimizing clinical outcomes.
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Affiliation(s)
- A Michael Sadove
- Division of Plastic Surgery, Riley Hospital for Children, Indiana University, Indianapolis, Ind, USA.
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Abstract
Pediatric breast anomalies are relatively common. Treatment options depend on whether the abnormalities are hyperplastic, deformational, or hypoplastic. Hyperplastic anomalies require reduction techniques, whereas deformational and hypoplastic lesions require augmentation techniques and are more likely to require revisional surgeries. These designations aid the surgeon in decision-making about timing for treatment and in optimizing aesthetic outcomes.
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Affiliation(s)
- John A van Aalst
- Division of Plastic and Reconstructive Surgery, University of North Carolina at Chapel Hill, CD# 7195, Suite 2100, Bioinformatics Building, Chapel Hill, NC 27599, USA.
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42
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Payne CE, Malata CM. Correction of postburn breast asymmetry using the LeJour-type mammaplasty technique. Plast Reconstr Surg 2003; 111:805-9. [PMID: 12560703 DOI: 10.1097/01.prs.0000040020.34859.7f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Caroline E Payne
- Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom
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43
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Veiga DF, Neto MS, Garcia EB, Filho JV, Juliano Y, Ferreira LM, Rocha JLBS. Evaluations of the aesthetic results and patient satisfaction with the late pedicled TRAM flap breast reconstruction. Ann Plast Surg 2002; 48:515-20. [PMID: 11981193 DOI: 10.1097/00000637-200205000-00012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
With the goal of evaluating the aesthetic results, testing the reliability of the rating systems used, and determining the patients' level of satisfaction with their breast reconstruction, pedicled transverse rectus abdominis musculocutaneous flap reconstruction was performed in 20 patients who had undergone mastectomy. The results were evaluated and compared 3, 6, and 12 months after reconstruction using the patients' own assessments (a rating of 0-10 points) and scoring by two senior plastic surgeons (using 0-10-point global rating scales as well as the five subscales of the modified Garbay system). The interrater and intrarater agreement was poor to fair for the majority of the subscales. When evaluating by grades, there was significant difference (p < 0.001) between the patients and the raters at postoperative months 3 and 6. At month 12, one of the raters attributed significantly lower grades (p < 0.001) than the patients and the other rater. The authors observed a higher level of satisfaction by the patients than by the raters.
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Kurokawa M, Yamada N, Fu I, Tsutsumi S. Reconstruction of breast using a laser lithographic model: a case report. Breast Cancer 2001; 8:162-5. [PMID: 11342991 DOI: 10.1007/bf02967497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A three-dimensional laser scanner enables the measurement of surface data from objects with no contact, both quickly and in three dimensions. A 40-year-old woman with a right breast cancer had undergone a simple mastectomy. The surface of the chest was then measured with the non-contact three-dimensional laser scanner. Using the mirror image of data obtained by the same system, a mask-like model of the breast was made using laser lithography technology. This model was used for reconstruction of the breast after mastectomy. It was effective in determining the position and form of the breast which was to be repaired.
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Affiliation(s)
- M Kurokawa
- Department of Plastic and Reconstructive Surgery, Nagahama Red Cross Hospital, Shiga, Japan
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Camilleri IG, Malata CM, Stavrianos S, McLean NR. A review of 120 Becker permanent tissue expanders in reconstruction of the breast. BRITISH JOURNAL OF PLASTIC SURGERY 1996; 49:346-51. [PMID: 8881779 DOI: 10.1016/s0007-1226(96)90001-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In reconstructive breast surgery, the permanent tissue expander has become popular because it avoids expander-implant exchange and gives the patient some control over the final breast size. It may, however, be associated with a number of complications. We therefore analysed the clinical notes of 111 consecutive recipients of Becker breast expanders with respect to complications and their possible predisposing factors. 120 prostheses were inserted in 111 consecutive patients with a mean age of 42.6 years. Median follow-up was 12 months (range 8 to 22). The commonest indication was postmastectomy breast reconstruction (81%) followed by congenital hypoplasia (14%) and acquired breast asymmetry following repeated biopsies (3%). Overexpansion before size adjustment was achieved after an average of 8 expander inflations. Complications included capsular contracture (9%), local tumour recurrence (8%), wound dehiscence (8%), filling port failure (6%), infected prostheses (4.5%) and ruptured implants (1.6%). The significant predisposing factors to wound dehiscence/infection were heavy smoking and radiotherapy (P < or = 0.05, chi 2 test). Expansion rate was not a factor. 89% of patients expressed satisfaction with the final aesthetic result. Despite the excellent results obtained with this technique, caution must be exercised in heavy smokers and the previously irradiated.
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Affiliation(s)
- I G Camilleri
- Department of Plastic and Reconstructive Surgery, Newcastle General Hospital, Newcastle upon Tyne, UK
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Abstract
A review of a surgical technique which uses the skin's ability to stretch to obtain tissue for reconstruction
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