Breast Shape Change Associated with Aging: A Study Using Prone Breast Magnetic Resonance Imaging

Changes in Skin Paddle Morphology after Autologous Breast Reconstruction

Background

Immediate autologous breast reconstruction (IABR) can provide favorable aesthetic outcomes after skin-sparing mastectomy. However, it is known that the morphology of the reconstructed breast changes over time. Therefore, it is necessary to be able to predict the likely amount of change preoperatively to reconstruct a symmetrical breast. In this study, we retrospectively examined the change in position and morphology of the skin paddle of the reconstructed breast over time.

Methods

Thirty-five patients who underwent IABR after skin-sparing mastectomy for unilateral breast cancer were included. Three-dimensional images were obtained at 1 month and 12 months postoperatively to compare changes in the position and size of the skin paddle over time.

Results

Significant increases were observed in the distance between the center of the skin paddle and the midpoint of the clavicle, the distance between the center of the skin paddle and the sternal notch, and projection. No significant change was observed in the distance between the inframammary fold and the center of the skin paddle. There was a significant increase in the area and short axis of the skin paddle.

Conclusions

Our main findings were that the skin paddle shifts toward the outer caudal side after IABR and tends to become larger. When planning delayed nipple reconstruction with a local flap designed on a skin paddle, the paddle should be positioned slightly more mediocranially than the healthy nipple and should be narrower.

Quantification of Breast Volume According to age and BMI: A Three-Dimensional MRI Analysis of 400 Women

OBJECTIVE

Breast size alteration is the most common aesthetic surgical procedure worldwide. This study aimed to assess the correlation between breast volume and BMI or age.

MATERIALS AND METHODS

The analyses were conducted utilizing 400 patients selected by a retrospective review of the archives at our institution. Epidemiological data and medical history were assessed. Adjusting for the age and BMI of patient from previously described cohorts, we calculated mean breast volumes per side and differences from the upper and lower percentiles to the mean volumes.

RESULTS

The patients had a median BMI of 23.5 (range: 14.7-45.6) and a median age of 51 (range: 24-82). The average total breast volume increased strongly with BMI (r=0.834, p<0.01) and moderately with age (r=0.305, p<0.01). Within a BMI range of 18-24, breast volumes in the 8th and 18th percentile differ on average by about 50 ml. One BMI unit increase in women with breast sizes in the 10th percentile accounts for a breast volume difference of about 30 ml.

CONCLUSION

BMI strongly correlates with breast size. To achieve natural results, preoperative consultation and planning of aesthetic and reconstructive breast surgery must recognize BMI as a major determinant of average breast size.

LEVEL OF EVIDENCE IV

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Evaluation of DIBH and VMAT in Hypofractionated Radiotherapy for Left-Sided Breast Cancers After Breast-Conserving Surgery: A Planning Study

Background: Dosimetric parameters of the planning target volume (PTV) and organs at risk (OARs) were compared among 3 different radiotherapy (RT) modalities in left breast cancer patients after breast-conserving surgery (BCS). Methods: Eleven patients with left breast cancer after BCS were enrolled and underwent CT simulation in the free breathing (FB) and deep inspiration breath-hold (DIBH) position. Three-dimensional conformal RT (3DCRT) and volumetric modulated arc therapy (VMAT) plans were generated for each patient in the DIBH positions. A 3DCRT plan was also created in the FB position. A dose-volume histogram (DVH) was used to analyze each evaluation index of PTV and OARs. The principal outcomes were PTV dose, heart dose, right breast dose, left anterior descending coronary artery (LADCA) dose, and left lung dose. Results: For 3DCRT plans, significant dose reductions were demonstrated in all evaluation parameters of the heart, LADCA, and left lung doses in the DIBH position compared with those in the FB position (P < 0.05). In the DIBH position, significant dose reductions were found in the heart and LADCA in VMAT plans compared to those in 3DCRT plans (P < 0.05). For the right breast, VMAT reduced Dmean significantly (0.32 Gy vs 0.08  Gy, P < 0.01). There were no significant differences between 3DCRT and VMAT plans for the left lung dose in the DIBH position. The indicators of PTV had no significant difference between the 3 plans. Conclusion: DIBH and VMAT could reduce dosimetric parameters of the OARs in left breast cancer patients after BCS. RT plans for left breast cancer after BCS can be optimized by DIBH and VMAT techniques to minimize radiation-induced toxicity.

Upper back pain in postmenopausal women and associated physical characteristics

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31–0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28–0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically.

Influence of Weight Loss on Volumetric Change in Contralateral Breast During 2-Stage Breast Reconstruction

Objective: During 2-stage breast reconstruction in patients with unilateral breast cancer, we sometimes experience cases in which the contralateral breast volume changes greatly. However, few studies have examined volumetric changes in the contralateral breast during 2-stage breast reconstruction. Methods: Changes in contralateral breast volume between the first and second operations were examined in patients who underwent 2-stage unilateral breast reconstruction between February 2013 and August 2016 (123 patients aged 49.1 ± 8.6 years). Influences of age, postoperative treatment, and body weight on volumetric changes in the contralateral breast were statistically analyzed. Results: A positive correlation was observed between changes in body weight and contralateral breast volume (correlation coefficient = 0.218, P = .015). Weight loss was particularly important: all patients who lost more than 3 kg showed decreased contralateral breast volume (P = .010). Age and postoperative treatment had no significant effect on the change in contralateral breast volume. Conclusion: Change in body weight, and massive weight loss in particular, is an important factor for volumetric changes in the contralateral breast during 2-stage unilateral breast reconstruction.

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.