Breast Asymmetry Research Articles

Optimizing Surgical Outcomes: A Case Series on BREAST-V for Treating Breast Asymmetries.

Breast asymmetry occurs when there is a discrepancy in the shape, volume, or positioning of the breasts. Various factors, including unequal development of breast buds, endocrine disorders, chest wall deformities, and surgical or posttraumatic sequelae, can contribute to this condition. Although breast asymmetry is common, clinically severe cases are rare and often require surgical correction because of potential postural, aesthetic, and psychological issues. Accurate assessment of the breast volume is crucial for planning and evaluating surgical interventions. This prospective, non-randomized, interventional study was conducted between 2019 and 2024 at the Breast Reconstruction Section of the Federal University of São Paulo, Brazil. Forty patients with breast asymmetry were evaluated using the BREAST-V, which calculates the breast volume based on three linear measurements. Patients underwent various surgical procedures, including augmentation, reduction mammoplasty, and mastopexy, tailored to their specific type of asymmetry. Preoperative and postoperative breast volumes were compared to assess the effectiveness of surgical correction RESULTS: The study included 40 participants, with an average age of 25.2 years. The mean preoperative breast volumes were 469.6g (right) and 448.8g (left). The postoperative volumes decreased to 338.3g (right) and 331.1g (left), showing an average reduction in asymmetry of 72.9%. The minimal clinically important difference (MCID) for pre-treatment asymmetry was 65.4g. The BREAST-V tool has significant potential for the objective assessment of breast asymmetry. Reliable volumetric measurements can aid in surgical planning and postoperative evaluation, ultimately enhancing the clinical outcomes. 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 .

Sisters But Not Twins: A Critical Appraisal of Long-Term Results in Breast Asymmetry Correction.

Breast asymmetry is a common disorder, which can lead to significant emotional distress. Despite this, there is currently no widely accepted approach for managing this prevalent condition. Due to the high dimorphism of the breast, despite a satisfactory result in the short-term post-op, the recurrence of asymmetry is one of the most common weak points of breast recontouring. The purpose of this paper is to investigate the long-lasting maintenance of breast symmetry in women who have undergone surgical correction of asymmetric breasts through mastopexy or reduction mammoplasty and to try to identify some specific elements to achieve more stable outcomes in the long term. A retrospective study was conducted on 1,984 breast surgical procedures carried out between 2002 and 2020 to evaluate patient satisfaction and the recurrence rate of asymmetry disorders. All the patients enrolled in this study were given a questionnaire to evaluate their satisfaction level. A retrospective iconographic-chart review was investigated by the same senior surgeon, who recorded the presence or the absence of recurring breast asymmetry. In total, 1984 patients were enrolled who respected the minimum standard of the study; 596 showed up at post-op follow-up longer than three years. Most of the patients showed great satisfaction with the results, even if several recurrences of asymmetry were reported. The recurrence of asymmetry is one of the most common weak points of breast asymmetry correction procedures due to the high dimorphism of the breasts. In order to fully assess the results of asymmetric breast correction, patients should be required to attend a post-op follow-up examination after a long time frame. Indeed, the strength of this paper lies in the focus on long-term postoperative follow-up. 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 .

Incidental Finding of Breast Tumor After Scoliosis Surgery: A Case Report.

Breast asymmetry (BA) is a common condition in patients with adolescent idiopathic scoliosis (AIS). Physicians may misdiagnose a patient with a unilateral breast tumor as a normal condition related to scoliosis. The present report describes the case of a patient with a breast tumor that was detected incidentally after surgical correction of scoliosis. A 21-year-old woman was diagnosed as having AIS and reported to our institute for management. Thoracic third to lumbar second vertebra instrumented spine de-rotation and associated fusion surgery were performed to correct the deformity. After the operation, enlargement of left breast volume and obvious BA were noted. Breast sonography was performed, and a large tumor was found. Finally, the biopsy revealed a fibroadenoma of the left breast. In managing patients with scoliosis and BA, comprehensive consideration of other possible etiologies is crucial to prevent misdiagnosis. This article reminds physicians that breast tumors can be concealed by BA related to AIS.

Breast implant-associated anaplastic large cell lymphoma.

Breast implant-associated anaplastic large cell lymphoma is a subtype of non-Hodgkin's lymphoma that can occur around the surface of textured breast implants or in patients who have previously had textured breast implants. The condition should be suspected in cases of late-onset breast asymmetry and seroma formation around a breast implant. If the implant and surrounding connective tissue capsule is removed, the prognosis is usually very good. The purpose of this clinical review article is to provide a brief overview of the diagnosis and treatment of breast implant-associated anaplastic large cell lymphoma.

Primary Breast Necrotising Fasciitis in an Elderly Woman Managed with Nipple–Areola Conservation and Delayed Primary Closure in a Resource-Poor Setting A Case Report

Abstract Primary breast necrotising fasciitis is a rare disease that can rapidly progress with high morbidity and mortality rates. Due to its rare occurrence, it is often misdiagnosed. This case was a 65-year-old, obese, immobile, and newly diagnosed woman who presented with a 2-week history of progressive left breast pain and swelling with associated darkening of the breast skin and discharge of foul-smelling fluid. There was no history of fever and the nipple–areola complex was spared. The surrounding healthy skin has a characteristic peau d’orange and erythematous. Two discrete and slightly tender left axillary lymph nodes were noted. At the presentation, her blood sugar was high. Initially, a breast malignancy was suspected but later an ultrasound showed increased fibrous and fatty tissue architecture of the mammary gland. It also noted inflammatory collections within the mammary glands and thus concluded breast inflammation. Early intervention with antibiotic cover and wound debridement forestalled the progress of the disease and nipple–areola salvage. The wound was later covered by delayed primary closure after 14 days of wound dressing with a silver-based solution. Breast asymmetry was noted as a surgical complication. Early aggressive intervention in necrotising fasciitis of the breast in an elderly woman with comorbidities contributed to the preservation of nipple–areola complex with eventual satisfactory management using direct wound closure.

Clinical Experience in the Management of the Polyacrylamide Hydrogel (PAAG) Associated Complications Including Four Breast Cancer Cases: A Retrospective Study of 135 Cases.

Complications often arose after polyacrylamide hydrogel (PAAG) injections for breast augmentation. This study aimed to explore the complications and clinical management of breast augmentation with PAAG. We retrospectively analyzed the data of 135 patients who underwent breast PAAG removal from January 2011 to December 2023 in our hospital. We also comprehensively analyzed the postoperative clinical results, subsequent complications, and clinical management after PAAG injections. Induration and nodules (60.0%), pain (27.4%), anxiety (22.2%), migration (13.3%), asymmetry (8.1%), swelling (5.9%), infection (5.2%), calcification (3.7%), and breast cancer (BC) (3.0%) were a few complications after PAAG injections. Although breast cancer was a rare complication, it might be covered up by PAAG tissue. Eighty-eight patients had undergone PAAG removal, while 47 patients had additional breast reconstruction surgery. The post-surgical complications included PAAG residue (17.0%), skin laxity (7.4%), hemorrhage (2.2%), reoperation (1.5%), and nipple or breast asymmetry (1.5%). Additionally, the BREAST-Q scores revealed that patients with breast reconstruction had a significant better outcomes in psychosocial well-being (p < 0.001), satisfaction with breasts (p < 0.001), and sexual well-being (p = 0.008). Multiple complications could occur after PAAG injections for breast augmentation. Although rare, BC might need more clinical attention. PAAG removal could alleviate some complications, and breast reconstruction contributed to improved patient satisfaction, psychosocial well-being,and sexual well-being. 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.

Modified peri-areolar mastopexy and fat grafting in complex breast ptosis: A randomized open-label controlled trial

BackgroundComplex breast ptosis may be caused by moderate and severe degrees of skin and glandular sagging associated with breast' and nipple-areola complex (NAC) asymmetries and deformity. The use of traditional peri-areolar mastopexy (t-PM) with or without implants is limited only for mild or moderate breast ptosis. ObjectivesThis article aims to report the safety and efficacy of the modified peri-areolar mastopexy (m-PM) characterized by a vertical shift of the classical pattern with implants and fat grafting (FG) in complex breast ptosis also evaluating the influence of breast and NAC asymmetries, breast, and chest deformities in the aesthetics outcomes. MethodsAn open label randomized controlled trial was performed. 40 women (study group - SG) affected by breast ptosis (moderate, and severe), asymmetries, and deformities were treated with m-PM, implants, and FG, comparing outcomes with those of a control group (CG) (n = 35) treated with t-PM and implants. Aesthetic outcomes were evaluated through the patient’s satisfaction grade, the physician's assessment score, and the visual Analog Scale (VAS). Results75% (n = 30) of SG patients reported excellent results on breast lift, shape, volume, NAC position, and scar quality after 12 months, while the CG reported the same outcomes in 60% (n = 21) of cases. SG patients showed a vertical NAC shift and a satisfaction degree higher than in the CG (p < 0.001 vs. CG). ConclusionsThe m-PM with implants and FG was safe and effective in this trial.

Bioenergetic analysis and anthropometric evaluation of bra-breast interface for improved design and breast health

Bioenergetics analysis of bra-breast Interface is an important technique for improving the design of bras and promoting breast health and comfort during physical activity. The objective of this study is to evaluate the compatibility between the anatomy of the breasts and bra. The study encompasses breast anthropometry via measurement. A measurement topology was proposed to determine breast mass, volume, shape, and asymmetry under loading (with-bra) and unloading (without-bra). Using the anthropometric data, the bioenergetics of the breasts were determined and compared to the rest of the body. From the bioenergetic analysis, a larger breast could require up to 69 J of energy during walking. The average mass of a breast ranges from 500 to 1000 g. Assuming breast shape to be standard, semi-conical, semi-spherical and semi-elliptical, breast volume was determined where semi conical and semi spherical breast shapes consistently predicted lower bound volume for each breast, whereas the standard and semi elliptical breast shapes predicted higher volume for the same breasts measurements. Mathematically, the medial-lateral boundaries of the breast were described by a secant of a curve, aligned on the coronal plane, causing eccentric loading when the two breast nipples were on different transverse planes. When this variation was more than 5% volume change, asymmetric breast shapes occurred and was responsible to displace bra heterogeneously compromising fit and support. A non-linear, leaf-function describing the relationship between the breast radius and volume invoked at a given body weight. In general, the current design for a bra assumes that the breasts are symmetrical, though the current investigation proves that this is not the case. The bra needs to be redesigned to better fit women, since left and right sides are not symmetrical. This is a significant problem today, as it is estimated that nearly 80% of women wear incorrectly- sized bras; 70% wore bras that are too small, and 10% wore bras that are too big. Current investigation highlights the crucial importance of incorporating the distance between the nipples into bra design to achieve optimal support, comfort, symmetry, and minimize breast movement. It ensures that the bra cups are positioned optimally to provide effective support and enhance the natural shape of the breasts. If the current bra models are redesigned, the amount of discomfort in women could potentially decrease.

Relative Distribution of Common Breast and Chest Asymmetries in 2051 Primary Augmentation Mammoplasties in Nonptotic Subgroup of Patients.

Breast and chest asymmetries are extremely common, and primary augmentation mammoplasty can be challenging in these cases. However, there is a paucity of information on the relative distribution of these asymmetries and the implant sizes used in these patients. A retrospective chart review of all consecutive cases of primary augmentation mammoplasty performed by a single surgeon from May 1999 to May 2012 was conducted. Patients with chest and breast asymmetries were noted by clinical examination and observation. These patients were selected to review how many patients had similar or different-sized implants. Patients presenting with unilateral or bilateral ptosis and requiring mastopexy were excluded. A total of 2051 patients underwent primary augmentation mammoplasty. Uneven chest wall or uneven ribs were noted in 274 patients (right more prominent 72, left more prominent 202). Of these, 169 patients had implants of the same size, and 37 patients had implants of different sizes. Similarly, 1008 patients presented with uneven breasts, and of these, 272 patients had different-sized implants. One patient needed revision surgery for implant size and breast volume readjustment. Chest and breast asymmetries are extremely common. Routine clinical examination is more than adequate to delineate such asymmetries. The majority of these patients have small differences, and not all patients with asymmetries require implants of different sizes.

Current understanding and future directions in diagnosis and treatment in breast asymmetry: a literature review

Breast asymmetry can be caused by hormonal fluctuations, surgery, or developmental abnormalities that result in disparities in the size, shape, or location of the breasts. When it comes to identifying and assessing asymmetry, diagnostic techniques such as mammography, ultrasonography, MRI, and 3D tomosynthesis provide clear advantages. To address both functional needs and aesthetic concerns, there are various treatment options available, including non-surgical techniques such as hormone therapy and fat grafting, as well as surgical techniques such as augmentation, reduction, and mastopexy. With the help of AI and machine learning, future advancements in imaging improve the accuracy of diagnoses, enabling customized treatment plans based on molecular and genetic profiles. The field is evolving due to advancements in minimally invasive, 3D-printed implants enabling customization, and regenerative therapies such as stem cell treatments, with the goal of optimizing outcomes while minimizing recovery time and complications. Non-surgical alternatives such as focused ultrasound and injectable fillers provide additional choices for patients preferring less invasive treatments. Holistic patient care integrates virtual reality for surgical planning and psychosocial support, ensuring comprehensive management of both physical and emotional aspects. Overall, ongoing innovations are poised to revolutionize breast asymmetry management, offering tailored solutions that improve patient outcomes and quality of life.

Oncoplastic Surgery Outcomes in the Older Breast Cancer Population: A Matched-Cohort Comparison Study.

Oncoplastic breast surgery (OBS) is a form of breast conservation surgery (BCS) that involves a partial mastectomy followed by immediate volume displacement or volume replacement surgical techniques. To date, there are few studies evaluating OBS in older patients. Therefore, we sought to determine if outcomes differed between patients 65 years and older versus younger patients who underwent oncoplastic surgical procedures. A retrospective chart review was performed for all oncoplastic breast operations within a single health system from 2015 to 2021. Patients were stratified by age, with patients 65 years and older (OBS65+) identified and then matched with younger patients (OBS <65) based on BMI. Primary outcomes were positive margin rates and overall complication rates; secondary outcomes were locoregional recurrence (LR), distant recurrence (DR), disease-free survival (DFS), overall survival (OS), and long-term breast asymmetry. A total of 217 patients underwent OBS over the 6-year period, with 22% being OBS65+. Preoperatively, older patients experienced higher American Anesthesia (ASA) scores, Charlson Co-morbidity index (CCI) scores, and higher rates of diabetes mellitus, hypertension, and grade 3 breast ptosis. Despite this, no significant differences were found between primary or secondary outcomes compared to younger patients undergoing the same procedures. Oncoplastic breast reconstruction is a safe option in patients 65 years and older, with overall similar recurrence rates, positive margin rates, and survival when compared to younger patients. Although the older cohort of patients had greater preoperative risk, there was no difference in overall surgical complication rates or outcomes. Supporting the argument that all oncoplastic breast reconstruction techniques should be offered to eligible patients, irrespective of age.

The association between breast implants and anaplastic large cell lymphoma - a comprehensive review

Introduction and purpose: Recently, the topic of the incidence of breast implant-associated anaplastic large cell lymphoma has become very popular. The aetiology of the disease is not fully understood. Many women worldwide have undergone breast implant surgery, so raising awareness about the possibility of developing BIA-ALCL is crucial for early diagnosis. The aim of this article is to review and compile the currently available knowledge regarding the association of anaplastic large cell lymphoma with breast implants in patients who have undergone implant plastic surgery. Brief description of the state of knowledge: Literature data indicate a multifactorial aetiology of BIA-ALCL. Textured surface breast implants are suspected to be a significant risk factor, as they may lead to the development of chronic inflammation. The most common symptoms of BIA-ALCL include the accumulation of serous fluid around the breast implant, pain, swelling or breast asymmetry. A proper diagnostic and therapeutic process improves the prognosis. Material and methods: A comprehensive literature review was conducted using PubMed and Google Scholar databases. The search strategy was based on the following terms: BIA-ALCL; lymphoma; breast implants; textured implants. Conclusions: Although BIA-ALCL is a rare disease, it is important to know the risk factors and clinical signs that may suggest the disease. A proper diagnostic process allows the disease to be detected at an early stage and treated effectively. Knowledge of the occurrence of potential complications of implant surgery allows patients to take informed consent and increases vigilance on the part of clinicians.

Can a Breast Augmentation Procedure Improve the Appearance of Pectus Excavatum Deformity in Female Patients? A Prospective Study.

This study evaluates a specific breast augmentation (BA) technique in patients with pectus excavatum(PE) and its results in improving this deformity, augmenting the breasts, and correcting the concurrent breast asymmetry. Twenty-eight patients with PE were treated from 2017 to 2021. All patients who visited our private practice were aiming to augment their breasts, correct their breast asymmetry, and improve their PE. The mean age of the patients was 25 years. In most cases, the submuscular dual-plane technique was chosen. Patients' quality of life regarding their chest wall deformity was assessed using the Single Step Questionnaire (SSQ). Subjects' quality of life regarding general self-esteem, psychosocial well-being, and physical function were assessed at initial screening and 24-month follow-up using the BREAST-Q V2 questionnaire. Also, patients filled out a pain-evaluating questionnaire concerning the first 5 postoperative days to determine the recovery of this specific technique. No complications were observed. The SSQ revealed high satisfaction (mean score=73) and significant (P = 0.001) improvement following the operation. The improvements regarding psychosocial well-being, sexual well-being, and satisfaction with the BREAST-Q were also equally high (P = 0.001). The pain was minimal during the first five postoperative days. This is the first prospective study that evaluates the quality of life using both the SSQ, the validated BREAST-Q, and the pain score when performing BA in patients with PE and breast asymmetry using breast silicone implants. BA is a procedure that can give excellent results both regarding chest wall deformity and BA in PE patients.

Abstract PO2-02-14: Development of a multi-institutional, photograph-rich clinical dataset to test and validate a novel inflammatory breast cancer (IBC) scoring system

Abstract Purpose: Susan G. Komen, The Inflammatory Breast Cancer (IBC) Research Foundation, and the Milburn Foundation convened a collaborative of patient advocates, clinicians, and researchers and proposed a novel quantitative scoring system for IBC diagnosis. The score includes timing of symptoms, extent of skin edema and erythema/other discoloration, breast and nipple asymmetry, lympho-vascular space invasion, nodal stage, and diffuse extent disease in the breast on breast imaging. Total scores were categorized (&amp;lt; 14 Not IBC, 14-24 Weak Possibility of IBC, 25-41 Strong Possibility of IBC, &amp;gt; 41 Definitely IBC). Herein, we developed a multi-institutional clinical dataset to retrospectively test and validate the proposed scoring system. Methods: IBC (N= 988) and non-IBC (N=322) cases were identified at two institutions with dedicated multi-disciplinary IBC programs, UT MD Anderson Cancer Center (MDA) and Dana-Farber Cancer Institute (DFCI). The DFCI cohort was diagnosed from 1986-2021 and the MDA cohort was diagnosed from 2010-2020. The non-IBC cohorts were identified as consecutive T4b and T4c cases in existing retrospective databases. Photographs were reviewed for available cases. All scoring variables were reviewed with data extractors and standard operating procedures (SOPs) developed for all ambiguous findings and language. A subset of scores were reviewed by IBC clinicians (FL, WW) and discrepancies discussed to inform the SOPs. Missing data imputation using three methods was examined. Area under the curve (AUC) - Receiver operator characteristic (ROC) curves and values, and sensitivity and specificity for the proposed score cut offs were examined. Results: Of 1320 patients currently in the analysis, 421 (31.9%) have missing data on &amp;gt; 1 characteristics and 47 (3.6%) are missing data on &amp;gt; 4. The rubric characteristic most commonly missing was “nipple abnormalities” accounting for 21.0% and 19.3% for IBC and non-IBC cohorts respectively. Unavailable bilateral breast photograph was the primary source of missing data. The highest scoring finding was present in the following percentage of IBC and non-IBC cases, respectively: timing of symptom onset &amp;lt; 3 months (74.1% vs 38.6%), any peau d’orange (61.2% vs 30.1%), clinically apparent enlargement or new asymmetry of breast size (87.8% vs 90.1%), complete or near complete involvement of the breast skin by erythema or discoloration (55.6% vs 25.6%), new nipple inversion (24.6% vs 9.0%), dermal lymphovascular emboli present (17.9% vs 1.8%), diffuse involvement of the breast parenchyma by imaging (72% vs 77.7%). True IBC cases were categorized as Definitely IBC, Strong Possibility, Weak Possibility, not IBC and unknown 19.7%, 49.1%, 0.4%, 0.1%, and 30.7%. True non-IBC were 0.6%, 51.8%, 9.9%, 2.1%, and 35.5%. Random imputation, lowest value imputation, and median value imputation were compared to impute missing data. AUC-ROC values for each method were similar, 0.80 - 0.84. Conclusion: We describe the development of the largest multi-institutional IBC clinical database to date. SOPs for the rubric characteristics were developed. The importance of bilateral photography to assess the score retrospectively is highlighted. The score is associated with a good AUC-ROC but still leaves much overlap among cases between 25 and 42. Further optimization of the current scoring system and association with outcomes are in progress. Citation Format: Filipa Lynce, Samuel Niman, Megumi Kai, Sean Ryan, Elizabeth Troll, Li Li, Kathy Miller, Reshma Jagsi, Ginny Mason, Beth Overmoyer, H. T. Carisa Le-Petross, Faina Nakhlis, Savitri Krishnamurthy, Beth Harrison, Susie X. Sun, Eren Yeh, Jennifer Bellon, Laura Warren, Michael Stauder, Meredith Regan, Wendy Woodward. Development of a multi-institutional, photograph-rich clinical dataset to test and validate a novel inflammatory breast cancer (IBC) scoring system [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-02-14.

Abstract PS10-08: Validation of a clinical image-based AI-risk model for individualized breast cancer screening in a multi-national setting

Abstract Background: Image-derived AI risk models for breast cancer have shown high discriminatory performances compared with clinical risk models based on family history and lifestyle factors. However, little is known about their generalizability across different screening settings and clinical feasibility. Purpose: To investigate the predictive performance of a clinically used image-derived AI-based breast cancer risk model in multiple European screening populations. Methods: Four European mammographic screening populations in three countries screened between 2009-2020 for women aged 45-69 was used to perform a nested case-control study. In total, 739 women with incident breast cancers were included together with 7,812 controls matched to cases on year of study-entry. Mammographic features (density, microcalcifications, masses, left-right breast asymmetries of these features) for risk assessment were extracted using AI from full-field digital mammograms. Breast cancer occurrence was assessed after two years of follow-up. Absolute risks of breast cancer were predicted using the risk model from negative mammograms at study-entry. Adjusted Area Under the receiver operating characteristic Curves (aAUC) estimated discriminatory performance and, adjusted risk-ratios estimated the stratification performance of women at high/general risk per the clinical guidelines. Results: The overall aAUC of the AI risk model was 0.72 (95%CI 0.70-0.75), range 0.71 (95%CI 0.67-0.75) to 0.74 (95%CI 0.69-0.78) for breast cancers developed in four screening populations. In the 4.6% of women classified at high risk using the NICE guidelines thresholds, cancers were more likely diagnosed after 2 years follow-up, risk-ratio (RR) 6.7 (95%CI 5.6-8.0), compared with the 71% of women classified at general risk by the model. Similar risk-ratios were observed across tertiles of mammographic density. In the high-risk group, 22% of the 2-year future cancers were diagnosed, and 29% of stage 2 and higher cancers, p&amp;lt; 0.01. Conclusions: The AI risk model showed generalizable discriminatory performances across European populations and, captured ~30% of clinically relevant stage 2 and higher breast cancers in ~5% of high-risk women who were sent home with a negative mammogram. Similar results were seen in fatty and dense breasts. An image-derived AI model is feasible for personalized screening to improve screening outcomes. Citation Format: Mikael Eriksson, Marta Román, Axel Gräwingholt, Sylvia Heywang-Köbrunner, Paolo Rossi, Per Hall. Validation of a clinical image-based AI-risk model for individualized breast cancer screening in a multi-national setting [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS10-08.

Abstract PO4-20-10: Value of 16α-18F-fluoro-17β-fluoroestradiol PET imaging in ER-positive breast cancer: a case report

Abstract Introduction: An appropriate use criteria workgroup recently recommended the use of PET imaging utilizing the 16α-18F-fluoro-17β-fluoroestradiol (FES) radiotracer as a measure of disease progression and endocrine treatment response for ER-positive breast cancers. Past studies report limitations of decreased FDG uptake, the most common PET radiotracer, when measuring low Ki-67 scoring tumors; FES-PET may noninvasively address this shortcoming in FDG activity detection. Its benefit of detecting low-grade, ER-positive tumor activity was demonstrated in a patient with breast cancer who exhibited tumor growth only on FES-PET while FDG-PET showed no measurable disease. Clinical Case: A 57-year-old postmenopausal woman presented in December 2017 with de novo metastatic invasive ductal carcinoma that was ER+ (100%), PR+ (100%), and HER2- involving the right breast, bone, lungs, and internal mammary, subcarinal, and right hilar lymph nodes. She received nab-paclitaxel and radiation to the right breast, regional lymph nodes, and T11 bone. In March 2019, she underwent a right mastectomy with pathology that noted residual disease in the breast measuring &amp;lt;5 mm and was placed on exemestane in April 2019. She transferred her care to City of Hope and follow-up FDG-PET restaging showed no evidence of new metabolically active metastatic disease. Her cancer antigen 27.29 levels were also within normal limits. In the absence of measurable disease growth, she continued to be treated with single agent exemestane. Due to persistent back discomfort that she attributed to breast asymmetry, she requested the left breast to be removed. One week prior to surgery, both FDG-PET/CT and bloodwork inclusive of tumor markers were normal. She underwent a left mastectomy in March 2023. Pathology identified an incidental 1.4 cm lymph node in the 2000 g specimen that was ER+ (&amp;gt;95%), PR-, and HER2- with a Ki-67 of 1-3%. Somatic gene testing of the tumor revealed an ESR1 D538G mutation. As her progressive disease was not evident on previous FDG-PET imaging, an FES-PET/CT was performed and demonstrated uptake in the ilium, T10, and T12 bones that was not identified on FDG-PET/CT. With objective evidence of evaluable disease, exemestane was discontinued and fulvestrant and ribociclib were initiated. Clinically, she has evidence of early response to therapy with improvement in back pain. Discussion: This case demonstrates the value of FES-PET/CT in identifying disease that was not appreciated on FDG-PET/CT or by cancer antigen 27.29 monitoring. Additionally, ESR1 status has not been consistently reported in studies of patients undergoing FES-PET imaging that investigate the radiotracer’s value in predicting response to subsequent endocrine therapy. Our patient has a documented ESR1 mutation, her disease was clearly identified only on FES-PET/CT, and FES uptake predicted for response to subsequent endocrine therapy. Incorporating FES-PET in routine staging should be considered in patients with metastatic breast cancer that is low-grade and ER-positive. Further evidence of response prediction in patients with ESR1 mutations will enhance the utility of FES-PET in the clinical management of these patients. Citation Format: Megan Wong, Veronica Jones, Dave Yamauchi, Joanne Mortimer. Value of 16α-18F-fluoro-17β-fluoroestradiol PET imaging in ER-positive breast cancer: a case report [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-20-10.

Using Photogrammetry to Analyze Anatomical Changes in the Nipple in Juvenile and Adolescent Scoliosis Patients.

The need for an objective set of anterior trunk measurements, such as nipple and clavicular shoulder joints, is essential to quantify the anterior asymmetry present in scoliosis. This study aims to characterize breast asymmetry (BA) in young individuals with scoliosis using photogrammetry. Digital photographs of the anterior trunk of the 51 scoliosis patients aged 4-20years were taken from an anterior perspective. These images were then transferred to a computer. Ten parameters were measured using the ImageJ software. The positions of patients' nipples were classified into 6 types based on ratios on the x-axis. The majority of patients had a right breast that was larger, intensifying the apparent BA due to trunk rotation. The apical vertebra level in patients was found at T8 in 23.6% and T9 in 45.1%. In 92.5% of the patients, the right breast was consistently larger. The lengths between the lateral boundaries and nipples of the right and left breasts and between the medial boundary and nipple of the right breast were statistically significantly higher in males than in females (p < 0.05). Significant differences were found when comparing the values of the lengths between the medial boundaries and nipples of the right and left breasts, the difference in length between the right and left acromioclavicular joint lines, and the angles of the nipple and acromioclavicular joint with the degrees of scoliosis in juvenile and adolescents (p < 0.05). Pearson regression analysis revealed a significant correlation between BA differences and the Cobb angle with a correlation coefficient of 0.901. Factors related to breast aesthetics, like differences in the height of nipples and the distance from the sternal notch to the nipple, represent 30% of the overall score. The study concluded that there is a significant correlation between the severity of scoliosis and BA differences. Augmentation mammaplasty for BA not only decreased the breast difference but also leveled the nipple disparities. Photogrammetry is considered to be an alternative to other methods and is believed to contribute to the follow-up of BA. 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 .

Rib Reduction Technique in Patients with Isolated Chondrocostal Chest Wall Prominence Undergoing Breast Augmentation.

When planning for breast augmentation, it is important to consider not only implant choice, surgical technique and patient desires, but also the chest wall shape and deformities or irregularities, which remain often underestimated. They can be responsible for implant malposition and breast asymmetry after augmentation. Chondrocostal junction prominence is a minor but frequent chest wall deformity. The aim of this study is to report a new technique for sculpturing isolated chondrocostal prominence deformities in patients undergoing breast augmentation. A retrospective study was conducted to review surgical outcomes of a novel technique for costal prominence sculpturing and reshaping in patients undergoing breast augmentation. After reaching the subpectoral space, an inferiorly-based perichondral-periosteal flap is harvested just above the prominence. Once the deformity is corrected, the perichondral flap is repositioned over the sculpted rib. A total of six patients presenting with isolated chondrocostal prominence underwent bilateral breast implant placement and costal reduction using the described technique. Three patients were primary augmentations while the remaining patients were two secondary breast augmentation and one augmentation mastopexy. No complications were reported. No additional pain was referred at the side of rib remodelling in comparison with the contralateral breast. All the patients were satisfied with cosmetic results. The described technique for contouring of isolated chondrocostal deformities is fast, easy reproducible and offers advantages over the standard partial rib reduction technique. It can prevent implant malposition and projection asymmetry, eventually enhancing breast augmentation outcomes. 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 .

Breast hypoplasia markers among women who report insufficient milk production: A retrospective online survey.

To estimate the proportions of anatomical breast characteristics suggestive of breast hypoplasia among breastfeeding women self-reporting low milk supply. We also explored breast hypoplasia risk factors. Online survey conducted between October 2021 and January 2022. Five low milk supply Facebook groups. 487 women reporting low milk supply with their first child born ≥ 37 weeks gestation within 5 years of participation in this study, and residing in the USA, Australia or the UK. We present data on the primary outcome ('breast type') for 399 women. Women were excluded if the dyad was separated for more than 24 hours during the hospital stay, or if the mother reported removing milk less than 6 times per day from each breast on most days before being aware of having insufficient milk production. The proportions of proposed breast hypoplasia markers including atypical breast type, widely spaced breasts, breast asymmetry, stretch marks on the breast and lack of pregnancy breast growth. We also estimated the odds of having breast hypoplasia markers in at-risk groups compared to reference groups, adjusting for covariates. Approximately 68% reported at least one atypical breast (270/399; 95% CI: 62.9%, 72.1%). Around 47% reported widely spaced breasts (212/449; 95% CI: 42.7%, 52.7%), 72% a lack of pregnancy breast growth (322/449; 95% CI: 68.3%, 77.4%), and 76% stretch marks on the breast (191/250; 95% CI: 70.7%, 81.3%). Multiple logistic regression analyses identified being overweight during pubertal years as a risk factor for atypical breast type and lack of pregnancy breast growth. Participants in low milk supply Facebook groups reported high rates of breast hypoplasia markers. Being overweight during adolescence was a risk factor for breast hypoplasia markers. These findings should be confirmed in well-conducted large cohort studies to determine the strongest combination of hypoplasia markers in predicting low supply.

Cardiac implantable electronic devices in female patients: Esthetic, breast implant, and anatomic considerations.

The implantation of a cardiac implantable electronic device (CIED) can have esthetic and psychological consequences on patients. We explore a heart team model for care coordination and discuss esthetic approaches for improved cosmetic outcomes in patients undergoing (CIED)-related procedures or de novo implantation. Patients undergoing CIED surgery for approved indications between June2015 andJune2022 were identified. Patients were included when surgical care was provided by a collaborative relationship between the primary electrophysiologist and the plastic surgeon. Patient demographics, details of the surgical procedure, information on breast implants, complications, and outcomes related to cosmesis were recorded. Twenty-two female patients were included in this study. The mean age was 50.2 ± 18.2 years. The mean follow-up duration was 2.2 ± 5.5 months. The top two indications for the procedure included CIED generator change (n = 9, 41%) and implantable cardioverter-defibrillator (ICD) implantation (n = 7, 32%). The most common reasons for involving plastic surgery in the procedure included surgery near breast implants (n = 10, 45%) and device displacement or discomfort (n = 8, 36%). CIED pocket position was prepectoral in 10 cases (45%), subpectoral in 11 patients (50%), and intramuscular in one patient (4.5%). The majority of the patients (20, 91%) had cosmetically acceptable results postprocedure. One patient (4.5%) had breast asymmetry on the CIED side, and another continued to have skin erosion over the CIED and leads. A heart team approach incorporating the expertize of cardiac electrophysiology and plastic surgery is essential for providing optimal care for patients with breast implants and patients requesting esthetic appeal.