A method of assessing female breast morphometry and its clinical application

The Role of the Inframammary Fold (IMF) in Aesthetic and Reconstructive Surgery: A Critical Analysis and Surgical Solution

INTRODUCTION

The inframammary fold (IMF) is a critical structure in breast aesthetics and is affected by various types of breast surgery. The ideal IMF has a semi-elliptical shape, which may become attenuated with age and descends in macromastia. The aim of this study was to analyse the IMF and retain/restore its shape with sutures.

METHODS

A retrospective study was conducted on breast surgeries performed over a four-year period (2019-2022). The morphometry of the IMF was evaluated preoperatively while the patients were standing. In cases where the IMF was symmetrical, sutures were used to reinforce it during surgery. When the loss of the semi-elliptical shape was clinically indicated, the IMF was mobilized, repositioned, and then sutured into place.

RESULTS

The study included 56 patients: 43 undergoing immediate breast reconstruction, and 13 undergoing bilateral breast reductions. In over two thirds of the patients, the lateral IMF was inferiorly displaced compared to the medial IMF.

CONCLUSION

It is recommended to reinforce the IMF in all patients undergoing breast surgery. Where the IMF has an elliptical shape preoperatively, it is reinforced. Where IMF is inferiorly displaced, mobilization and superior advancement of the IMF, followed by suture reinforcement, are necessary. This approach results in a well-defined IMF with improved breast aesthetics.

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 .

Exploring natural breast symmetry in the female plastic surgical patient population

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.

Dealing with the Displaced Nipple–Areola Complex in Macromastia Using a Superomedial Pedicle and Inverted T Pattern

In macromastia, especially in patients with a raised BMI, the nipple areola complex (NAC) may be displaced from the breast midline/meridian. This is poorly documented, and there is little published on surgical management. The aim of the study was to identify the incidence of displaced NAC in macromastia and discuss the management using the superomedial pedicle, by canting the vertical limbs of the inverted T/keyhole. The study also aimed to postulate a theory of pathogenesis.

Intraoperative 3D Comparison of Round and Anatomical Breast Implants: Dispelling a Myth

Background: Thanks to 3D imaging, it is possible to measure the influence of different parameters on breast augmentation. In this study, we compare the effect of different shapes and sizes of breast implants on the topography of the resulting breast. Furthermore, the impact of different breast implants on inter-landmark distances and on changes of the nipple position was assessed. Methods: This interventional prospective study was carried out on 10 female patients after collecting informed consent. 3D scans of the native and augmented breasts were performed intraoperatively with small, medium, and large sizes of both anatomical and round implants, resulting in a total of n = 130 single breast scans. These scans were analyzed for topographic shift quantification, nipple migration, and inter-landmark distances of the breast. Results: Implant size, but not implant shape leads to significant topographic shifts of the breast (p < 0.001 and p = 0.900, respectively). Both round and anatomical implants lead to a significantly higher volumetric increase in the upper quadrants compared to the lower quadrants (p < 0.001). Nipple migration into the superomedial quadrant was seen in about 90% of augmentations. No evident differences in inter-landmark distances were observed when round and anatomical implants of different sizes were compared. Conclusions: Implant size rather than shape influences the postoperative aesthetic results. No significant difference in topographic shift was found comparing round and anatomical implants, suggesting that both implant shapes result in comparable aesthetic outcomes.

Social Media as a Tool to Educate Plastic Surgeons on Patients' Concerns Before and After Cosmetic Breast Surgeries

BACKGROUND

The rapid evolution of the social media platform has had a major effect on the field of medicine.

OBJECTIVE

To identify patterns, trends and patients' concerns before and after aesthetic surgeries involving breast implants, by analyzing social media posts.

METHODS

We examined comments posted on popular Israeli online public forums between January 2019 and May 2021, regarding: breast augmentation, mastopexy-augmentation and breast implant removal.

RESULTS

During the study period, 561 comments were posted on the three forums investigated: 165 pre-operative and 396 post-operative. In the pre-operative period, the main interests were implant size, type and location, as discussed in 69 posts (42%). During the first two months post-operative, questions reflected concerns regarding post-operative instructions, wound management and asymmetry: 76 (43%), 59 (34%) and 27 (16%), respectively. These topics continued to be in focus up to one year post-operative. Beyond the first post-operative year, patients' main interests were breast implant-associated anaplastic large cell lymphoma (25 posts, 28%), capsule formation (23 posts, 26%) and systemic effects (23 posts, 26%).

CONCLUSIONS

Social media harnessing to identify patterns, trends and patient concerns pre- and post-aesthetic breast surgeries is a novel approach. Misinformation was common, particularly in comments posted more than one year post-operative. Four topics that especially concerned patients in the immediate and late post-operative period were asymmetric results, breast implant-associated anaplastic large cell lymphoma, capsule removal and systemic effects. We advise surgeon and plastic surgeon societies to issue position papers on controversial subjects, to counter the dissemination of potentially misleading information.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.

An Analysis of Ptosis following Subfascial Breast Augmentation: Calculations That Explain Dogma

BACKGROUND

Implant placement can improve ptosis due to the position of the nipple, inframammary crease, and base of the breast acting together. The interrelationship between these was quantified via changes in morphometry following subfascial augmentation, and explains the circumstances under which dogma holds true.

METHODS

One hundred seventy-five patients underwent a series of static measurements before and 3 months after subfascial breast augmentation. Ptosis in the nipple and base of the breast was calculated before and after surgery.

RESULTS

All measurements except that of the the lateral sternal margin increased after surgery. All grades of ptosis reduced following surgery. There was lowering of the base in grade 1 patients, but not for other grades. Increased base ptosis correlated with reduced lateral sternal margin (1.9 cm compared with 2.9 cm; left, H5 = 24.7, p < 0.01; right, H5 = 24.5, p < 0.01). Implant volume did not correlate with change in ptosis at the nipple or base. Reduced ptosis was associated with implants that are a narrow match of implant to breast (0.52 to 0.95) (left, H5 = 28.3, p < 0.01; right, H5 = 24.9, p < 0.01). Decreasing ptosis correlated with lower lateral sternal margin compared to breasts that increased ptosis. Change in ptosis following surgery does not correlate with having children.

CONCLUSIONS

Subfascial placement has varying effects on ptosis. Non-ptotic or mildly ptotic breasts appear to improve due to a disproportionate descent of the inframammary crease relative to the nipple and base. Patients with little breast tissue are more susceptible to an increase in "bottoming out," particularly if broad implants are used. A ratio matching implant to the base width has predictive value on outcome.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

Observations Concerning the Match between Breast Implant Dimensions, Breast Morphometry, and a Patient-reported Outcome

Background:

Outcome studies in breast augmentation do not assess how an implant has been matched to the soft tissue envelope. The study hypothesis is that there is a relationship between breast and implant dimensions and the subjective outcome of patient satisfaction.

Methods:

In a study of patients undergoing subfascial breast augmentation (n = 341), morphometric measurements and a postsurgical survey of satisfaction with breast size were performed 3 months postoperatively. A ratio empirically derived from breast width, implant width, and projection (Rib) was calculated in patients who wished to have smaller, bigger, or no change in their implant size.

Results:

76% were content with breast size, 16.7% wished to be larger, and 7.3% wished to be smaller. Rib differed between groups who did not want to change size (n = 259, mean = 5.8, SD = 0.9), those who wished to be bigger (n = 57, mean = 5.6, SD = 1.1), and those who wished to be smaller (n = 25, mean = 5.3, SD = 1.3, H(341) = 14.0, P < 0.01). Rib differed between groups whose result was as expected (mean = 5.6, SD = 0.9), compared with those who expected to be bigger (mean = 5.4, SD = 1.2) or who expected a smaller outcome (mean = 5.6 SD = 1.0, H(341) = 18.3, P < 0.01).

Conclusions:

These data provide an objective measurement by which studies concerning breast augmentation can be reported and compared. The method may guide standardization of clinical research regarding breast implant surgery.

Sustained Breast Development and Breast Anthropometric Changes in 3 Years of Gender-Affirming Hormone Treatment

CONTEXT

Breast development is important for most trans women. An important limitation of current breast development measurement methods is that these do not allow for 3D volume analyses.

OBJECTIVES

To examine breast development and change in anthropometry during the first 3 years of gender-affirming hormone treatment using 3D imaging. Associations with clinical or laboratory parameters and satisfaction with the gained breast development were also studied.

DESIGN

Prospective cohort study.

SETTING

Specialized tertiary gender identity clinic in Amsterdam, the Netherlands.

PARTICIPANTS

Participants were 69 adult trans women with a median age of 26 years (interquartile range, 21-38).

INTERVENTIONS

Gender-affirming hormone treatment.

MAIN OUTCOME MEASURES

Volumetric and anthropometric breast development and satisfaction.

RESULTS

Breast volume increased by 72 cc (95% confidence interval [CI], 48-97) to 100 cc (standard deviation 48). This resulted in a cup-size <A-cup in 71% of the participants. Although the change in breast-chest difference plateaued after approximately 9 months, sustained increase in breast volume was observed during the 3-year observation period. Sternal notch to nipple distance increased by 1.3 cm (95% CI, 0.9-1.7) and internipple distance increased by 1.0 cm (95% CI, 0.4-1.5). At least 58% of trans women were satisfied with the gained breast size.

CONCLUSIONS

Sustained breast growth and development during hormone treatment was observed during the full 3-year observation period. The breasts of trans women are positioned more laterally and caudally on the chest compared with cis women. Although modest breast volumes were observed, breast development was satisfactory to most trans women.

A Comprehensive Outcome Review of Subfascial Breast Augmentation over a 10-Year Period

BACKGROUND

Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. There are few large series with longitudinal follow-up and outcome measures.

METHODS

Seven hundred eighty-three patients underwent subfascial breast augmentation and were followed up for 10 years. Adverse outcomes, changes in breast morphometry, and patient satisfaction were outcome measures.

RESULTS

All morphometry increased except soft-tissue thickness at the lateral sternal margin. The distance from the nipple-areola complex to the inframammary crease increased by 40 percent, with a concomitant 6.2 percent increase in the distance from the suprasternal notch to the nipple-areola complex. The capsular contracture rate was 6.48 percent, and correlates with a lateral sternal margin of less than 20 mm (r = 0.57, p < 0.001). Ripples occurred in patients with less than 10 mm of soft tissue at the lateral sternal margin; 11.6 percent of patients would choose a larger implant and 2.7 percent would choose a smaller implant.

CONCLUSIONS

Subfascial placement of breast implants provides a reliable technique. It can be used in patients with at least 20 mm of soft tissue at the lateral sternal margin. Those with 10 to 20 mm should be counseled that ripples may occur if they lose body fat. The technique is unsuitable for individuals with less than 10 mm measurable at the lateral sternal margin.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.

JPEG and raw image files compared to direct measurement of the breast region

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.

The impact of age and body mass index on a bra sizing system formed by anthropometric measurements of Sichuan Chinese females

Existing bra sizing systems are based only on bust and underbust girths, which do not guarantee an accurate fit or comfort for consumers. This study presents a comprehensive investigation of the impact of age and body mass index (BMI) on bra sizing systems, and the distributions of band and cup sizes based on anthropometric measurement data. The first four principal components were extracted by principal component analysis, and the factor loadings of age and BMI were found to be significant determinants of bra size along with 12 other variables. Furthermore, chi-square analysis revealed that bra size allocations were significantly influenced by age and BMI. Thus, we propose that age and BMI should be considered as auxiliary criteria for the bra sizing system. Taken together, these findings will be of value to designers and bra manufacturers in developing well-fitting bras for their target consumers, and to consumers for selecting well-fitting bras with confidence. Practitioner Summary: This study contributes to an understanding of how bra sizing systems are affected by age and BMI. This understanding is valuable to bra designers, manufacturers, and retailers, as it will enable the adjustment of bra sizes for different target markets and in turn improve consumer confidence in selecting proper fitting and comfortable bras.

"Topographic Shift": a new digital approach to evaluating topographic changes of the female breast

PURPOSE

To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans.

METHOD

The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift.

RESULTS

The mean implant volume was 283 cc (SD = 68.6 cc, range = 210-395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8-10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm).

CONCLUSION

The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the décolleté.

Anthropometric breast measurements of young women with no history of pregnancy or surgery in Turkey

Anthropometric measurements of the breast play a guiding role in surgical planning. In our study, it was aimed to determine the normal shape and size of the breast by taking measurements in young women who did not experience pregnancy or surgery and comparing them with the results of other studies. The breast parameters of 88 women aged between 18 to 30 years old, with a normal body mass index, with no history of previous pregnancy, surgery or rapid weight gain were measured. The measured parameters were age, body mass index, cup size, distance between nipple and suprasternal notch, distance between both nipples, distance between midclavicular point and nipple, distance between midclavicular point and upper border of the breast, the distance between the midaxillary line and nipple, the distance between the nipple and inframammarian fold, the projection of the breast, the projection of the nipple and the chest circumference under the breast. The mean values ​​were determined and the correlation between the parameters was evaluated statistically. A significant correlation was found between cup size and all parameters except for the chest circumference and nipple projection. The distance between the midclavicular point and upper border of the breast was found correlated with the cup size. In addition, a significant correlation was found between body mass index and all other parameters. This study revealed the average breast size and measurements of women in Turkey. It can be useful to guide for both reconstructive and aesthetic procedures of the breast.

Breast and torso characteristics of female contact football players: implications for the design of sports bras and breast protection

This study aimed to provide normative data characterising the breast size, breast position and torso size of female contact football players. 117 AFL, Rugby League, Rugby Union and Rugby 7s players attended a single testing session where a three-dimensional scan was taken of their naked breasts and torso. Dimensions relevant to the design of sports bras and breast protective equipment were then calculated from the scans. Several breast and torso characteristics of female contact football athletes differed to measurements reported for females in the general population and amongst the contact football codes. Designers and manufacturers of sports bras or breast protective equipment should consider the specific breast and torso dimensions of female contact football players to maximise the fit, comfort and efficacy of these garments. Practitioner summary: Using three-dimensional scanning, this study characterised the breast and torso size and shape of 117 female contact football players. These normative data should be used to improve the fit and comfort of sports bras and breast protective equipment for female contact football players.

Short-term Safety of Augmentation Mammaplasty Using the BellaGel Implants in Korean Women

Supplemental Digital Content is available in the text.

Asian women are stereotypically characterized by a slim body, smaller breasts and areolae, and larger nipples when compared with White women. They would therefore be vulnerable to displacement of a breast implant if they receive larger implants. They are also prone to hypertrophic and prolonged hyperemic scars. Surgeons should therefore be aware of Asian women’s breast anatomy, healing tendency, and preferences. We conducted this multicenter, retrospective study to assess the short-term safety of the BellaGel implants in Korean women.

Anthropometric Breast Measurement: Analysis of the Average Breast in Young Nulliparous Saudi Female Population

Anthropometric measurements and proportions of the female body play a significant role in plastic and reconstructive surgery. This study is aimed to identify the descriptive measurements of the breast in a sample population of young nulliparous Saudi women.

Natural Breast Symmetry in Preoperative Breast Cancer Patients

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.

There are two sides to every story: implications of asymmetry on breast support requirements for sports bra manufacturers

This study aimed to investigate: (1) the prevalence and magnitude of breast movement asymmetry, (2) the interaction between static and dynamic breast asymmetry and (3) the influence of sports bras on breast asymmetry during running. Position data were collected from 167 females whilst treadmill running and then a sub-group of 12 participants in different bra conditions. Breast movement asymmetry existed in 89% of participants, with resultant static breast position asymmetry larger in participants displaying dynamic asymmetry. Asymmetry was most commonly caused (60% to 75%) by greater movement of the left breast. No significant relationships were found between asymmetry and bra size or breast pain. Sports bras reduced asymmetry prevalence from 75% to 33% of participants in the antero-posterior direction but only from 75% to 67% of participants in the infero-superior direction. The magnitude of range-of-motion asymmetry reduced from 67 mm with no bra to between 6 and 64 mm in-bra in the infero-superior direction, with the best performing bra incorporating encapsulating cups and adjustable straps and underband. It is recommended that sports bras allow underband and strap adjustment to facilitate individual breast support and that asymmetry is considered when designing and fitting bras, which could utilise resultant asymmetry measured statically.

Investigation of the Anthropometric Changes in Breast Volume and Measurements After Breast Reduction

Objective

This study aims to compare breast volume changes and other anthropometric measurements by using before and after breast reduction pictures of women who underwent breast reduction operation in Plastic and Reconstructive Surgery clinic and by performing measurements from the anatomic points indicated in the literature.

Background

Landmarks (previously identified as anatomic points) that show the success of breast reduction operation are not sufficient. Anthropometric points and their identification are of great importance for choosing the landmarks and identifying the statistical approaches to be used.

Methods

A total of 40 women were measured breast anthropometric measurements in pre- and post-operative breast reduction surgery changes by a photographic technique using Image J programme from the anatomical points determined in the literature. Comparison of right and left breast anthropometric measurements before and after the operation was performed using the paired t test or Wilcoxon signed rank test. The intraclass correlation coefficient (ICC) and Bland-Altman plots were used to determine the agreement between each pair of measurements.

Results

There was a statistically significant agreement between all the measurements (p<0.001). According to the Bland-Altman graphics, right and left breast measurements after the operation were within the limits of agreement according to all measurement points.

Conclusion

This study presented anthropometric measurements to show and guide patient satisfaction and aesthetic success of the operations performed by plastic surgeons.

Metrics of the Aesthetically Perfect Breast

Breast surgery has long been viewed as an art more than a science. However, defining and objectively measuring the ideal breast morphology and aesthetic proportions are fundamental for surgical planning and to setting the goals of surgery as well as to evaluate surgical outcomes. Despite the fact that much has been written about aesthetic and reconstructive breast surgery, there is still no real consensus about what the attributes are of an ideal breast. Moreover, there are in fact no objective standard measurement systems and guidelines to describe ideal or even normal breast shape. Though there is great variability in the perception of beauty among patients and surgeons alike due to many factors among which are age, sex, and sociocultural background, there is common agreement that beauty is a universal phenomenon that has a universal standard present across all civilizations and centuries, and that perceived beauty is enhanced and optimal aesthetics are achieved when proper measurements are made and anthropometric proportions as well as attractive harmonious ratios are respected. The current review is an attempt to summarize the most relevant information available trying to introduce some harmony in our perception of aesthetic ideals of breast surgery. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of age and body mass index on breast characteristics: a cluster analysis

Limited research has quantified variation in the characteristics of the breasts among women and determined how these breast characteristics are influenced by age and body mass. The aim of this study was to classify the breasts of women in the community into different categories based on comprehensive and objective measurements of the characteristics of their breasts and torsos, and to determine the effect of age and body mass index on the prevalence of these breast categories. Four breast characteristic clusters were identified (X-Large, Very-ptotic & Splayed; Large, Ptotic & Splayed; Medium & Mildly-ptotic; and Small & Non-ptotic), with age and BMI shown to significantly affect the breast characteristic clusters. These results highlight the difference in breast characteristics exhibited among women and how these clusters are affected by age and BMI. The breast characteristic clusters identified in this study could be used as a basis for future bra designs and sizing systems in order to improve bra fit for women. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the diverse breast characteristics exhibited by women within the population and the significant effect that both body mass index and age have on the breast characteristic clusters. Future bra designs should consider the variation in breast characteristics among women.

ABBREVIATIONS

BMI: Body Mass Index; UBCC: Under-bust chest circumference.

Lateral Inframammary Approach for Asian Augmentation Mammaplasty

Background:

The inframammary fold (IMF) approach for augmentation mammaplasty is less popular in Asia. The incision was modified to lateral IMF(L-IMF) for easy access and better outcome. The aim of this study was to evaluate if L-IMF approach is feasible in Asian women.

Methods:

Between 2002 and 2016, 53 patients with 96 augmentation mammaplasties were performed using lateral (L-IMF, 31 cases, 56 breasts) and traditional IMF approaches (T-IMF, 22 cases, 40 breasts). Surgical outcome was compared between L-IMF and T-IMF groups. Scar was assessed using photographic images by 4 assessors with a modified Manchester Scar Score, and telephone surveys available in L-IMF group.

Results:

The average age was 41 ± 10.7 years (range, 20–73 years). There were no statistical differences in demographics in both groups besides of implant type (P < 0.01). At a follow-up of 80.1 months (range, 20–173 months), the capsular contracture rate and overall complication rate were statistically lower in L-IMF group, 3.6%, and 3.6%, than in T-IMF group, 15%, and 20% (P = 0.05, and P < 0.01, respectively). The modified Manchester Scar for L-IMF scars was 8.47 ± 2.4. The average score of 24 of 31 patients with L-IMF incision was 3.8 ± 0.96/5 points with patient-reported questionnaire. Nineteen patients (79.2%) would recommend or strongly recommend the procedure to friends.

Conclusions:

The scar of L-IMF group healed satisfactorily with lower capsular contracture and overall complication rates than T-IMF group. Patients were satisfied with the outcome of breast augmentation and scar appearance using L-IMF approach.

Can breast characteristics predict upper torso musculoskeletal pain?

BACKGROUND

Several studies have associated a large breast size with an increased prevalence and severity of musculoskeletal pain, particularly pain in the upper torso. Despite this evidence, no research has explored whether breast size or related characteristics are risk factors for upper torso musculoskeletal pain.

METHODS

A backward multiple regression analysis was performed to identify whether characteristics of the breasts and upper torso, as well as physical factors known to be associated with musculoskeletal pain, could predict musculoskeletal pain among a cohort of 378 Australian women aged 18 years and over who had a wide range of breast sizes.

FINDINGS

The model identified that breast volume, age and nipple-to-nipple distance predicted 23% of the variance in upper torso musculoskeletal pain reported by the participants.

INTERPRETATION

Women with a larger breast volume, lower age and a greater nipple-to-nipple distance were predicted to report a higher upper torso musculoskeletal pain score.

Quantification of gravity-induced skin strain across the breast surface

BACKGROUND

Quantification of the magnitude of skin strain in different regions of the breast may help to estimate possible gravity-induced damage whilst also being able to inform the selection of incision locations during breast surgery. The aim of this study was to quantify static skin strain over the breast surface and to estimate the risk of skin damage caused by gravitational loading.

METHODS

Fourteen participants had 21 markers applied to their torso and left breast. The non-gravity breast position was estimated as the mid-point of the breast positions in water and soybean oil (higher and lower density than breast respectively). The static gravity-loaded breast position was also measured. Skin strain was calculated as the percentage extension between adjacent breast markers in the gravity and non-gravity loaded conditions.

FINDINGS

Gravity induced breast deformation caused peak strains ranging from 14 to 75% across participants, with potentially damaging skin strain (>60%) in one participant and skin strains above 30% (skin resistance zone) in a further four participants. These peak strain values all occurred in the longitudinal direction in the upper region of the breast skin. In the latitudinal direction, smaller-breasted participants experienced greater strain on the outer (lateral) breast regions and less strain on the inner (medial) breast regions, a trend which was reversed in the larger breasted participants (above size 34D).

INTERPRETATION

To reduce tension on surgical incisions it is suggested that preference should be given to medial latitudinal locations for smaller breasted women and lateral latitudinal locations for larger breasted women.

Assessment of Breast Asymmetry in Adolescent Idiopathic Scoliosis Using an Automated 3D Body Surface Measurement Technique

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.

Preoperative implant selection for unilateral breast reconstruction using 3D imaging with the Microsoft Kinect sensor

AIMS

This study aimed to investigate whether breast volume measured preoperatively using a Kinect 3D sensor could be used to determine the most appropriate implant size for reconstruction.

METHODS

Ten patients underwent 3D imaging before and after unilateral implant-based reconstruction. Imaging used seven configurations, varying patient pose and Kinect location, which were compared regarding suitability for volume measurement. Four methods of defining the breast boundary for automated volume calculation were compared, and repeatability assessed over five repetitions.

RESULTS

The most repeatable breast boundary annotation used an ellipse to track the inframammary fold and a plane describing the chest wall (coefficient of repeatability: 70 ml). The most reproducible imaging position comparing pre- and postoperative volume measurement of the healthy breast was achieved for the sitting patient with elevated arms and Kinect centrally positioned (coefficient of repeatability: 141 ml). Optimal implant volume was calculated by correcting used implant volume by the observed postoperative asymmetry. It was possible to predict implant size using a linear model derived from preoperative volume measurement of the healthy breast (coefficient of determination R² = 0.78, standard error of prediction 120 ml). Mastectomy specimen weight and experienced surgeons' choice showed similar predictive ability (both: R² = 0.74, standard error: 141/142 ml). A leave one-out validation showed that in 61% of cases, 3D imaging could predict implant volume to within 10%; however for 17% of cases it was >30%.

CONCLUSION

This technology has the potential to facilitate reconstruction surgery planning and implant procurement to maximise symmetry after unilateral reconstruction.

Breast Durometer (Mammometer): A Novel Device for Measuring Soft-Tissue Firmness and Its Application in Cosmetic Breast Surgery

The measurement of soft-tissue firmness has many potential applications in medical practice. This study reports a user-friendly, novel device that is capable of measuring changes in soft-tissue firmness in a reproducible manner. The study reports the development of the equipment and how it has been applied to breast implant surgery. The device was tested for both intra- and inter-observer variability on an in vitro model, using a breast implant. Once reproducibility was confirmed, breast firmness was measured on a series of patients who underwent sub-fascial breast augmentation (n = 50) to examine how it varied post-operatively. Firmness in the upper half of the breast increased to a maximum level two weeks post-surgery (0.44-0.61 Pa), reducing to pre-operative levels by 6 weeks (0.37-0.54 Pa). There was no further significant change at 12 weeks. Firmness in the nipple areolar complex (NAC) and at the lower outer quadrant (LOQ) followed a similar pattern, but remained firmer at 12 weeks. We interpret these patterns as implying that measurements taken at the upper half of the breast are indicative of post-operative oedema, whereas those at the NAC and LOQ represent changes in firmness produced by the breast implant composite. We consider the potential for this novel device in the measurement of soft-tissue firmness in aesthetic breast surgery and would encourage other researchers to explore novel applications. 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 .

Vertical breast measurement in East Asian women: A guide for mastopexy and reduction to form nonptotic breasts in unilateral prosthetic breast reconstruction

BACKGROUND

Following unilateral breast cancer surgery, mastopexy and reduction of the unaffected breast are often performed to obtain symmetrical breasts. The use of implants in breast reconstruction results in a nonptotic breast. To achieve symmetry following the procedure, the unaffected side should be nonptotic too. However, no study has yet reported any indices for the design of mastopexy and reduction in this direction. We present a new method of preoperative design that uses vertical breast measurements to form nonptotic breasts according to individual breast shapes.

METHODS

We performed vertical breast measurements of the unaffected breasts of 193 patients scheduled to undergo surgery for unilateral breast cancer. The vertical base dimension (VBD) and vertical surface dimension (VSD) of the ptotic and nonptotic breasts and the height of the nipple in the nonptotic breast were measured in centimeters.

RESULTS

The borderline between ptotic and nonptotic breasts was expressed using the formula VSD = 1.13 × VBD + 1.86. The height of the nipple in nonptotic breasts was 0.8 times the distance between the sternal notch and lowest point of the inframammary fold on the midline. From these findings, we formulated a new method for forming a nonptotic breast from a ptotic breast using an inverted T design.

CONCLUSION

These results can be used for the design of mastopexy and reduction when forming a nonptotic breast on the unaffected side. These procedures can be performed without significantly lifting the nipple-areolar complex if required during unilateral prosthetic breast reconstruction.

Objective Sensory Changes Following Subfascial Breast Augmentation

BACKGROUND

Sensory changes occur following breast augmentation, and describing the incidence, pattern, and course of deficit is important for informed consent.

OBJECTIVES

To examine sensory changes following subfascial breast augmentation, and the influence of change in breast volume caused by an implant.

METHODS

One hundred and sixty-two consecutive patients undergoing subfascial breast augmentation were assessed for sensory changes using a Semmes Weinstein monofilament test before surgery, 2, 6, and 12 weeks postoperatively. Morphometric measurements allowed a breast volume to be calculated and the percentage change in volume produced by the implant.

RESULTS

Most women (92.5%) regained preoperative levels of sensation in all areas of the breast, excepting the lower-outer quadrants (16.15%) by 12 weeks following surgery. Four percent of nipple-areolar complexes (NAC) failed return to preoperative levels of sensitivity by 12 weeks after surgery. Younger patients or those who have a high BMI and a measurably thicker soft tissue envelope were more likely to experience sensory deficits. Breast augmentation in this series produced calculated volume changes by an implant of between 12.1% and 102.7%. Within these limits there is no association between percentage increase in breast volume and sensory deficits.

CONCLUSIONS

The study demonstrates that for calculated volume increases of up to 102% of the initial breast volume, sensory loss at 12 weeks after surgery is 4% at the NAC. The commonest area of diminished sensitivity is the lower-outer quadrant (16.15%), relating to the use of the inframammary crease incision. It provides a useful adjunct in monitoring patient recovery following subfascial breast augmentation. LEVEL OF EVIDENCE 4: Therapeutic.

Male and Female Perception of Physical Attractiveness

Waist-to-hip ratio (WHR) and breast size are morphological traits that are associated with female attractiveness. Previous studies using line drawings of women have shown that men across cultures rate low WHRs (0.6 and 0.7) as most attractive. In this study, we used additional viewing measurements (i.e., first fixation duration and visual regressions) to measure visual attention and record how long participants first focused on the female body and whether they regressed back to an area of interest. Additionally, we manipulated skin tone to determine whether they preferred light- or dark-skinned women. In two eye tracking experiments, participants rated the attractiveness of female nude images varying in WHR (0.5–0.9), breast size, and skin tone. We measured first fixation duration, gaze duration, and total time. The overall results of both studies revealed that visual attention fell mostly on the face, the breasts, and the midriff of the female body, supporting the evolutionary view that reproductively relevant regions of the female body are important to female attractiveness. Because the stimuli varied in skin tone and the participants were mainly Hispanic of Mexican American descent, the findings from these studies also support a preference for low WHRs and reproductively relevant regions of the female body.

Asymmetry of Inframammary Folds in Patients Undergoing Augmentation Mammaplasty

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.

An Anthropometric-Based Subject-Specific Finite Element Model of the Human Breast for Predicting Large Deformations

The large deformation of the human breast threatens proper nodules tracking when the subject mammograms are used as pre-planning data for biopsy. However, techniques capable of accurately supporting the surgeons during biopsy are missing. Finite element (FE) models are at the basis of currently investigated methodologies to track nodules displacement. Nonetheless, the impact of breast material modeling on the mechanical response of its tissues (e.g., tumors) is not clear. This study proposes a subject-specific FE model of the breast, obtained by anthropometric measurements, to predict breast large deformation. A healthy breast subject-specific FE parametric model was developed and validated by Cranio-caudal (CC) and Medio-Lateral Oblique (MLO) mammograms. The model was successively modified, including nodules, and utilized to investigate the effect of nodules size, typology, and material modeling on nodules shift under the effect of CC, MLO, and gravity loads. Results show that a Mooney–Rivlin material model can estimate healthy breast large deformation. For a pathological breast, under CC compression, the nodules displacement is very close to zero when a linear elastic material model is used. Finally, when nodules are modeled, including tumor material properties, under CC, or MLO or gravity loads, nodules shift shows ~15% average relative difference.

Asian Breast Augmentation: A Systematic Review

BACKGROUND

Economic, cultural, and regulatory phenomena may explain recent popularization of implant-based augmentation in Asia; but the collective Eastern experience remains limited. Asian surgeons and their patients rely on evidence-based medicine that originates elsewhere and may not be entirely relevant. Distinct anatomic and cultural features of Asian women warrant a tailored approach to breast augmentation. We explore the Asian experience with a thorough exploration of the recent literature.

METHODS

A literature search was performed for articles written after 2000, of Asian women who underwent augmentation mammoplasty using MEDLINE, Embase, and Pubmed Databases. Technique and outcomes data were summarized.

RESULTS

Twelve articles reported outcomes of 2089 women. Korea contributed most series (English language, 7), followed by China (3), Taiwan (1), and Japan (1). Silicone implants were used in 82.1% of women studied, and almost exclusively after 2009. More round (68.9%) than anatomic implants (31.1%) were placed. Non-inframammary (axillary, areolar, and umbilical) incisions were used in 96.9% of cases. Nearly all implants were positioned below the muscle or fascia; subglandular placement accounted for 1.1% of cases. Implant/nipple malposition (1.3%), capsular contracture (1.9%), hematoma (0.6%), and infection (0.2%) rates were reported in most series. Undesirable scarring was the most frequent complication (7.3%), but was reported only in 4 of 12 series.

CONCLUSIONS

Studies of Asian women undergoing augmentation mammoplasty are limited, often with ill-defined outcomes and inadequate follow-up. As experience accumulates, an expanding literature relevant to Asian women will provide evidence-based guidelines that improve outcomes and patient satisfaction, and foster innovation.

Photographs for anthropometric measurements of the breast region. Are there limitations?

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.

The Standardization of Bra Cup Measurements: Redefining Bra Sizing Language

There are many challenges in developing a standardized bra cup system, the most significant being that bra cup sizes are a continuum. Women's breasts occur as a fluid range of shapes, sizes, and volumes. Patients have specific expectations regarding bra cup size, and failure to achieve expectations remains the leading cause of patient dissatisfaction. Implant selection that determines eventual bra cup size is critical in patient education and management of patient expectations; however, this is not achievable until all speak the same bra cup language. Patient and surgeon perceptions may never be exact, but it is important to establish guidelines and standards to bridge this gap.

The Role of Breast Size and Areolar Pigmentation in Perceptions of Women's Sexual Attractiveness, Reproductive Health, Sexual Maturity, Maternal Nurturing Abilities, and Age

Women's breast morphology is thought to have evolved via sexual selection as a signal of maturity, health, and fecundity. While research demonstrates that breast morphology is important in men's judgments of women's attractiveness, it remains to be determined how perceptions might differ when considering a larger suite of mate relevant attributes. Here, we tested how variation in breast size and areolar pigmentation affected perceptions of women's sexual attractiveness, reproductive health, sexual maturity, maternal nurturing abilities, and age. Participants (100 men; 100 women) rated images of female torsos modeled to vary in breast size (very small, small, medium, and large) and areolar pigmentation (light, medium, and dark) for each of the five attributes listed above. Sexual attractiveness ratings increased linearly with breast size, but large breasts were not judged to be significantly more attractive than medium-sized breasts. Small and medium-sized breasts were rated as most attractive if they included light or medium colored areolae, whereas large breasts were more attractive if they had medium or dark areolae. Ratings for perceived age, sexual maturity, and nurturing ability also increased with breast size. Darkening the areolae reduced ratings of the reproductive health of medium and small breasts, whereas it increased ratings for large breasts. There were no significant sex differences in ratings of any of the perceptual measures. These results demonstrate that breast size and areolar pigmentation interact to determine ratings for a suite of sociosexual attributes, each of which may be relevant to mate choice in men and intra-sexual competition in women.

Correlation between nipple elevation and breast resection weight: How to preoperatively plan breast reduction

Breast hypertrophy is often associated with functional limitations. Beyond the aesthetic concerns, breast reduction can improve symptoms and self-esteem. In different countries, health-care system regulations have fixed the threshold for reimbursement in 500 g of predicted tissue resection for each breast. Different preoperative measurements have been proposed to predict breast-tissue weight to be removed, showing a variable correlation with post-operative evaluation. We describe a reliable, simple measurement to predict the quantity of breast reduction in grams, which can be applicable to any surgical technique. A total of 128 patients undergoing bilateral breast reduction were evaluated. The correlation between the preoperative nipple-areola complex (NAC) lift distance and the weight of removed breast tissue was tested with linear regression and Pearson's test. Other anthropometric measurements were tested as a control. The ratio between resected grams and lift distance was explored to find a multiplication coefficient to be used at preoperative planning. The mean resection weight was 686.65 g. The mean NAC-lift distance was 7.6 cm. Positive correlation between the NAC-lift distance and the weight of breast tissue removed was found (r: 0.87; p < 0.001). The mean weight of the removed breast tissue (g) per centimetre of NAC lift was 81 g/cm in the group between 6 and 12 cm and 70 g/cm in the group with >12 cm of lift distance. The NAC-lift distance is a single, objective, repeatable measure that can provide a reliable prediction of breast-tissue grams to be removed; it helps in classifying breast-reduction indications.

Image analysis software versus direct anthropometry for breast measurements

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.

A Consideration of Breast Imagery in Art as Depicted through Western Painting

The aim of this study is to consider breast imagery in art as depicted through western painting. Twenty western art paintings were collated. Most of the sample paintings were created from the mid-nineteenth century to the late twentieth century and some are from the Renaissance period. Ten anthropometric items were used to measure 15 distances between two landmarks and 3 angles between three points. The distance from the nipple to the sternal notch and to the midclavicular point was the same and they were 0.46 of the distance from the sternal notch to the umbilicus. The shape of the projection of the breast was almost an isosceles triangle and the altitude of the triangle was at a proportion of 0.45 of the bottom length and 0.16 of the distance from the sternal notch to the umbilicus. The distance between the lateral ends of the breasts was 2.14 times the facial width and the distance between nipples was 1.36 times the facial width. Proportions from works of art are more ideal and attractive than clinically measured proportions. The desirable ratios measured from historical paintings might be useful in planning breast surgeries.

Association of the nipple-areola complexes with age, parity, and breastfeeding in Korean premenopausal women

BACKGROUND

There is no standard method of measuring the nipple-areola complex or defining the normal range and the changes seen in this complex. Numerous factors are involved in the anthropometric characteristics of the nipple-areola complex.

OBJECTIVE

The purpose of this study was to evaluate the anthropometric characteristics of the nipple-areola complex related to age, parity, and breastfeeding in 234 premenopausal Korean women (468 breasts).

METHODS

This cross-sectional study was conducted from May 2011 to June 2012. Five parameters of both nipple-areola complexes were measured in volunteers who were placed in a supine position. The diameters of the nipple-areola complex and the nipple projection were measured using micrometer calipers.

RESULTS

The size of the nipple-areola complex increased according to age (P < .05). The measurements of the right nipple and the vertical diameter of the right areola were larger than those of the left sides in all age groups. There were no differences in the horizontal areola diameter and nipple projection between the 2 sides. The left horizontal areola diameter in breastfeeding parous women was larger than that in the non-breastfeeding parous women group (P = .011). The nipple projection was associated with the duration of breastfeeding (especially more than 12 months). The percentage of women with retracted nipples was 11.2%.

CONCLUSION

Our study may be helpful in understanding nipple-areola complex changes related to age, parity, and breastfeeding. These results should be evaluated with larger study cohorts and more longitudinal studies to better understand factors related to changes of the nipple-areola complex.

Is Breast Asymmetry Present in Girls with Adolescent Idiopathic Scoliosis?

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.

The influence of ageing on bra preferences and self-perception of breasts among mature women

The ageing process has both psychological and physiological effects on women, and tactical choices are often made regarding beauty interventions to mask the outward signs of increasing age. The bra is believed to counteract the negative effects of ageing on the breast and alter the perceptions of one's body. Due to the profound anatomical changes to the breast with increasing age, this paper aimed to examine the influence of ageing on women's perceptions of their breasts and their bra preferences. 208 women aged 45-65 years were surveyed about their breasts, their bras and how they felt ageing may have influenced these. The findings showed 80 % of women surveyed had noticed a significant change in their breasts with ageing, just 7 % of the women surveyed were still proud of their breasts and 84 % of women dressed to look younger. Further, over 50 % of respondents would now not wear the bra they had worn in their twenties, indicating a change in bra preferences with age. The bra variables of primary importance to participants were: comfort, the bra's ability to stay in place, optimal fit, appearance under clothing, support, discreetness, shoulder strap design, silhouette, breast shape, fabric and breast lift. These variables are perceived as being influential in the appropriateness of the bra and its social role for mature women; therefore, it is these bra variables that should be the focus of subsequent research regarding the optimisation of bras for women aged 45-65 years.

Inter-observer reliability of clinical measurement of suprasternal notch-nipple distance and breast ptosis

Context:

Suprasternal notch-nipple distance and breast ptosis are two measurements that are often used in everyday plastic surgical clinical practice. Nonetheless, the reliability of standard breast measurements has never been tested.

Aim:

The aim of the present study was to test the inter-observer reliability of clinical measurement of ptosis and suprasternal notch-nipple distance.

Settings and Design:

Six raters measured ptosis and suprasternal notch-nipple distance in 12 breasts on the same day.

Statistical Analysis Used:

Intra-class correlation (ICC) coefficients, the coefficient of variation (CV) and Bland–Altman plots.

Results and Conclusions:

The results show that there is certain variation between different raters. The ICC of average measures between raters is 0.92 for the ptosis and 0.94 for the suprasternal notch-nipple distance, that is, the agreement between different raters is high. According to the Bland — Altman plots, the overall assessment of the comparisons of measurements between the different raters shows that the direction of the mean differences is close to zero. This study shows that there is a good reliability for measurements of suprasternal notch-nipple distance and ptosis. Nonetheless, there is a slight inter-rater variability in the measurements. Even though standardised, measurement of breasts is not an exact science and care has to be taken when the measurements are performed. The surgeon should have this in mind when measurements are used in clinical practice to evaluate breasts and to choose the right surgical method, as well as when guidelines for indications for surgery are set up.

Anthropometry of the breast region: how to measure?

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 .

The affecting factors of breast anthropometry in Korean women

BACKGROUND

Breast anthropometric morphology affects various factors with diverse physiognomy, making accurate measurements very difficult. The aim of this study was to measure the female breast using anthropometry and to use this method on normal subjects to examine breast asymmetry and consider the influence of age, height, weight, body mass index (BMI), parity, delivery mode, and breastfeeding in premenopausal Korean women.

SUBJECTS AND METHODS

In total, 17 parameters of breast were measured with participants in a standing position. Breast volume was also assessed.

RESULTS

The mean values of the right and left breast volumes were calculated as 386.0±342.5 mL and 393.3±347.2 mL, respectively. With aging, the height of women decreased, but the weight, BMI, upper chest, middle chest, lower chest, waist, and hip widths, nipple-nipple length, and ptosis increased with statistical significance. No asymmetric differences were observed between each breast, except for nipple-inframammary fold length in 20-30-year-old women and upper arm length in 41-50-year-old women. In our study, the breast volume increased with age as a result of weight gain, but the delivery mode and breastfeeding did not affect anthropometric breast measurements.

CONCLUSIONS

In conclusion, age, weight, and BMI are important factors in determining breast anthropometry in our study. The results of the present study will help in the comparison of the anthropometric breast values of Korean women with those of women in other countries and may also be useful in the understanding of breast physiologic change-related obstetrical factors and epidemiologic factors.