Breast Footprint Research Articles

Multi-Flap Microsurgical Autologous Breast Reconstruction.

Microsurgical autologous breast reconstruction (MABR) remains the gold standard technique of breast reconstruction, providing a durable, natural, and aesthetically pleasing result. However, some patients may not be candidates for a traditional deep inferior epigastric perforator (DIEP) flap, either due to abdominal tissue paucity, the need for higher-volume reconstruction, or prior surgical procedures. In these patients, alternative flaps must be considered to achieve the optimal result. Such configurations include the conjoined (or double pedicle) DIEP flap, and alternative flaps such as the lumbar artery perforator (LAP) and profunda artery perforator (PAP) flaps, which can be combined in a stacked fashion. By combining multiple flaps in a conjoined or stacked fashion, breast reconstruction can be optimized to fulfill the three critical components of breast reconstruction in restoring the skin envelope, breast footprint, and conus shape. When harvesting multiple flaps, the surgical sequence of events must be meticulously planned to ensure an efficient and successful operation. Preoperative imaging can aid the surgeon in identifying the ideal perforator, assess for side branches for possible intra-flap anastomoses, expedite the operative time, and decrease intraoperative complications. Reconstructive surgeons should be familiar with the variety of configurations with conjoined and/or stacked flaps to address patient-specific reconstructive needs.

Expanding Access to 3D Technology in Plastic Surgery of the Breast: Validation of the iPhone Against the Vectra H2.

The iPhone (Apple Inc, Cupertino, California) contains a high-fidelity 3D-scanner and is widely distributed in the United States. Presently, 3D analysis of the breast necessitates ownership of cost-prohibitive cameras and software packages such as the Vectra system. We compared the accuracy of 3D photos of the breast obtained with the iPhone X 3D scanner against the Canfield Vectra H2 (Canfield Scientific Inc. Parsippany, NJ) in an effort to expand access to 3D technology in plastic surgery. Twenty breasts (n=20) were 3D-photographed with iPhone X and the Vectra H2 and compared with color map analysis and by measuring distances across the model between key anatomical landmarks. These distances included sternal notch to nipple (SN-N), mid-chest to nipple (M-N), nipple to mid-inframammary fold (N-IMF), and inframammary fold width (IMF). Statistical tests included the Bland-Altman Plot analysis. When comparing absolute differences in distances between key anatomical landmarks, the average discrepancy in measurements between iPhone and Vectra image pairs were the following: SN-N: 0.94mm, M-N: 0.70mm, N-IMF 0.81mm, and IMF 0.96mm. Colormap analysis demonstrated an average error of 1.53mm, mean of 0.53mm, and standard deviation of ±1.81mm. Bland-Altman Plot revealed a mean difference of 0.13mm and an agreement interval between -1.90 and 2.17mm. The iPhone is capable of capturing 3D-photographs with a high level of fidelity when compared to Vectra. 3D-scans obtained with the iPhone may be useful for planning nipple position, measuring the breast footprint, choosing implants, and performing other functions using 3D technology that are typically performed using the more expensive systems.

Prepectoral Breast Reconstruction Prompts Revisiting the Anatomic Boundaries of the Breast: A Radiographic and Cadaveric study.

This study aimed to determine the location of superficial fascial system (SFS) condensations in relation to classic anatomic breast boundaries. Cadaveric studies have provided some understanding, but knowledge about the precise location of these condensations remains limited. Preoperative breast MRI was conducted to assess the fascial condensations defining the breast footprint relative to landmarks like the latissimus, clavicle, sternal border, and inframammary fold (IMF). Concurrently, cadaveric mastectomies were performed to measure the breast borders in relation to these landmarks for comparison. 290 breasts underwent preoperative MRI. Eight cadaveric breast dissections were completed. Radiographically, the lateral breast fascial condensation was 3.9 cm medial to the latissimus dorsi, while cadaveric measurements were 4.5 cm. The medial condensation was 2.1 cm lateral to the sternal border radiographically and 4.8 cm to midline in cadavers. The superior fascial condensation was 2.3 cm inferior to the clavicle radiographically and 5.5 cm by dissection. The inferior condensation was above the IMF in 82.7% of breasts by MRI and 100% of cadaveric breasts. MRI and cadaveric investigation showed similar patterns of breast tissue fascial condensations relative to standard breast boundaries. Breast skin flap thickness was greater peripherally (MRI: 11.5 mm, cadaver: 11.1 mm) than centrally (MRI: 6.6 mm, cadaver: 5.5 mm). MRI and cadaveric analysis demonstrated a close correlation between SFS and standard breast boundaries, although variations existed among subjects. Collaborating with breast oncologists and utilizing preoperative imaging to identify individual fascial condensations may enhance the camouflage of prepectoral implants after mastectomy.

Footprint Elevation and Fullness of the Upper Pole of the Breast in Free-Style Reduction Mammaplasty Procedures

Background: Despite the significant advances in the reduction mammaplasty fields, they all have drawbacks. A persistent lack of fullness in the upper pole was observed after 6 to 8 months in most of the instances given by the pioneers. The author’s goal was to enhance the cosmetic aspect of the breast and to achieve this goal; they searched for a superior approach that could provide upper pole fullness over the long term. Patients and methods: The project aimed to achieve all the other objectives of breast reduction while also enhancing the footprint elevation and fullness of the upper pole in free-style reduction mammaplasty surgeries. This study was carried out on 117 patients between February 2015 and July 2021. Results: In this study, the upper breast border produced an esthetically acceptable upper border in 114 (97.4%) cases for 2 to 7 years, whereas the outcomes were unsatisfactory for 4 patients (2.6%). Conclusions: The second rib, the second intercostal space, the third rib, the third intercostal space, or more are the possible starting levels of the upper border of the breast footprint. By severing the superior breast ligament and attaching the medial and lateral pillars to the pectoral fascia at the level of the second rib, the upper border of the breast can be stably elevated. Level of Evidence: IV therapeutic

Classification of Breast Implant Malposition.

Implant malposition is a well-recognized complication of prosthetic breast implants. However, to date, no objective classification system has been described. The aim of this study was to perform a prospective trial of an objective and reproducible classification system for implant malposition formulated by analyzing retrospective data from a large cohort of patients with implant malposition. The authors retrospectively analyzed the degree of medial/lateral and inferior/superior implant malposition relative to their optimal position within the breast footprint in a series of 189 breasts (n = 100 patients). An objective classification system for implant malposition was devised and then applied to a prospective cohort of 53 breasts in 28 patients with implant malposition. The degree of malposition in a single or combination of axes was categorized according to the distance (measured in centimeters) from the ideal breast footprint. The classification system incorporated the axis of malposition and distance to generate a treatment decision-making guide. Cases of Grade 1 malposition did not warrant surgical intervention, whereas surgical correction was warranted in all Grade 3 cases. In the combined patient cohort (n = 242 breasts, 128 patients), lateral, inferior, medial, and superior displacement ranged between Grades 1 and 3. There was no interobserver variability in the grades assigned to 9 out of 10 patients in the prospective group. A simple and reproducible classification system for implant malposition has been created that allows surgeons to objectively record the extent of malposition, guides surgical decision-making, and can be used to document the results of any intervention.

The Utility of a Novel Bidirectional Lateral Intercostal Artery Perforator Flap for Reconstructing Partial Mastectomy Defects.

Smaller breasts require volume replacement to allow for breast conservation for large tumor to breast size ratios. The lateral intercostal artery perforator (LICAP) flap is one of the most commonly used approaches to replace volume as it readily fills lateral breast defects where most cancers typically arise. The LICAP flap was initially described with the bulk of its tissue volume oriented posteriorly, lateral to the breast footprint. Recently, the "reverse LICAP" flap was described, which uses the same perforators but recruits tissue instead from below the inframammary fold. Here, we combine these two approaches, preserving the same perforators, but harvesting tissue from both below the inframammary fold and lateral to the breast footprint, to create a single, larger, bidirectional LICAP flap. This modified flap replaces more volume than previously described for uni-directional approaches allowing us to potentially avoid mastectomy or more extensive flap reconstructions. Here, we describe 10 consecutive patients where the bidirectional LICAP flap was used to facilitate oncoplastic breast conservation.

Creating a New Inframammary Fold, Raising the Breast Footprint and Elongating the Torso with Multiplane Concept.

Augmentation mastopexy focus on restoring the youthful appearance of the female breast. Despite those benefits, there is large scarring to be considered, and the reduction of this side effect is the main goal to enhance the aesthetic result. This article aims to describe a variation of the L-shaped mastopexy technique without complex marking and performed in planes, which brings long-term results for patients undergoing this approach. This is a retrospective, observational study, based on a series of cases conducted by the author. The preoperative appointment and the surgical technique are described, and divided into steps according to their components: cutaneous, glandular tissue, and muscular. Between January 2016 and July 2021, 632 women underwent surgery. The mean age was 38 years (18-71 years). The mean volume of implants was 285cc (175-550cc). All the implants used were round with a nanotextured surface. The mean tissue resected from each breast was 117g (5-550g). Follow-ups ranged from 12 to 84 months, and photographic documentation was performed from 30 days after surgery. Complications totaled 19.30% and were divided into minor - treated with expectant treatment, non-invasive or with the possibility of correction with local anesthesia, corresponding to 10.44%; and major - in which it was necessary to return to the operating room, corresponding to 8.86%. Multiplane L-Scar Mastopexy is a versatile and safe technique with predictable results, which allows the systematic treatment of the most diverse breast types, with complications similar to other already described and solidified techniques.

Single-incision approach to aesthetic flat closure after bilateral mastectomy in morbidly obese patients

There has been a recent emphasis to offer women who forego reconstruction after mastectomy a surgically optimized flat closure (aesthetic flat closure (AFC)). While this certainly requires attention to details not previously considered by many surgeons, additional complexity is encountered in performing this procedure in the morbidly obese patient. Most of this additional complexity revolves around resecting additional subcutaneous tissue adjacent to the breast footprint. Here, we combine two previously described techniques, one to facilitate AFC in patients with normal body mass indices (BMIs) and another approach used to facilitate removal of excess lateral subcutaneous tissue after mastectomy in patients with elevated BMIs with our single-incision approach. The single-incision approach facilitates an expedited surgical procedure and resection of excess midline tissue with more reliably symmetrical incisions bilaterally . This report describes 10 consecutive morbidly obese patients who underwent mastectomy and AFC.

Optimizing aesthetic results in autologous breast reconstruction.

Advances in breast cancer management have provided most patients with the hope for cure or avoidance of cancer altogether. Such advances have made quality of life much more important after treatment and have led to equally incredible advances in breast reconstruction, to the point where reconstructive goals have altered the way mastectomies are now performed. As experience and expertise in microsurgery has grown, the surgical feat of successfully transferring tissue to restore breast volume is no longer considered an adequate endpoint for aesthetic breast reconstruction. A shift towards patient-centered care has motivated plastic surgeons to adapt their approaches to reconstruction integrating aesthetic principles to the process of recreating a breast mound in order to provide patients with a long-term, natural, and optimal result. Vital to restoring a shapely breast is a thorough preoperative assessment and the understanding of the breast footprint, breast conus, skin envelope and nipple-areolar complex (NAC) position. These aesthetic goals should also extend to the donor site, where adequate contour improvement is sought to offset the price of the donor site scar and the morbidity is minimized. By utilizing strategies for optimizing the NAC position, incorporating novel techniques to ensure core projection, and paying attention to the donor site, the skilled microsurgeon can elevate breast reconstruction to the level of true aesthetic surgery where the reconstructed appearance is superior to the presurgical one.

The NIU (Nipple-Inframammary Fold-Upper Breast Border) Principle: Preoperative Marking of the Ideal Nipple Position in Augmentation Mastopexy.

Although the beauty of the breast depends on aesthetic proportions, the position of the nipple-areola complex (NAC) on the breast mound and in relation to the implant during breast augmentation or mastopexy augmentation is critical. In fact, lack of nipple position determination in relation to the breast footprint is a deficiency of most currently applied measurements and evaluation tools. The authors hereby present a simple formula that allows accurate and proper prediction of the ideal NAC positioning for every patient depending on the chosen implant in case of mastopexy augmentation, or revision mastopexy with exchange of implants. A prospective level IV analysis of all consecutive patients undergoing primary mastopexy augmentation or revision mastopexy with exchange of implants was performed between January of 2021 and January of 2022. Forty-eight consecutive patients were included in the study. The nipple-inframammary fold-upper breast border (NIU) principle was applied to all patients to determine the ideal position of the NAC. Patients were photographed preoperatively and postoperatively in a standardized manner. The main endpoint was to determine whether the NAC is located at the most projected point of the breast on follow-up. The NIU principle was applied to 48 patients between January of 2021 and January of 2022. Of those patients, 27 underwent primary augmentation mastopexy, and 21 underwent revision augmentation mastopexy with exchange of implants. The mean follow-up duration was 9.2 months (range, 6 to 18 months). All patients demonstrated proper NAC positioning on follow-up. The NIU principle is a simple and reliable method to determine the ideal NAC position during mastopexy augmentation or mastopexy with implant exchange. Therapeutic, IV.

Expanding Access to 3D Technology in Plastic Surgery of the Breast: Validation of the Iphone X 3D Camera Against the Vectra M1

Abstract Goals/Purpose The iPhone X is the first mainstream smartphone to be released that contains a high-fidelity 3D scanner and is already in the hands of tens of millions of individuals in the United States. At the present time, the vast majority of 3D analysis of the breast necessitates ownership of expensive cost-prohibitive camera and software packages. The most popular of these is the Canfield Vectra M1 system. In an effort to expand access to 3D technology in plastic surgery of the breast, the purpose of this study was to compare the accuracy of the iPhone X 3D scanner against the Canfield Vectra M1 in obtaining 3D scans of the breast. Methods/Technique Twenty breasts (n=20) in patients undergoing breast reconstructive surgery were 3D photographed using both the iPhone X and the Canfield Vectra M1. The accuracy of the iPhone 3D image was compared with the Vectra image using color map analysis and surface distances across the 3D model between key anatomical landmarks. These included distances between sternal notch to nipple (SN-N), mid-chest to nipple (M-N), nipple to mid-inframammary fold (N-IMF), and inframammary fold width (IMF). Results/Complications When comparing absolute differences in distances between key anatomical landmarks, the average discrepancy in measurements between iPhone and Vectra image pairs were the following: SN-N: 0.84mm, M-N: 0.70mm, N-IMF 0.81mm, and IMF 0.91mm. Colormap analysis demonstrated an average root mean square error of 1.85mm, with a mean of 0.57mm and standard deviation of ±1.88mm. Conclusion The iPhone X is capable of capturing 3D photographs of the breast with an average discrepancy of approximately 1.0 to 2.0 millimeters as determined by landmark to landmark surface distance analysis and color map analysis. These data demonstrate that the 3D scans obtained with the iPhone may be useful for determining nipple position, measuring the breast footprint, choosing implants, and performing other functions using 3D technology are typically performed using the more expensive systems. These are early data and additional studies should compare volumetric analysis and clinical outcomes between using the iPhone and more established 3D technology systems in breast reconstructive surgery.

The Value of Synthetic and Biologic Meshes in Implant-Based Breast Reconstruction

Implant based breast reconstruction (IBBR) keeps evolving and has been influenced heavily by the use of synthetic and biologic meshes in the last years. In both, subpectoral as well as prepectoral approaches the use of synthetic and biologic meshes has made it possible to place implants precisely according to the breast's footprint and strengthen soft-tissue coverage, particularly in the lower pole of the breast with lower complication rates and better cosmesis. Various mesh options that differ in material, processing, size and cost are currently in clinical use. This review aims to define the role of biologic and synthetic meshes in IBBR regarding the advantages and disadvantages of their use.

Immediate fine-tuning of DIEP flaps using the Wise pattern mastectomy: Description of the technique and a retrospective analysis of complication rates

Elliptical skin-sparing mastectomy in patients with large or ptotic breasts usually leaves loose mastectomy skin flaps, which need to be either resected or gathered over the DIEP flap. This results in poor control of the breast footprint and under-projected DIEP flaps in a loose mastectomy skin pocket, that tend to slip laterally towards the axilla. We believe that the use of a Wise pattern mastectomy will allow for immediate treatment of these concerns. A retrospective, uncontrolled analysis of a prospectively-maintained database of patients operated by the five surgeons performing breast reconstructions at the University of Montreal Hospital Centre. Study population was patients with a BMI of over 25 and grade II/III breast ptosis who underwent a Wise pattern mastectomy with immediate DIEP flap reconstruction. Analysis was performed of the complication rates of the technique in the first six months after the surgery. Out of a total of 53 breasts in 44 patients reconstructed with a DIEP flap immediately post Wise pattern mastectomy, we report nine cases of partial mastectomy-flap necrosis not needing revision, five cases of significant mastectomy flap necrosis needing debridement and skin grafting, and two cases of inability to adequately close the Wise pattern intraoperatively after DIEP placement, necessitating retention of DIEP skin in the inferior pole. None of the mastectomy flap complications occurred in irradiated breasts. In patients with large or ptotic breasts, the Wise pattern mastectomy before an immediate DIEP reconstruction allows for immediate shaping of the breast by controlling the breast pocket, footprint, and excess skin.

Revising Prepectoral Breast Reconstruction.

Prepectoral prosthetic breast reconstruction continues to gain popularity, largely due to its decreased postoperative pain, animation deformity, and operative time as compared to subpectoral reconstruction. Widespread use has led to opportunities for surgical revisions. While some techniques for submuscular reconstruction revisions, such as implant exchange and fat grafting, also apply to prepectoral revisions, others require modification for the prepectoral space. The prosthesis' unique reliance on the mastectomy flaps and acellular dermal matrix for support leads to a progressive alteration of the breast footprint, conus, envelope, and nipple-areola complex position. To date, revisions of prepectoral reconstructions have not been addressed in the literature. This article presents the senior author's (N.P.B.) techniques for (1) revising prepectoral breast reconstructions, including staged and direct-to-implant reconstructions, with a special focus on nipple-sparing reconstruction, and (2) minimizing undesirable outcomes of prepectoral reconstruction.

Anatomy of the Breast Fascial System: A Systematic Review of the Literature.

Understanding the anatomy of the fascial and ligamentous structures of the breast is important in both aesthetic and reconstructive breast surgery. Several structures have been identified that play a significant role in the aesthetic qualities and support of the breast warranting consideration in the context of breast reconstruction. The authors performed a systematic review of anatomical, clinical, histologic, and radiologic studies that have described, characterized, and named these structures. The authors have summarized and critically appraised prior research to clarify and define the key fascial structures of the breast, their anatomical function, and their clinical significance in aesthetic and reconstructive breast surgery. Through their review, six distinct breast fascial structures were encountered consistently in the literature. The authors have organized them into intraglandular and extraglandular structures and have reviewed their significance in the context of reconstructive breast surgery. The primary fascial structures of the breast are important anatomical landmarks with numerous clinical applications. Cooper ligaments divide the breast parenchyma. The superficial and deep layers of the superficial fascia encase the breast in a "pocket," condensing into one thickened layer of fascia along the peripheral breast footprint. The inframammary fold supports and defines the inferior pole. The horizontal septum is a reliable neurovascular landmark. The vertical septum is a newly discovered fascial structure. There are certainly clinical implications that have yet to be described because of the relatively limited and disputed information on the fascia of the female breast and, ultimately, more research is warranted.

The Lateral Breast Flap Sling: A Novel Technique for the Revision of Autologous Breast Reconstructions.

IntroductionA wide breast footprint is a common complaint expressed by breast reconstruction patients following abdominally-based autologous breast reconstruction. Our aim is to describe the lateral autologous breast sling, a novel technique, which modifies the lateral flap inset to address this common patient complaint.MethodsA review of consecutive women who underwent the lateral autologous breast flap sling procedure over a four-year period was completed. Patient demographics, oncologic treatment, operative interventions, surgical indications, and complications were evaluated.ResultsFourteen patients underwent 21 lateral autologous breast flap sling procedures with a mean follow-up of 18 months. Eleven patients underwent delayed breast reconstruction while three were completed immediately, including one patient who had concurrent unilateral mastectomy, free tissue transfer, and a lateral breast sling procedure. Revision surgery was sought for breast asymmetry, excessive lateral breast tissue, and poor superior pole volume. Simultaneous revision procedures were performed in 12 patients and included fat grafting, abdominal donor site revision, contralateral breast reduction, and V to Y advancement of the lateral breast/ chest soft tissues. Reconstruction was complete in 10 patients, with an average duration of 13.5 months and four reconstructive procedures. There were no major perioperative complications. Three patients developed fat necrosis following lipofilling and two of these patients required drainage and/or excision of fat necrosis.ConclusionsThe lateral autologous breast flap sling technique adds to the armamentarium for narrowing the wide breast and improving the lateral breast curve. It may be performed in combination with other revision procedures. The use of this technique is associated with a low complication rate and does not significantly increase the total number of reconstructive procedures or duration of reconstruction. This technique may be useful during initial free tissue transfer.

Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: Comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction.

Volume replacement oncoplastic breast-conserving surgery (VR-OBCS) uses islanded or pedicled chest wall fasciocutaneous perforator flaps from outside of the breast footprint to replace the volume that has been excised during lumpectomy, extending the options for breast conservation to patients who may otherwise require mastectomy. This study compares outcomes for VR-OBCS with both standard volume displacement oncoplastic breast-conserving surgery (VD-OBCS) and mastectomy with immediate total breast reconstruction (TBR). A retrospective cohort study was conducted; demographic data, clinicopathologic factors, surgical details, and postoperative events were collected until patients had completed their reconstructions. Variables were compared using the t test and analysis of variance test, or chi-square analysis and Fisher's exact test, as appropriate. Ninety-seven consecutive patients (109 immediate breast reconstruction procedures) were included: 43 percent underwent standard VD-OBCS procedures, 35 percent underwent mastectomy with immediate TBR, and VR-OBCS techniques were used in 22 percent, of which only one patient required a delayed procedure for symmetry. Mean whole tumor size was similar in the VR-OBCS and TBR groups and was significantly higher than for the VD-OBCS group (p < 0.05). Overall rate of complications affecting the breast area (p < 0.001), need for additional surgery to either breast (p < 0.001), and time to reconstruction completion (p < 0.001) were significantly higher in the TBR group. VR-OBCS extends the options for breast conservation to many patients that would otherwise require mastectomy. The complication rate is lower, fewer procedures are necessary, and less time is required to complete the reconstruction when compared with mastectomy and immediate TBR. Therapeutic, III.

No-Scar Breast Reduction Utilizing Power-Assisted Liposuction Mammaplasty, Loops, and Lipofilling.

In continued interest to develop and refine minimally invasive procedures, recent publications reported a scarless approach in breast lifting. The authors sought to describe a power-assisted lipomodeling technique combined with surgical loops to achieve breast reduction and reshaping with minimal scars. Between 2014 and 2018, 94 patients underwent breast reduction by combined liposuction and loops. Following infiltration of the breasts, liposuction of the outer quadrants and the lower pole was achieved to reduce the breast footprint and the lateral and inferior heaviness of the breast. After multiaxial multiplanar tunnelization, 3 types of loops were taken around the breast to suspend and elevate the breast skin envelope and parenchyma. Each loop was guided through a 3-mm, 3-hole cannula passed through skin stab incisions. The first loop was designed to reduce the breast footprint and enhance the breast projection, whereas the second loop was designed to achieve breast conus remodeling. The third loop was passed circumferentially around the areola and then cephalad along the breast axis and pulled until the desired nipple-areola complex elevation was reached. Each loop was pulled to achieve the desired breast projection and shape. The authors achieved breast reduction with a mean nipple elevation of 7.3 cm, and 88% of patients were satisfied with their breast shape. The total complication rate was 1%, including mild cellulitis in 1 breast, treated efficiently with oral antibiotics. The proposed technique is a novel, simple, and safe alternative to achieve breast reduction and reshaping without a scar.

Full breast reconstruction with fat and how to recycle the "dog-ear".

Mastectomy without immediate reconstruction leaves us with a population of women who may need a new breast in a delayed fashion. These women are often elderly, not fit for major flap surgery or reluctant to have long scars or implants. Free fat grafting has mainly been used as an adjunct to other reconstructive methods. We present an option for delayed full breast reconstruction with free fat grafting alone. In some cases, we utilize the lateral excess as a flap in combination with fat grafting. Patient selection is crucial. A lady fitting this reconstruction method should have fat to donate, preferably in several different regions as well as redundant skin on the chest-wall and only minor radiation damage. Also, breast size requirements need to be sensible. The Fat is harvested in a closed system under general or local anesthesia. Following a few minutes decantation, the fat is put into syringes and injected from 4-6 entrance points into 3-4 layers with a blunt cannula. Depending on the width, height and thickness of the receiving chest wall, the transferred volume varies between 150-300 cc/operation. In general, 2-5 operations are needed to reconstruct a breast with fat alone. If the patient presents with lateral excess tissue, this can be utilized as a local, fasciocutaneous flap, de-epithelialized and rotated 180 degrees to support the inferior border of the new breast. This enables inferolateral definition and control of the breast footprint. The secret behind success in free fat grafting for full breast reconstruction lies in the small technical details and works safely and efficiently in a selected group of patients.

Aesthetic Breast Surgery: What Do the Measurements Reveal?

Do plastic surgeons really know what happens to the breast after surgery? We often think that we do, but we have very few measurements to show whether we are on the right track. Only when the surgeon can predict the changes can she or he achieve consistent outcomes. Measurements lead to understanding; understanding what the measurements show allows us to refine our approach. Consecutive patients in 4 categories were analyzed: breast reduction, mastopexy, augmentation, and mastopexy-augmentation. All procedures were performed by a single surgeon and all measurements were performed by the same surgeon. A standard measuring tape was utilized, and data were collected immediately preoperatively and at each follow-up visit. Only those patients with preoperative and complete 1-year postoperative measurements were included in this review. The parameters measured were clavicle to upper breast border (UBB), UBB to nipple, suprasternal notch (SSN) to nipple, SSN to inframammary fold (IMF), and chest midline to nipple. The changes were consistent. The borders of the breast footprint were expanded with the addition of an implant (UBB and IMF) and reduced with the removal of parenchyma (IMF). The existing SSN to nipple position was stretched when volume was added to the breast mound and it remained unchanged from the preoperatively marked position in a breast reduction. Although measurements are not necessary to achieve good aesthetic results in breast surgery, surgeons should understand what the measurements show and what happens to the different breast parameters.