Reply

Abstract

Sir:FigureWe thank Drs. Bonomi, Salval, and Settembrini for their comments on our recently published article, “A Reliable Method for the Preoperative Estimation of Tissue to Be Removed during Reduction Mammaplasty.” As we initially conducted the study in response to insurance recommendations, we found it informative to learn that pressures to predict breast reduction weights also exist internationally. We also thank these doctors for bringing to our attention the study by Nicoletti and colleagues,1 which corroborates the utility of sternal notch–to–nipple distance as a predictor of breast volume. In our study, we introduced two breast-specific orthogonal surface measurements that, based on our analysis, predicted breast reduction resection weights more accurately than sternal notch–to–nipple measurements. We hypothesize that these surface measurements, which focus on the breast mound rather than the trunk as a whole, correlate more closely with actual breast volume than partial or nonbreast surface measurements, such as sternal notch–to–nipple distance. We are currently working with three-dimensional imaging in an attempt to substantiate this. Regarding the question of the consistency of the upper breast border used for the vertical dimension measurement, we agree that variability increases when measurements are obtained by different examiners. For this reason, we have designed our method to be a surgeon-specific tool and recommend that measurements be taken by a single individual. Finally, we would like to acknowledge that various types of glandular resections performed by different surgeons might uncover inconsistency. For this reason, future studies directed at analyzing our method in such settings may be warranted. Ergun Kocak, M.D., M.S. Katherine H. Carruthers James D. McMahan, M.D. Department of Plastic Surgery, The Ohio State University, Columbus, Ohio