Breast Cup Size Research Articles

Our Experience with 131 Cases of Simultaneous Breast Implant Exhange with Fat (SIEF).

Background:Breast augmentation with fat injection is a growing trend in Japan. Many Japanese patients experiencing breast implant complications are requesting to have their breast implants removed and simultaneously exchanged with autologous fat injection. The keys of our simultaneous implant exchange with fat (SIEF) process are to embrace the “Coleman technique” and to carefully detach implant capsules when removing breast implants. Furthermore, we carefully inject fat to avoid necrosis.Methods:Between January 2010 and January 2015, we investigated consecutively 131 Japanese patients whom we could follow up for over 6 months postsurgery. We ascertained the usefulness of SIEF by assessing changes in breast size, complications, and a satisfaction survey.Results:There were no serious complications. We had experienced mild complications in 9.2% of patients (12/131). Partial fat necrosis with inflammation occurred in 2.3% of patients (3/131), seroma in the capsule in 3.1% (4/131), complaints of nodules (cysts, lumps) in 3.1% (4/131), and 1 hematoma patient (0.8%). At 6 months after surgery (n = 131), breast cup size (by Japanese Industrial Standards) had decreased by less than 1 cup size, despite SIEF. At 6 months, we performed a postsurgery satisfaction survey, and only 4% of the patients (5/131) were not satisfied with their surgery results.Conclusions:SIEF is a very safe and effective procedure. Breast implants removed with a low invasive traumatic approach and centrifuged fat injected with the “Coleman technique” are important principles in our practice. Furthermore, avoiding fat necrosis is one of the most important considerations, and our SIEF approach allows us to better control this potential complication during the surgical process.

Cosmetic Outcomes and Quality of Life in Thai Women Post Breast Conserving Therapy for Breast Cancer.

To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in post breast-conserving therapy (BCT) women. This cross-sectional study concerned one-year post-completed BCT Thai women. The data included subjective and objective CO with a questionnaire covering demographic and clinical data, anti-hormonal treatment status, Eastern Cooperative Oncology Group (ECOG) performance status, Self-Reported Cosmetic Outcomes (SRCO), Self-Reported Breast Symmetry (SRBS), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy with Breast Cancer subscale (FACT-B). Participants had breast photographs taken for the evaluation of objective cosmetic outcome (OCO) after breast cancer conservation treatment. The relationship between CO and FACT-B was tested using Spearman's rank correlation Results: A total 127 participants volunteered for the study. The participant characteristics were age 52(±9), Buddhist 87%, married 65%, body mass index 25.0(±4.6), breast cup size A-C 91%, college educated 60%, employed 66%, ECOG 0-1 95%, tumor size less than or equal to 2 cm 55%, no lymph node metastasis 98%, and taking tamoxifen 57%. Two percent of the participants regretted their decision to undergo BCT. The SRCO was excellent in 2%, good in 68%, fair in 30%, and poor in 0%. For SRBS, rates were 17%, 58%, 24% and 1% for excellent, good, fair and poor cosmetic outcomes, respectively. The BCCT scores were excellent 24%, good 39%, fair 32%, and poor 6%. The median total QOL score of the participants was 130 (93-144). There was no significant correlation between CO and FACT-B scores. The significance of CO for FACT-B in Thai women with breast cancer could not be assessed in detail because of a very low level of correlation. The results may be due to the effects of cultural background.

Evaluation of factors impacting cosmetic outcome of breast conservative surgery--a study in Iran.

Breast conservative surgery (BCS) followed by radiotherapy is the standard approach in management of stage I-II breast cancer. Several factors can affect cosmetic outcomes. The aim of this study was to evaluate the cosmetic results of BCS and influencing factors in the Iranian Breast Cancer Research Center. Patients who had undergone BCS were included. Photographs were taken of both breasts of the patients in three aspects and were evaluated by three specialists. The cosmetic scores were calculated based on a standard questionnaire. The data were analyzed using univariate and multivariate regression for relationships between cosmetic scores and clinical data. A total number of 103 patients were included in the study. Mean age and BMI of the patients were 46.8±8.9 and 28.1±3.9, respectively. Breast cup sizes C and D accounted for 74.7% of the study group. The mean cosmetic score obtained from three referees was 5.72+2.06, consisting of 35.9% excellent-good, 35% moderate, and 29.1% unsatisfactory results. Patient BMI, volume of the resected tissue and breast cup size (D) showed significant correlation with the cosmetic score. On multivariate regression analysis, cosmetic score and BMI (p=0.022,) as well as breast cup size (p=0.040), remained significant. Immediate or delayed symmetrization of the breasts is suggested during breast conservative surgery, meanwhile performing oncoplastic techniques to improve the results significantly. Also it is suggested to discuss anticipation of less satisfactory results with patients having higher BMI and large breast cup size.

Chinese women's preferences and concerns regarding incision location for breast augmentation surgery: a survey of 216 patients.

The axillary approach is the dominant incision used in China for breast augmentation. Systematic preoperative education regarding incision locations for breast augmentation is scarce in China. In this study, we surveyed Chinese patients to ascertain their preferences and concerns for incision location based on a comprehensive understanding of different incisions. We used a literature review, patient interviews, and expert panels to develop the preoperative education material and questionnaire regarding different incision locations. The respondents were requested to choose one incision location before and after they received the preoperative education. Their initial choices and final decisions as well as the reasons for these choices were recorded and analyzed. Multinomial logistic regression was preformed to analyze the affecting factors on the incision choice. A total of 216 Chinese women participated in the study between 2012.5 and 2014.1. Initially, 176 (81.48%) women chose axillary incision, 27 (12.50%) chose periareolar incision, and 13 (6.02%) chose inframammary fold (IMF) incision. After they received preoperative education on incisions, the axillary and periareolar approaches decreased to 117 (54.17%) and 13 (6.02%), respectively, while IMF increased to 86 (39.81%). The easily hidden scar (43.98%), lower capsular contracture rate (23.15%), and lower possibility of injury to the breast parenchyma (17.13%) ranked as the top 3 reasons for the incision choice. Patients with a preoperative cup size of AA were 12.316 times more likely to choose the axillary approach relative to the IMF approach compared with those with a B cup (P = 0.044; 95% confidence interval [CI] 1.069-141.923). For each one-unit increase in BMI, the odds that a patient would choose the axillary versus the periareolar approach decreased by 32.4% (P = 0.049; 95% CI 0.457-0.999). The systematic and objective preoperative education material and questionnaire regarding different incision locations helped the Chinese patients make truly informed decisions and express their personal requirements. The axillary approach was the first option for more than half of Chinese women mainly because an easily hidden scar was considered the primary concern during the decision-making process. The patients with a low BMI and a small preoperative breast cup size were more likely to choose an axillary incision. However, a considerable number of Chinese women would choose the IMF incision and value its superiority in terms of a lower capsular contracture rate, less tissue trauma, and lower possibility of injury to the breast parenchyma. 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.

Direct-to-implant single-stage immediate breast reconstruction with acellular dermal matrix: predictors of failure.

Direct-to-implant single-stage immediate breast reconstruction using acellular dermal matrix is a cost-effective alternative to two-stage expander-implant reconstruction. The purpose of this study was to identify predictors of direct-to-implant single-stage immediate breast reconstruction failure, defined as need for early (≤6 months) revision surgery. The authors conducted a retrospective cohort study of all patients with direct-to-implant single-stage immediate breast reconstruction in 2010 and 2011 at three University of British Columbia hospitals. Data were compared between successful and failed single-stage reconstructions. Predictors of failure were identified using multivariate logistic regression. Patient demographics and complications were compared to a random sample of control patients with two-stage alloplastic reconstruction without acellular dermal matrix. Of 164 breasts that underwent direct-to-implant single-stage immediate breast reconstruction, 52 (31.7 percent) required early revision. Increasing breast cup size was the only significant predictor of early revision compared with bra size A (OR for bra size B, 4.86; C, 4.96; D, 6.01; p < 0.05). Prophylactic mastectomies showed a trend toward successful single stage (OR, 0.47; p = 0.061), whereas smoking history trended toward failure (OR, 1.79; p = 0.065). Mastectomy flap necrosis was significantly higher in direct-to-implant single-stage immediate reconstruction cases compared to two-stage controls. Direct-to-implant breast reconstruction can be reliably performed in a single stage in patients with small breast size. Increasing breast cup size confers a higher chance of early revision. A two-stage approach may be more cost-effective in larger breasted patients. Risk, III.

Factors Influencing Eligibility for Breast Boost Using Non-Invasive Image-Guided Breast Brachytherapy

The intact breast presents a challenge for targeting of the tumor bed (TB) due to patient, breast, and respiratory motion. Non-invasive image-guided breast brachytherapy (NIBB) allows for accurate targeting of the TB for breast boost by utilizing breast immobilization and image-guidance. However, not all patients are ideal candidates for this technique. We evaluated our clinical experience using NIBB to indentify patient and anatomic factors which predict suitability for this technique. Consecutive patients with early stage breast cancer treated with breast conserving therapy were evaluated from April to November 2013. Only patients who were candidates for boost were included in this analysis. Patients with very small breast size (cup size A or smaller) for whom breast immobilization could not be achieved using NIBB were treated with en face electrons. All other patients underwent simulation for NIBB boost. NIBB was delivered using the AccuBoost System (Advanced Radiation Therapy, Inc., Billerica, MA). Patients who were found to be ineligible for NIBB boost on simulation underwent boost treatment with en face electrons or 3D conformal photons. The rate of eligibility for NIBB, reasons for ineligibility, and related patient and anatomic factors were analyzed. Fifty-two patients were evaluated of which 6 patients were ineligible for NIBB due to small breast size. Of the remaining patients who underwent simulation for NIBB boost, 33 patients (72%) were treated with NIBB. The most common reasons for ineligibility were absence of identifiable TB (n=5), inability to position the patient/breast to adequately target the TB (n=4), posterior TB location (n=3), and discomfort during breast compression (n=1). The likelihood of being eligible for NIBB boost was dependent on breast size and breast quadrant. The eligibility for NIBB according to breast cup size was: ≤ A (0%), B (50%), C (71%), D-DD (77%), and >DD (80%), p=0.002. The eligibility based on breast quadrant was: retroareolar/central (100%), upper outer (72%), upper inner (67%), lower outer (38%), lower inner (25%), p=0.07. For patients with a posterior TB, located along the chest wall, 73% were good candidates for NIBB. This was not statistically different compared to a non-posterior location, p=0.2. For patients without clips defining the TB only 45% were candidates for NIBB as compared with 79% of patients who had clips, p=0.05. NIBB boost is feasible in the majority of patients. Patients with larger breast size and a tumor bed located in the central breast or upper outer quadrant are more likely to be good candidates. Posterior TB location can be challenging for NIBB but the majority of patients are still candidates. Surgical clips are very helpful in defining the tumor bed for boost and greatly increase the likelihood of eligibility for NIBB.

Orthosis reduces breast pain and mechanical forces through natural and augmented breast tissue in women lying prone

BackgroundBreast implant displacement or rupture can cause aesthetic problems and serious medical complications. Activities with prone positioning and loading of the anterior chest wall, such as massage, chiropractic or osteopathic therapies may increase the risk of implant failure and can also cause discomfort in women with natural breast tissue. Here we test the effectiveness of a newly developed orthosis on pain, mechanical pressure and displacement of breast tissue in women with cosmetic augmentation, post-mastectomy reconstruction, lactating or natural breast tissue.MethodsThirty-two females volunteers, aged 25–56 years with augmented, reconstructed, natural or lactating breast tissue and cup sizes B-F, participated in this open-label clinical trial. We measured pain perception, peak pressure, maximum force, and breast tissue displacement using different sizes of the orthosis compared to no orthosis. Different densities of the orthosis were also tested in a subgroup of women (n = 7). Pain perception was rated using a validated 11-point visual-analogue scale. Peak pressure and maximum force were assessed using a bilateral set of capacitance-pliance® sensor strips whilst participants were load bearing in a prone position, and breast displacement was measured by magnetic-resonance-imaging.ResultsThe orthosis significantly reduced pain, breast displacement and mechanical pressures in women with natural and augmented breast tissue in prone position. Greater relief of pain and greater reduction in mechanical forces were found with increased size and density of the orthosis. Use of the orthosis improved overall comfort by 64-100%, lowered peak pressure by up to 85% and maximum force by up to 96%. Medio-lateral displacement of breast tissue was reduced by 16%, resulting in a 51% desirable increase of breast tissue height.ConclusionOur study demonstrated that the newly developed orthosis significantly reduced pain, mechanical pressure and breast tissue displacement in women with augmented and natural breast tissue when lying prone. Our findings are of clinical significance, potentially reducing the risk of complication from prone activities in women with breast augmentation or reconstruction, as well as improving comfort whilst undergoing prone procedures.Trial registrationAustralia and New Zealand Clinical Trials Register, ACTRN12613000541707.

VMAT Radiation Therapy (VMAT) Versus Intensity Modulated Radiation Therapy (IMRT) for Small-Sized Breast

Purpose/Objective(s): This study aims to analyze the dosimetric difference between VMAT therapy and intensity modulated therapy (IMRT) on small breast volume after receiving breast cancer conservation surgery. Materials/Methods: All patients underwent CT simulation for RT planning using the AAA algorithm with a calculation gird of 2.5 mm. All patients were treated with VMAT technique and a corresponding Intensity modulated radiation therapy (IMRT) plan was generated for comparison. These 10 small size breast (cup size 32A, 32B, 34A, 34B) patients had received breast conservation surgery prior to radiation therapy. VMAT using 6 MV x-rays simultaneous integrated field boost technique were given to irradiate the whole breast with 50 Gy and a concomitant boost irradiation to the surgical bed for 60.2 Gy in 28 fractions. The planning objectives were: PTV V95% >95%, Dmax <107%; Mean lung dose (MLD) <15 Gy, V20 Gy <20%. Heart dose should be 10 Gy. Results: The minimum follow-up was 6 months. Comparison between VMAT and IMRT revealed significant dose-volume differences for PTV dose coverage, treatment time in terms of MU, and dose to ipsilateral lung tissue. Dose-volume distribution to the heart, spine, contralateral lung, normal tissue, and normal breast was similar for both VMAT and IMRT technique with no significant difference. The mean VPTV95% was 98.6% 0.002(VMAT) and 98.8% 0.003 (IMRT). The mean V107% was higher for the VMAT (43.9% 12.1) when compared with IMRT (14.8% 27.4). The mean conformity index was similar for VMAT (0.742 0.09) and IMRT (0.748 0.07). The mean homogeneity index was similar for RA (1.08 0.017) and IMRT (1.096 0.011). The mean ipsilateral lung dose was higher for the VMAT technique (11.7 Gy 2.8) compared with the IMRT technique (9.3 Gy 1.9). However, the D2% (Gy) and V20 Gy (%) was higher for the IMRT than the VMAT technique (40.7 Gy 1.9, 17.9% 0.05 vs 38.4 Gy 2.5, 15.1% 2.5 respectively). Treatment time in terms of monitor unit (MU) was found to be significantly lower for the RA technique when compared with IMRT (791 MU vs 1337 MU, p Z 0.007). Conclusions: IMRT is a mature and well-accepted technique for breast cancer irradiation; VMAT is a recent development that is also suitable for breast irradiation. We found in this study that VMAT is comparable with IMRT in terms of PTV coverage, tumor dose conformity and homogeneity index for small sized breast. This study also found that VMAT is an

Tissue Compliance Meter is a More Reproducible Method of Measuring Radiation-Induced Fibrosis than Late Effects of Normal Tissue-Subjective Objective Management Analytical in Patients Treated with Intracavitary Brachytherapy Accelerated Partial Breast Irr

Identification of radiation-induced fibrosis (RIF) remains a challenge with Late Effects of Normal Tissue-Subjective Objective Management Analytical (LENT-SOMA). Tissue compliance meter (TCM), a non-invasive applicator, may render a more reproducible tool for measuring RIF. In this study, we prospectively quantify RIF after intracavitary brachytherapy (IB) accelerated partial breast irradiation (APBI) with TCM and compare it with LENT-SOMA. Thirty-nine women with American Joint Committee on Cancer Stages 0-I breast cancer, treated with lumpectomy and intracavitary brachytherapy delivered by accelerated partial breast irradiation (IBAPBI), were evaluated by two raters in a prospective manner pre-IBAPBI and every 6 months post-IBAPBI for development of RIF, using TCM and LENT-SOMA. TCM classification scale grades RIF as 0 = none, 1 = mild, 2 = moderate, and 3 = severe, corresponding to a change in TCM (ΔTCM) between the IBAPBI and nonirradiated breasts of ≤2.9, 3.0-5.9, 6.0-8.9, ≥9.0 mm, respectively. LENT-SOMA scale employs clinical palpation to grade RIF as 0 = none, 1 = mild, 2 = moderate, and 3 = severe. Correlation coefficients-Intraclass (ICC), Pearson (r), and Cohen's kappa (κ)-were employed to assess reliability of TCM and LENT-SOMA. Multivariate and univariate linear models explored the relationship between RIF and anatomical parameters [bra cup size], antihormonal therapy, and dosimetric factors [balloon diameter, skin-to-balloon distance (SBD), V150, and V200]. Median time to follow-up from completion of IBAPBI is 3.6 years (range, 0.8-4.9 years). Median age is 69 years (range, 47-82 years). Median breast cup size is 39D (range, 34B-44DDD). Median balloon size is 41.2 cc (range, 37.6-50.0 cc), and median SBD is 1.4 cm (range, 0.2-5.5 cm). At pre-IBAPBI, TCM measurements demonstrate high interobserver agreement between two raters in all four quadrants of both breasts ICC ≥ 0.997 (95% CI 0.994-1.000). After 36 months, RIF is graded by TCM scale as 0, 1, 2, and 3 in 10/39 (26%), 17/39 (43%), 9/39 (23%), and 3/39 (8%) of patients, respectively. ΔTCM ≥6 mm (moderate-severe RIF) is statistically different from ΔTCM ≤3 mm (none-mild RIF) (p < 0.05). At 36 months post-IBAPBI, TCM measurements for two raters render ICC = 0.992 (95% CI 0.987-0.995) and r = 0.983 (p < 0.0001), whereas LENT-SOMA demonstrates κ = 0.45 (95% CI 0.18-0.80). SBD and V150 are the only factors closest to 0.05 significance of contributing to RIF. This prospective study indicates that TCM is a more reproducible method than LENT-SOMA in measuring RIF in patients treated with IBAPBI. This tool renders a promising future application in assessing RIF.

The Effect of Reduction Mammaplasty on the Vertebral Column: A Radiologic Study

Some studies emphasized that anatomic mechanisms of vertebral aberrations could be associated with large breasts. The effect of mammaplasty operation on the vertebral column and body posture seems to be beneficial; in this trial, it was planned to investigate the objective radiologic effect of reduction mammaplasty on the posture of the vertebral column in a group of patients operated due to the large breasts. Thirty-four white women with large breasts were enrolled in this study. The patients were divided into three groups according to their breast cup sizes. Anteroposterior and lateral radiographs of the lumbosacral and thoracic spine were taken at baseline preoperatively, and the same radiographic images were taken in an average of 12 months later than the reduction mammaplasty operation. All were evaluated and compared for thoracic kyphosis angle and lumbar lordosis angle both preoperatively and postoperatively. The mean thoracic kyphosis angle was 40,53 preoperatively and 39,38 postoperatively. However, there was no statistically significant difference between the preoperative and postoperative measurements in all groups (P > 0,05). The mean lumbar lordosis angle was 54,71 preoperatively and 53,18 postoperatively. Regarding the preoperative and postoperative measurements of lumbar lordosis angles, no statistically significant difference was found between the groups (P > 0,05). Although breast size may be an important factor that affects body posture, reduction mammaplasty operations have little or no radiologic effect on the vertebral column.

Nipple-Sparing Mastectomy and Immediate Free-Flap Reconstruction in the Large Ptotic Breast

Because of increased risk for nipple necrosis, many surgeons believe large ptotic breasts to be a relative contraindication to nipple-sparing mastectomy (NSM). A retrospective review was performed on 85 consecutive patients who underwent NSM with 141 immediate perforator free-flap breast reconstructions. We analyzed the subset of patients with large ptotic breasts, defined as cup size C or greater, sternal notch to nipple distance greater than 24 cm and grade 2 or 3 breast ptosis. Of the 85 patients, 19 fit the inclusion criteria. Breast cup size ranged from 34C to 38DDD. There was 1 case of nipple necrosis in the patient with previous breast radiation (5%), 1 hematoma (5%), and no flap losses. Five (26%) patients underwent subsequent mastopexy or breast reduction, a mean of 6.6 months after the primary procedure. We demonstrate that NSM and free-flap breast reconstruction can be safely and reliably performed in selected patients.

Predictors of Three-Dimensional Breast Kinematics during Bare-Breasted Running

This study aimed to analyze differences in breast kinematics between breast cup sizes during running and the ability of breast and body size measurements to explain these differences. Forty-eight women (A to G cup; mean ± SD: age = 26.0 ± 6.0 yr, stature = 1.667 ± 0.064 m, mass = 62.78 ± 8.24 kg) with chest sizes of 32 to 38 inches participated. Chest and breast girths, a restricted anthropometric profile, suprasternal notch to nipple distances, and body mass index were measured, and breast mass was estimated. Multiplanar relative breast displacement, velocity, and acceleration during treadmill running were then recorded. Differences in breast kinematics were compared between cup sizes before and after allometric/polynomial scaling using significant breast and body size measures. All kinematic variables significantly increased with breast cup size (P < 0.05). Mean anterior-posterior (a/p), medial-lateral (m/l), and vertical bare-breasted displacements ranged from 0.030 to 0.059 m, from 0.018 to 0.062 m, and from 0.042 to 0.099 m, respectively, across A to G cups. Breast velocities ranged from 0.428 to 1.244 m·s(-1) (a/p), 0.411 to 1.708 m·s(-1)(m/l), and 0.819 to 2.174 m·s(-1) (vertical), respectively. Increases in breast acceleration varied from 11.664 to 48.438 m·s(-1) (a/p), 15.572 to 51.987 m·s(-1) (m/l), and 23.301 to 66.447 m·s(-1) (vertical), respectively. Scaling models found that breast mass was the only anthropometric measure to consistently explain differences in breast kinematics between cup sizes. Bare-breasted kinematics significantly increased with cup size during running. Differences in breast displacement, velocity, and acceleration between cup sizes could be predicted using estimates of breast mass based on conventional brassiere sizing. These data inform the design and evaluation of effective bra support.

Impact of Time Interval Between Surgery and Radiation on Partial Breast Radiation and Infection and Cosmesis

Median followup was 491 days (min 19 and max 1115). There were 5 relapses and all were elsewhere failures. 2 died of intercurrent disease and 92 were alive with no evidence of disease. Conclusions: The initial data seem show good concordance between physicians and nurses and patients in about 50% of the patients. The presence of seroma and number of re-excisions seem to have an impact on cosmesis. We plan to continue this study by including surgeons in the cosmesis evaluation. The data required breast cup size, laterality and quadrant will be presented at the MTG. Impact of chemotherapy will also be evaluated.

Three-Dimensional Kinematics of the Breast during a Two-Step Star Jump

Anecdotal reports suggest two-step star jumps cause excessive breast movement and discomfort, leading to recommendations for this activity as a diagnostic tool to determine effective breast support in a retail environment. The aim was to investigate multiplanar bare-breast kinematics during the two-step star jump and to establish the relationship between breast kinematics, discomfort and cup size. Thirty-nine females completed five two-step star jumps with no breast support after which breast discomfort was rated. To establish relative breast kinematics infrared cameras tracked the 3D co-ordinates of breast and body markers. Maximum resultant breast displacement, velocity and acceleration during jumping reached 18.7 cm, 93.1 cm·s⁻¹ and 3.6 g, respectively. Significantly more vertical breast displacement (p < 0.01) and velocity (p < 0.01) occurred compared with mediolateral and anteroposterior kinematics. Breast discomfort increased as cup size increased (r = .61). Two-step star jumping stimulated multiplanar breast kinematics and high levels of breast discomfort. Therefore, this activity may be useful in a retail outlet to determine the function and comfort of a sports bra.

SU‐FF‐T‐428: Deformable Computational Breast Phantoms for Monte Carlo Based Calibrations of Detector Systems Used for Assessing Internal Radioactivity Burden in the Lungs

Purpose: To demonstrate the feasibility of deformable patient modeling for the virtual calibration of detectors used to measure inhaled radioactivity in a female patient's lungs for internal dose assessment. Materials and Methods: We have developed the ability to deform a mesh‐based phantom that consists of 140 highly detailed organs or tissues. The phantom can be adjusted to match a desired patient. A software was developed to deform the breasts of this phantom to create new models representing female patients with different breast cup sizes (ranging from AA to G) and breast glandularities. The geometries of these phantoms and a Phoswhich detector system were defined in a Monte Carlo code for virtual in‐vivo lung counting simulations involving various photon emitting radionuclides. The counting efficiencies for each of the virtual patients were calculated and compared. Results: The counting efficiency was found to decrease with increasing breast size and mass because of greater attenuation in the patient. For low energy emitting radionuclides such as Am‐241, roughly a 50% drop in counting efficiency was observed for the model with G cup size as compared to the smaller breasted AA model. Higher breast glandularities resulted in lower counting efficiencies; however, this effect was small. For the E breast cup size model, the counting efficiency for low energy emitters decreased by roughly 2% as the glandularity increased from 7% to 40%. Conclusions: In order to obtain accurate internal dosimetry estimates for female patients, the in‐vivo measurements of the activity in the lungs should account for breast size. The effect of breast glandularity can be ignored because it is negligibly small compared to other sources of experimental uncertainty.

The Impact of Breast Size on the Vertebral Column: A Radiologic Study

Macromastia usually is associated with the physical and psychological symptoms reported comprehensively by many studies. Reduction mammoplasty seems to be the most reasonable solution for these symptoms, and many articles have reported improvement of these complaints after surgery. Some authors have postulated that the anatomic mechanisms of postural aberrations are heavy breasts and related pain symptoms. However, limited numbers of studies have tried to explain the effect of the heavy breasts on the vertebral column. This study enrolled 100 females in four groups according to their breast cup sizes (groups A, B, C, D). All four groups were compared with each other statistically using one-way analysis of variance (ANOVA) followed by a post hoc test according to the body mass index (BMI) as well as the thoracic kyphosis, lumbar lordosis, and sacral inclination angles. The BMI was significantly higher in the D cup-sized breast group. There was a statistically significant difference between groups A and D in terms of the thoracic kyphosis and the lumbar lordosis angles, and between groups B and D in terms of the lumbar lordosis angle. No statistically significant difference was detected between the groups in terms of the sacral inclination angle. Breast size seems to be an important factor that affects posture, especially the thoracic kyphosis and lumbar lordosis angles.

Choice of beam energy and dosimetric implications for radiation treatment in a subpopulation of women with large breasts in the United States and Japan

Radiation complications are often related to the dose inhomogeneity (hot spot) in breast tissue treated with conservative therapy, especially for large patients. The effect of photon energy on radiation dose distribution is analyzed to provide guidelines for the selection of beam energy when tangential fields and limited slices are used to treat women with large breasts. Forty-eight patients with chest wall separation > 22 cm were selected for dosimetric analysis. We compared the maximum dose in the central axis (CAX) plane (2D) using 6-, 10-, and 18-MV photon beams in all patients and 3D data set for 16 patients. Correlation between hot spot dose (HSD), separation, breast cup size, breast volume, and body weight was derived with beam energy. Among the 48 patients in this study, HSD > 10% in the CAX plane was noted in 98%, 46%, and 4% of the population when 2D dosimetry was performed; however, with 3D study, it was in 50%, 19%, and 6% of the patients with 6-MV, 10-MV and 18-MV beams, respectively. The chest wall separation, body weight, and breast volume were correlated with the HSD in both the 2D and 3D plans. Patient’s bra size was not correlated with the hot spot. The chest wall separation was found to be the most important parameter to correlate with hot spot in tangential breast treatment. Simple guidelines are provided for dose uniformity in breast with respect to chest wall separation, body weight, bra size, and breast volume with tangential field irradiations.

The 6Th Annual Toronto Breast Surgery Symposium, March 30, 2006, and the 36Th Annual Symposium On: Aesthetic Plastic Surgery, March 31–April 1, 2006

The 6Th Annual Toronto Breast Surgery Symposium, March 30, 2006, and the 36Th Annual Symposium On: Aesthetic Plastic Surgery, March 31–April 1, 2006

Assessment of the breast volume by a new simple formula

Background: With the recent introduction of improved techniques for plastic surgery of the breast and increased public awareness toward these procedures, plastic surgeons are continuously trying to improve their methods and results to reach perfection. Assessment of the breast volume is an important issue prior to the use of breast implants in any aesthetic or reconstructive breast surgery. Previous methods to measure breast volume have included use of a simple bra and breast cup size, cumbersome fluid displacement, appliances and approximate visual estimation. Objectives: In this work we have tried to develop an easy method for assessment of the breast volume for both the patient and the the surgeon through a simple mathematical formula. Materials and Methods: Fifty two volunteers were included in this study. For every one, general parameters including age, weight and height were recorded. Local breast measurements and water volume displacement were also recorded. Results: The collected data were statistically correlated. Using the analyzed data, the breast volume was calculated through a simple and direct formula on the basis of the breast circumference. Conclusion: Our method has, as its principle, the use of an accurate and simple formula, which is based only on one measurement. This is easy for both the patient and the plastic surgeon. This equation is not only a significant technical advantage for the surgeon, but also provides a universal standardization of the breast volume.

Assessment of the breast volume by a new simple formula

Abstract Background: With the recent introduction of improved techniques for plastic surgery of the breast and increased public awareness toward these procedures, plastic surgeons are continuously trying to improve their methods and results to reach perfection. Assessment of the breast volume is an important issue prior to the use of breast implants in any aesthetic or reconstructive breast surgery. Previous methods to measure breast volume have included use of a simple bra and breast cup size, cumbersome fluid displacement, appliances and approximate visual estimation. Objectives: In this work we have tried to develop an easy method for assessment of the breast volume for both the patient and the the surgeon through a simple mathematical formula. Materials and Methods: Fifty two volunteers were included in this study. For every one, general parameters including age, weight and height were recorded. Local breast measurements and water volume displacement were also recorded. Results: The collected data were statistically correlated. Using the analyzed data, the breast volume was calculated through a simple and direct formula on the basis of the breast circumference. Conclusion: Our method has, as its principle, the use of an accurate and simple formula, which is based only on one measurement. This is easy for both the patient and the plastic surgeon. This equation is not only a significant technical advantage for the surgeon, but also provides a universal standardization of the breast volume.