Breast Asymmetry Research Articles

A Novel, Deep Learning-Based, Automatic Photometric Analysis Software for Breast Aesthetic Scoring.

Background Breast aesthetics evaluation often relies on subjective assessments, leading to the need for objective, automated tools. We developed the Seoul Breast Esthetic Scoring Tool (S-BEST), a photometric analysis software that utilizes a DenseNet-264 deep learning model to automatically evaluate breast landmarks and asymmetry indices. Methods S-BEST was trained on a dataset of frontal breast photographs annotated with 30 specific landmarks, divided into an 80-20 training-validation split. The software requires the distances of sternal notch to nipple or nipple-to-nipple as input and performs image preprocessing steps, including ratio correction and 8-bit normalization. Breast asymmetry indices and centimeter-based measurements are provided as the output. The accuracy of S-BEST was validated using a paired t -test and Bland-Altman plots, comparing its measurements to those obtained from physical examinations of 100 females diagnosed with breast cancer. Results S-BEST demonstrated high accuracy in automatic landmark localization, with most distances showing no statistically significant difference compared with physical measurements. However, the nipple to inframammary fold distance showed a significant bias, with a coefficient of determination ranging from 0.3787 to 0.4234 for the left and right sides, respectively. Conclusion S-BEST provides a fast, reliable, and automated approach for breast aesthetic evaluation based on 2D frontal photographs. While limited by its inability to capture volumetric attributes or multiple viewpoints, it serves as an accessible tool for both clinical and research applications.

Transumbilical Silicone Breast Augmentation: A 13-Year Experience and 5-Year Analysis.

Transumbilical breast augmentation (TUBA) with saline implants has been considered a safe and efficient technique for decades. However, because silicone implants are more popular than saline ones, TUBA with saline implants is not widely performed. In 2014, we published a report on transumbilical breast augmentation using silicone cohesive gel implants. As we have performed transumbilical silicone breast augmentation (TUSBA) for 13 years with slight modifications, this study aimed to describe this novel technique and present accompanying patient outcomes over 5 years. We enrolled patients desiring breast augmentation at a single center. The preoperative design was initially determined with the patients in standing positions before they underwent surgery under general anesthesia in a supine position. Between January 2018 and December 2022, 69 women and one man underwent TUSBA at a single center. All patients underwent cohesive gel silicone implantation in the subpectoral pocket. The implant size varied from 225 to 300mL (average 272mL) because two patients underwent surgery with implants of different sizes due to breast asymmetry. All patients were satisfied with the surgery outcome except one who was dissatisfied because of abdominal bulging. TUSBA offers advantages such as minimal scarring and unrestricted arm movement; thus, it can be an alternative option for patients seeking breast augmentation. 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 https://www.springer.com/00266 .

Breast Cancer in the Tissue of the Contralateral Breast Reduction

Breast cancer is the most prevalent malignancy among women worldwide, and the increasing number of survivors is due to advances in early diagnosis and treatment efficacy. Consequently, the risk of developing contralateral breast cancer (CBC) among these survivors has become a concern. While surgical intervention with lumpectomy is a widely used primary approach for breast cancer, post-operative breast asymmetry is a potential concern. Many women opt for symmetrizing reduction procedures to improve aesthetic outcomes and quality of life. However, despite careful radiological screening, there is a chance of accidentally finding CBC. To address this, tissue excised during symmetrizing surgery is examined pathologically. In some cases, CBC or in situ lesions have been incidentally discovered in these specimens, prompting a need for a more thorough examination. Resection in pieces and the absence of surgical marking and pathological inking of the margin have made it challenging to precisely identify tumor location and assess tumor size and margin status, hampering adjuvant treatment decisions. A new protocol introduced in July 2022 aims to enhance the precision of CBC diagnosis, allowing for tailored treatment plans, including re-excision, systemic adjuvant therapy, or radiation therapy.

New Insights Into Breast and Chest Wall Asymmetry in the Aesthetic Patient

Abstract Background Asymmetry, a prevalent phenomenon throughout the human body, prompts this retrospective study, in which the authors aim at discerning potential patterns in its manifestation. Building upon our previous investigations in which left-sided chest wall and pelvic bone width surpassed their right-sided counterparts, a hypothesis is formulated suggesting the likelihood of the right breast being narrower and longer compared with the left. Objectives Our objective in this study is to investigate the correlation between the left-sidedness phenomenon in the chest wall and breast shape and appearance, with the aim of understanding its potential impact on outcomes in breast aesthetic surgery. Methods A random selection of pictures from 600 female patients undergoing various aesthetic breast procedures formed the basis of this study. Exclusion criteria involved the elimination of 254 pictures with nonstandard photography. Horizontal and vertical parameters of breasts and chest walls were measured, and the results on both sides were systematically compared to validate our hypothesis. Results On the left side, the chest wall, the distance between the nipple and the midline, and that of the nipple and the anterior axillary line were significantly wider. Vertical measurements, including the sternal notch to the nipple, the clavicle to the nipple, and the clavicle to inferior breast distance, although longer, did not exhibit statistical significance. Conclusions Approximately 77% of patients displayed wider breasts and chest walls on the left side. However, this observed asymmetry did not yield a statistically significant impact on the length of the breasts. Level of Evidence: 3 (Diagnostic)

The Impact of Tuberous Breast on Adolescents: A Cross-sectional Study.

Tuberous breast deformity is a nondiagnostic, descriptive term for a congenital breast difference that becomes apparent at puberty. Although the negative physical and psychosocial effects of macromastia and breast asymmetry are established, no studies to date have explored the impact of tuberous breasts on health-related quality of life (HRQoL) outcomes using a robust sample size. In this cross-sectional study, HRQoL surveys were administered to adolescent women with tuberous breasts and healthy female controls, aged 12-21 years. Surveys included the Short-Form 36v2, Rosenberg Self-Esteem Scale, and Eating Attitudes Test-26. Demographics were compared, and linear regressions were fit to determine the effect of tuberous breast deformity on survey scores, with body mass index (BMI) category as a covariate. Thirty-four patients with tuberous breasts and 264 controls participated. Patients with tuberous breasts had higher mean BMI than controls (P < 0.05). After adjusting for differences in BMI category, patients with tuberous breasts scored lower than controls on the Rosenberg Self-Esteem Scale and in Short-Form 36v2 domains related to physical and psychological health (P < 0.05, all). Compared with controls, patients with tuberous breasts had a higher mean score on the Eating Attitudes Test-26 (P < 0.05). Tuberous breast deformity may negatively impact patients' physical and psychosocial HRQoL and increase their risk for disordered eating and higher BMIs. It is imperative that healthcare providers and third-party payors understand tuberous breast deformity is not just a cosmetic issue and tailor care and coverage policies accordingly.

Impact of sternal notch-to-nipple distance and resection weight asymmetry on complication rates and patient reported outcomes in reduction mammaplasty

While there are numerous predictive models for estimating resection weight, their accuracy may not be strong. Through institutional data of patients who received reduction mammaplasty, this study demonstrates that preoperative sternal notch-to-nipple distance is not an optimal predictive factor for differences in final resection weight, complication rates, and patient reported outcomes. Our results showed that there is a weak correlation between preoperative sternal notch to nipple asymmetry and final resection weight asymmetry. Additionally, significant breast asymmetry is not tied to an increase in complication rates or poorer patient reported outcomes. There is an indication to reconsider the use of such absolute measures for determining who may benefit from reduction mammaplasty.

Reconstructive surgery for severe breast asymmetry post-paediatric cardiovascular operation by anterolateral thoracotomy.

Breast maldevelopment is a troublesome long-term complication of anterolateral thoracotomies, and several cases of this event have been reported. However, breast reconstruction in such cases has not yet been reported in detail, and solutions for managing this event remain unexplained. Herein, we present a case of breast maldevelopment after anterolateral thoracotomy, in which symmetrical breasts were successfully obtained by breast reconstruction based on autologous tissue transfer. The surgical approach prior to pleurotomy in anterolateral thoracotomy, particularly when performed on female infant patients, must be modified to prevent postoperative breast malformation.

Quantitative assessment of breast volume changes after whole-breast irradiation for breast cancer using breast auto-segmentation.

This study aimed to quantitatively estimate the changes in breast volume associated with radiotherapy in patients undergoing breast-conserving surgery and whole-breast irradiation (WBI). Pre-WBI simulation computed tomography (CT) scans and post-WBI follow-up chest CT scans from a total of 1,151 breast cancer patients were analyzed using a deep-learning-driven auto-segmentation approach. The CT-based asymmetry index (CTAI) was calculated by dividing the volume of the irradiated breast by the volume of the contralateral breast. Significant breast shrinkage was defined as a CTAI < 0.85. To quantify changes in CTAI over the follow-up period, the CTAI ratio was determined as the post-WBI CTAI divided by the pre-WBI CTAI. A multivariate logistic regression analysis was conducted to identify potential variables associated with post-WBI significant breast shrinkage. The median CTAI values for pre- and post-WBI CT scans were 0.973 (interquartile range: 0.887-1.069) and 0.866 (interquartile range: 0.773-0.967), respectively. The difference between them was statistically significant (p < 0.001). Following WBI, there was an increase in the rate of significant breast shrinkage from 16.3 to 44.8%. The CTAI ratio showed a negative association with the time interval (p < 0.001, Pearson r = -0.310). In the multivariate logistic regression analysis, lower pre-WBI CTAI, younger age, and longer interval between CT scans were found to be significantly associated with a higher occurrence of post-WBI significant breast shrinkage. Breast volume decreases following WBI, and this decrease is correlated with an increased duration after WBI. These findings highlight the long-term consequences of WBI on breast asymmetry.

A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study.

Approximately 25-30% of patients suffer from breast deformity and/or asymmetry after conventional breast-conserving surgery (CBCS). Generally, it is thought that oncoplastic breast-conserving surgery (OBCS) results in an improved cosmetic result; however, studies comparing the prognosis and aesthetic outcomes of CBCS and OBCS in early breast cancer (EBC) are inadequate. A total of 143 patients were included in this retrospective cohort study; 53 underwent OBCS and 90 underwent CBCS. The resected weight, complications, esthetic results, patient satisfaction, and recurrence rate were compared between the groups. Patient-reported outcomes (PRO) were assessed by the BREAST-Q questionnaire. The mean age of the patients in OBCS group was 43.8 years. This was younger than that in CBCS group (49.1 years, p < 0.001). Postoperative complications (11.3% vs. 8.9%, p = 0.64) and re-excision (5.7% vs. 6.7%, p > 0.99) rates were similar. The OBCS group had higher breast satisfaction and psychosocial well-being than the CBCS group (75 vs. 63, p < 0.001 and 84 vs. 77, p = 0.05); however, sexual well-being (56 vs. 66, p = 0.05) and physical well-being (65 vs. 76, p < 0.001) were worse in OBCS. After 42.3 (range: 12.6-69.2)-month median follow-up, no difference in event-free survival (EFS) was demonstrated between the groups (p = 0.13). Although OBCS has the better aesthetic outcomes and identical oncological safety in comparison with CBCS, the sexual and physical well-being in OBCS are not improved for Asian patients. Hence, choosing an appropriate procedure may be more important for the typically small to moderate-sized breasts characteristic of Asian females unlike Westerners. 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 .

Iatrogenic Endometriosis of the Breast Mimicking Fat Necrosis: A Case Report.

A female patient with a history of ductal carcinoma in situ in the left breast, status-post bilateral mastectomy with deep inferior epigastric perforator artery flap reconstructive surgery, presented with a right breast asymmetry concerning for fat necrosis. Histological analysis revealed the presence of benign glands and associated stroma within fibroadipose tissue, confirmed as endometriosis by immunohistochemical analysis. Further investigation revealed that the patient had a previous diagnosis of endometriosis associated with a cesarean section scar that likely seeded the ectopic endometrial glands into a tertiary site by utilizing abdominal tissue that may have harbored endometriosis.

WTP8.9 3D volume assessment as an objective tool in breast asymmetry management

Abstract Background The normal symmetrical appearance of the breast is a vital. It can be psychologically distressing to patients and affects their body perception when these differences are obvious. The goal of breast surgeons is minimising these differences to make them more acceptable to patients. Methods This study was done on 20 females seeking breast asymmetry correction. Age ranged from 18 to 45 years (mean age: 30.4). All patients had volumetric breast assessment using a (3D) imaging system (3D LifeViz®, Quantificare system). The first 10 patients were chosen randomly for breast (MRI) volumetry to confirm the results of the 3D system. The patients were managed with different single-stage surgical procedures depending upon the objective assessment of the volume difference between their breasts. Results Breast volume assessment using the 3D camera was done in all 20 patients pre-operatively 30 and postoperatively. The preoperative mean volume difference was 159.45 cm3, and the postoperative mean difference was 16.75 cm3, with an overall reduction in mean volume difference of 89.5%. Breast MRI volumetry was done for 10 randomly chosen patients to confirm the results and ranged between 3 and 12 cm3 (average 7.1 cm3) on the right and 0 and 15 cm3 (average 6.3 cm3) on the left. Comparing the 3D camera and MRI in assessing breast volume difference showed that the difference ranged between 1 and 5 cm3 with an average of 2.4 cm3, which was not statistically significant. Conclusion The 3D technology is useful objective tool to augment the surgeons’ experience. It helped to achieve an 84.57% reduction in volume difference in managing asymmetry with single-stage procedure.

Translation and validation of the French version of the adolescent idiopathic scoliosis Truncal Anterior Asymmetry Scoliosis Questionnaire (TAASQ).

Scoliosis is an abnormality which causes anterior trunk asymmetry. The Truncal Anterior Asymmetry Scoliosis Questionnaire-adolescent idiopathic scoliosis (AIS) (TAASQ) measures the feeling about anterior trunk appearance in girls with AIS. It comprises 14 questions which evaluate frontal asymmetry of breasts, shoulders, and waist as well as behavioral attitude. There is currently no validated questionnaire in French to evaluate truncal asymmetry in AIS girls. The aim of this study was to translate and validate the French version of the TAASQ (TAASQ-VF). The study reports the translation and transcultural adaptation of the TAASQ into French. The translation was tested on 20 patients to verify comprehension and modify if necessary. To assess the reliability of the translated version, each domain as well as the total measure were tested for internal consistency. Convergent validity was evaluated on 63 patients and test-retest on a sample of 15. The translation and content validation process resulted in a French version of the TAASQ. Internal consistency was over 0.80 for each item, over 0.70 for each domain, and 0.88 for the total scores. SAQ were used to perform convergent validity with TAASQ-VF. The TAASQ-FV correlated well with many of the SAQ domains (p < 0.05) and every TAASQ-FV domain correlated with at least one SAQ domain (p < 0.05). Test-retest reliability for the total score and for each domain was good. The translation and cross-cultural adaptation of the TAASQ questionnaire provides a French version that can measure the feeling about frontal appearance in girls with idiopathic scoliosis.

Differences in complications and asymmetry in patients who did not receive a balancing procedure in two-stage and direct-to-implant breast reconstruction

Background Implant-based immediate breast reconstruction surgery with nipple-sparing mastectomy has recently been favored by patients. However, in patients who do not wish to undergo balancing procedures, it is difficult to select the appropriate implant size, making it challenging to achieve a symmetrical breast shape. Therefore, this study investigated the differences in breast asymmetry and other complications in patients who underwent a two-stage procedure or direct-to-implant (DTI) breast reconstruction to determine whether the two-stage procedure can produce more favorable outcomes.Methods The participants of this study were patients who underwent immediate two-stage breast reconstruction or DTI breast reconstruction from May 2018 to April 2022, did not receive postoperative radiotherapy, and did not wish to undergo any balancing procedures. An acellular dermal matrix was used for breast reconstruction in all patients, and a single reconstructive surgeon performed all the operations. Statistical significance was set at P&lt;0.05.Results No significant differences in complications were found between the patients who underwent DTI breast reconstruction and those who underwent two-stage breast reconstruction. In the two-stage breast reconstruction group, breast volume asymmetry was observed in 18.4% (seven patients), which was significantly lower than the percentage of 44.7% (17 patients) observed in the DTI group.Conclusions Breast asymmetry was observed in a significant proportion of the patients in both groups. However, because breast volume asymmetry was more common in the DTI group than in the two-stage breast reconstruction group, two-stage breast reconstruction may be a favorable method for patients who do not wish to undergo balancing procedures.

THORAX AND IDIOPATHIC SCOLIOSIS

This review is related to the role of thorax in scoliogenesis. The embryology, the prenatal and the postnatal growth of the rib cage of (RC) and the lungs are briefly described. The development of normal RC, the frontal and sagittal diameters of it, the values of mid-thoracic diameters, the thoracic index, the biomechanical contribution of the RC to thoracic stability, the increase in frontal and sagittal thoracic diameter during breathing are defined. The infancy, childhood, puberty (ICP) model of growth is used in both the segmental thoracic ratios (TR) and the Segmental Rib-vertebra angles (RVA) in order to assess the normal and deformed RC in Early Onset (EOS) and Late Onset Scoliosis (LOS). The neuromuscular mechanisms as possible factors causing age-related RVAs changes are discussed. Then the posterior truncal/thoracic asymmetries are reviewed related to school scoliosis screening (SSS) referrals. Next, the development of RC is analyzed in resolving and progressive infantile idiopathic scoliosis (IIS), and in adolescent idiopathic scoliosis (AIS). The menarche and laterality of thoracic scoliotic curves, congenitally fused ribs and pulmonary function in children with idiopathic scoliosis (IS) is also discussed. The pathogenesis of IS according to the Nottingham concept and RC, the thorax and pelvis complex during gait and rotational inertia, the Double Rib Contour Sign (DRCS) and Rib Index (RI), the effect of growth on the relationship of spinal and thoracic deformity are explained. The postoperative fate of IS hump deformity in relation to the RI and the aetiological implications for IS are then stated. The role of the rib-sternum complex is mentioned. John Sevastiks thoracospinal concept of aetiopathogenesis of AIS and his research about IS are described, namely experiments on ribs, correction of experimentally produced scoliosis, suggested surgical intervention on the ribs, experiments on nerves, vascular changes in the chest wall after unilateral resection of the intercostal nerves, and breast asymmetries in female suffering AIS. A biomechanical model using different Cobb angle and rib hump (RH) correction is mentioned. The issue of thoracic kyphosis and hypokyphosis and the impact of the lateral spinal profile (LSP), that is the sagittal plane, is discussed. Finally, IS and evolution of thoracic shape as a scar of evolution are pointed out.

Aesthetic outcomes of oncoplastic surgical techniques in large benign lump of breast using breast Q tool

Large benign breast tumors encompass an array of conditions resulting in breast asymmetry with significant physical and mental morbidities. Breast oncoplasty, in these conditions have better aesthetic outcomes. Here, as the opinion of the patient is superior when compared to subjective opinion of the surgeon, breast Q tool, can be a tool to assess outcomes after using oncoplastic techniques. The following case series includes 20 patients admitted with large benign lesions of breast undergoing oncoplastic surgery, who were assessed to evaluate their satisfaction with breast, nipples, information surgeon and medical team, before and after breast oncoplasty, using breast Q tool version 2.0 reduction mastopexy module, where pre-operative and post operative scores are noted and also converted into equivalent RASCH scores (statistical analysis used: statistical package for the social sciences (SPSS) v.20 software). From the case series it was found that the average pre-operative scores for satisfaction with breasts was 21.95 and post-operative score was 42.95 (p value of 0.0001). Majority of patients had maximum scores for satisfaction with nipples (47% with breast Q score of 20 out of 20), satisfaction with outcome (45% with RASCH score of 100 and 55% with RASCH score of 92), satisfaction with information (55% with RASCH score of 100) and satisfaction with medical team (75% with RASCH score of 100). It was clearly noted that from breast Q tool for reduction mammoplasty, there was excellent post-operative satisfaction among patients across various domains, when oncoplasty is employed for large benign breast diseases.

Breast tissue density as a predictor of complications in reconstructive and plastic surgery

Aesthetic breast surgery is consistently a leading position in plastic surgery. According to the International Society of Aesthetic Plastic Surgery (ISAPS), in 2019, 1 795 551 breast augmentations were performed. However, as the number of primary surgeries increases, so does the percentage of complications and consequent patient dissatisfaction with the primary intervention results. Approximately 20% of women experience postoperative complications, such as breast asymmetry, implant displacement, double fold (“double bubble”), rippling, capsular contracture, seroma, hematoma, suture dehiscence, and others. Women with decreased breast tissue tone due to postinvolutive changes are at risk for postoperative complications. The risk of complications also increases when not just breast augmentation, but a combination of augmentation and mastopexy is required. In most cases, when a surgical intervention is recommended in several stages, patients are not willing to wait for a long time. This group of women is the most difficult for the clinician and therefore requires an analysis of all possible risk factors for complications development. Therefore, finding new possible ways to predict complications in reconstructive and plastic breast surgery is a relevant and priority direction.Purpose of a study: to develop a technique for preventing complications in reconstructive and plastic breast surgery.Material and methods. The results of 37 breast augmentation surgeries with T-shaped mastopexy in patients with different breast tissue density were analyzed, based on which an improved method of this operation was proposed. A comparative analysis of postoperative complications in early and late postoperative periods was carried out, and patients were surveyed before breast reconstruction and plastic surgery and 3, 6, and 12 months after plastic surgery to evaluate patient satisfaction with the outcome.Results. The analysis of the obtained data showed that breast tissue density plays a key role in choosing the tactics of breast augmentation with T-shaped mastopexy and is a predictor of complications development in the postoperative period.Conclusion. The planning of breast augmentation with T-shaped mastopexy should be carried out taking into account the determination of a patient's breast tissue density, which can affect the reduction of the risk of surgical complications during the surgery and in the postoperative period. The use of mastopexy technique with a preliminary marking of incisions with a margin of 1 cm to the central line from the classical V-shaped marking line is expedient in the presence of dense breast tissue in the patient.

Short-term safety and cosmetic outcomes of endoscopic direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation for breast cancer: a prospective analysis of 33 patients

BackgroundFor patients with small breasts, breast-conserving surgery (BCS) and unilateral nipple-/skin-sparing mastectomy (N/SSM) with breast reconstruction may result in visible breast deformities or asymmetry, and contralateral breast augmentation often require a two-staged operation. We propose a novel endoscopic technique, direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation (DTI-BR-SCBA), and report its short-term safety and cosmetic outcomes.MethodsIn this prospective study, patients with early breast cancer who underwent endoscopic DTI-BR-SCBA between November 2020 and August 2022 were followed for more than 3 months to analysed short-term postoperative safety (complications and oncological safety) and cosmetic outcomes (doctor-assessed results by Ueda scale and patient-reported results by Breast-Q scale).ResultsA total of 33 patients, including 30 treated with endoscopic prepectoral DTI-BR-SCBA, 1 with endoscopic dual-plane DTI-BR-SCBA and 2 with endoscopic subpectoral DTI-BR-SCBA, were analysed. The mean age was 39.7 ± 6.7 years. The mean operation time was 165.1 ± 36.1 min. The overall surgical complication rate was 18.2%. All complications were minor, including haemorrhage (3.0%), cured by compression haemostasis, surgical site infection (9.1%), cured by oral antibiotics, and self-healing nipple-areolar complex ischaemia (6.1%). Furthermore, rippling and implant edge visibility occurred in 6.2% of them. The outcome was graded as “Excellent” and “Good” in 87.9% and 12.1% of patients in the doctor cosmetic assessment, respectively, and patient satisfaction with breasts was significantly improved (55.0 ± 9.5 vs. 58.8 ± 7.9, P = 0.046).ConclusionsThe novel endoscopic DTI-BR-SCBA method may be an ideal alternative for patients with small breasts because it can improve cosmetic results with a relatively low complications rate, which makes it worthy of clinical promotion.

Oncoplastic Breast Reconstruction for Large Pediatric Breast Tumors: A Case Series.

Large breast fibroadenomas in pediatric females may cause discomfort, asymmetry, and psychological stress, and patients may elect for surgical excision. There are no criteria for reconstruction after the excision of these masses, and the research is limited in describing oncoplastic techniques in pediatric fibroadenoma excision. Nononcoplastic techniques, such as mastectomy with implant or flap reconstruction, have been used for pediatric fibroadenoma excision reconstruction. Oncoplastic techniques using Wise pattern or circumareolar incisions have shown to have efficacious outcomes. In addition, pediatric females undergoing breast surgery risk long-term complications such as continued breast asymmetry due to further breast growth, nipple and breast hypoesthesia, and future breastfeeding difficulty. This case series describes the oncoplastic techniques used for large benign mass excision and reconstruction of 3 pediatric females. A Wise pattern technique was used for all 3 patients, and 2 underwent a free-nipple graft. Oncoplastic techniques for pediatric breast mass excision provide satisfactory aesthetic outcomes with minimal surgical morbidity. Further research assessing the long-term effects of pediatric breast mass excision and reconstruction would be beneficial.

Role of tomosynthesis and ultrasound in the assessment of asymmetric breast densities: a comparative prospective study

BackgroundTomosynthesis is a recent advancement of full-field digital mammography involves transforming two-dimensional (2D) breast images into three dimensions (3D) images. It reduces the adverse effect of tissue superimposition on conventional 2D- mammography, therefore having high potential enhancing identification and assessment of asymmetric breast densities. The aim of the study was to assess and compare the diagnostic performance of breast ultrasound and 3D digital breast tomosynthesis in the assessment of asymmetric breast densities.ResultsIn the current study, 80 patients with 80 mammographically and/or tomosynthesized breast asymmetries were included. The patients' ages ranged from 30 to 70 years old, with a mean age of 47.2 ± 9.2 SD. Breast ultrasound outperformed digital breast tomosynthesis in terms of diagnostic performance. Tomosynthesis had a sensitivity of 86.4%, specificity of 93.1%, positive predictive value of 82.6%, negative predictive value of 94.7%, and accuracy of 91.3% compared to ultrasounds' sensitivity of 100.00%, specificity of 93.1%, positive predictive value of 84.6%, negative predictive value of 100.00%, and accuracy of 95%.ConclusionsIncorporating ultrasonography in the assessment of asymmetric breast densities outperformed tomosynthesis and shown to be more precise in characterisation of lesions underlying asymmetric breast density.

What’s beyond breast asymmetry? Comparative study between artificial intelligence and contrast-enhanced spectral mammography in the assessment of various types of breast asymmetries

BackgroundBreast asymmetries are prevalent findings in mammograms and are commonly caused by variations in normal breast tissue. However, they may imply significant underlying causes in some cases. Such cases necessitate further assessment by adding further mammography views, targeted ultrasound, and investigations to exclude underlying pathology.ObjectivesTo investigate the role of artificial intelligence (AI) compared to contrast-enhanced spectral mammography (CESM) in the assessment of breast asymmetries and their performance as diagnostic modality among different types of breast asymmetries as well as the additive value of AI software to mammography in these cases.MethodsSixty-four female patients were diagnosed with breast asymmetries by standard mammography (MMG) on both craniocaudal (CC) and mediolateral oblique (MLO). Digital breast tomosynthesis (DBT) may have been added. After evaluating the breast asymmetry by MMG and complementary breast ultrasound (US), both CESM and AI were performed for all cases and analyzed, then the interpreted results were compared accordingly either by histopathology from suspected lesions scored as BI-RADS 4 or 5 or through further close follow-up by single-view mammography in benign cases scored as BI-RADS 2 or 3.ResultsThe sensitivity and specificity of CESM in the assessment of breast asymmetry in correlation with pathological data/follow-up results were 100% and 60% (p < 0.001). The corresponding values for AI were 70.83% and 75%; however, the estimated overall accuracy for both CESM and AI was close to each other measuring 75% and 73.44%, respectively (p < 0.001). The diagnostic accuracy of CESM to detect malignant causes of breast asymmetry was 100%; however, the detection of benign causes of breast asymmetry was 40%. The corresponding values for AI were 70.83% and 25%, respectively, with significant p-value (p < 0.001).ConclusionsThe CESM was more sensitive; however, the AI was more specific in the assessment of different breast asymmetries. Although the diagnostic accuracy of both is close to each other. Therefore, AI-aided reading can replace CESM in most cases, especially for those contraindicated to do CESM. AI also can reduce the radiation exposure hazards of a second dose of radiation for CESM and its financial cost as well. AI-aided reading in breast screening programs can reduce the recall of patients, unnecessary biopsies, and short-interval follow-up exams.