Breast Size Research Articles

Adding quilting sutures to Y plasty to avoid postmastectomy lateral dog ears in patients with large cup sized breast

Background Total mastectomy without reconstruction is a commonly adopted procedure for managing breast cancer. Formation of lateral dog ears is very common, especially with large breast cup size. In this study, we assessed the feasibility of adding quilting sutures to the Y plasty technique to achieve more acceptable results in the avoidance of lateral dog ears in comparison to using Y plasty alone. Methods The study included 150 female patients with large breast cup size. Patients were randomized 2 : 1 between group A and group B. In group A, 3–5 quilting sutures were added to the lateral flaps of Y plasty. In group B, Y plasty only was adopted without the quilting sutures. Patients were followed up at 4-month intervals for at least 1 year. One year after surgery, patients filled in a questionnaire inquiring about the degree of discomfort in the area beneath the arm. Also, a plastic surgeon was asked to give a score about the cosmetic outcome of managing lateral dog ears both at 3 weeks and 12 months after surgery. Results Both groups were comparable in regard to age, BMI, breast cup size, and postoperative radiotherapy exposure. Patients in group A had better scores for satisfaction with the shape of the scar and comfort with the bra. Also, the blinded cosmetic outcome assessment was in favor of group A. Conclusion Adding quilting sutures to the lateral flap of the V-Y plasty technique is associated with a better cosmetic outcome in the management of lateral dog ears in mastectomy patients with large breast cup size.

Prediction of axillary lymph node metastasis using tumor volume to breast volume ratio: retrospective cohort study.

Tumour size appear to be a risk factor of axillary lymph node metastasis in breast cancer. Recent evidence shows that higher the T staging is associated with higher rate of axillary lymph node metastasis. However, no studies shows that in the same T staging or tumour size but different breast size or breast volume the incidence of axillary lymph node metastasis differ or not . This Study aimed to investigate the association between tumour to breast ratio in breast cancer as a predictive factor of axillary lymph node metastasis. This study included 200 consecutive patients diagnosed with breast cancer between January 2012 to march 2022. The authors retrospectively reviewed medical data pathologic report and Ultrasonography and mammography of breast. Tumour diameter reported in pathologic report was used to calculate tumour volume using formula for ellipse. Breast volume was calculate using formula referencing from study of Jack W. Rostas et all by formula Breast Volume=1/3׶×Radius2ccview×Heightccview by measuring from mammography of patient. Tumour volume to breast volume ratio was calculated and analyzed. Of 200 patient included in this study, 84 patient (42%) was in lymph node positive group and 116 patient (58%) was in lymph node-negative group. Median for tumour and breast volume ratio in node positive group was higher [median 0.0093 (interquartile range=0.0047-0.023)] than in node-negative group [median 0.0065 (interquartile range (0.0028-0.0199)]. P=0.0414 receiver operating characteristic curve for tumour to breast ratio showed AUC of 0.7389 (95% CI 0.67993-0.82335) Which seems to be a significance as predictive factors for Axillary lymph node metastasis. Higher tumour volume to breast volume ratio tends to be a significance predictive factors for axillary lymph node metastasis in breast cancer patients.

Automated digital templating of component sizing is accurate in robotic total hip arthroplasty when compared to predicate software

Accurate pre-operative templating of prosthesis components is an essential factor in successful total hip arthroplasty (THA), including robotically-assisted THA (RA-THA) techniques. We sought to validate the accuracy of a novel, robotic-optimized THA planning software compared to a predicate THA planner for component sizing. We analyzed a series of 199 patients who received manual THA (mTHA) and fluoroscopy-based RA-THA at a single institution. All cases were templated using a predicate pre-operative templating software. For RA-THA cases, the novel robotic-optimized pre-operative planner software was also used for templating. The differences between templated and implanted acetabular cup, femoral head, and stem component sizes were compared based on matching within 1, 2, and ≥3 sizes. Differences in templated and implanted femoral stem implant geometry were also compared. The robot-optimized pre-operative RA-THA plans demonstrated equivalent accuracy to that of predicate pre-operative plans for both RA-THA and mTHA cases. Templated acetabular cups (90.4 vs. 86.8 vs. 82.8; p = 0.421), femoral stems (76.0 vs. 65.1 vs. 67.7; p = 0.096), and femoral heads (91.3 vs. 96.2 vs. 88.2; p = 0.302) were within +/−1 size of implanted components. No significant differences were detected in the proportion of matching templated and implanted stem geometry across the study cohorts.

The Role of Serum Nestin in Diagnosis and Prognosis of Breast Cancer: A Prospective Observational Study.

The molecular classification of breast cancer has enabled targeted therapy for specific molecular subtypes. Nestin, which has been studied for its role in oncogenesis, could contribute to this direction. This study aimed to investigate the differences between serum nestin levels and molecular profiling, as well as histopathological tumor types, in women who underwent surgery for breast cancer. Women who underwent surgery for breast cancer at the Breast Unit of the 1st Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens were prospectively included. Patients' demographic data were recorded and serum nestin levels were measured. Molecular biomarker analysis was performed, as well as histopathologic assessment. Seventy patients were included in the analysis. Among patients with breast cancer, 93% were estrogen receptor (ER) positive, 91% were progesterone receptor (PR) positive, and 43% were human epidermal growth factor receptor 2 (HER2) positive. Ki67 was expressed in 16% of patients and p53 was expressed in 32% of patients. Invasive ductal carcinoma was diagnosed in 80% of patients, with 44% of tumors classified as T1 and 46% as T2. Additionally, 43% were G1 and 56% were N0, while 34% were N1. No statistically significant difference was observed between serum nestin levels and ER, PR, HER2, Ki67, and p53 expression. Furthermore, no difference was observed between serum nestin levels and breast cancer histological type, size, N-stage, and grading. The diagnostic and prognostic role of circulating nestin for breast cancer was not confirmed and no correlation with immunohistochemistry results was observed. Thus, the necessity of larger prospective studies is enhanced.

Supported to perform: sports bras and breast volume do not impair cycling performance in females.

Despite the importance of sports bras for comfort during exercise in people with breasts, concerns persist regarding their potential effects on athletic performance. Discrepancies in previous studies necessitate a closer examination of the interaction between sports bras, breast volume, exertional symptoms, and exercise performance. Twenty-three recreationally-active, normal bodyweight females completed three 10-km time-trials on a cycle ergometer on three separate occasions in a randomized order, while wearing a professionally fitted high-support sports bra, a professionally fitted low-support sports bralette, or a personal, self-selected sports bra. Performance was quantified as the time to complete the 10-km distance. Cardiorespiratory and symptom responses were measured throughout. Participants were grouped by their estimated breast volumes (small: mean ± SD 284 ± 38 ml, median bra size: 32C; large: 560 ± 97 ml, 34DD; p = 0.002, g = 3.84). The average time-trial duration was 23.1 ± 3.1 min and comparable across breast volume groups and sports bra conditions (between-group: p = 0.794, η p 2 < 0.01; between-bras: p = 0.273, η p 2 < 0.01). Notably, larger-breasted participants experienced stronger symptoms of chest tightness (p = 0.042, η p 2 = 0.18), which were associated with their ratings of perceived exertion and breathlessness (intensity and unpleasantness). Irrespective of breast volume, the high-support sports bra also evoked stronger symptoms of chest tightness (p = 0.039, η p 2 = 0.15). Stronger symptoms of chest tightness associated with larger breast volumes or high-support sports bras do not impede performance during self-paced non-weight-bearing exercise in recreationally-active females.

Level-2 Oncoplastic Surgical Techniques for Breast Cancer: A Preliminary Vietnamese Report.

Breast cancer is the most common malignancy and remains the first cause of death related to cancer among Vietnamese women, with an incidence of 21,555 cases in 2020. Most breast cancer patients present with invasive disease and relatively large tumor sizes. While oncoplastic surgery (OPS) are commonly applied in Western countries, data on Asian population remains relatively limited. This study aims to assess the outcomes of level-2 oncoplastic techniques in breast-conserving surgeries at the Vietnam National Cancer Hospital. From January 2017 to June 2021, a cohort of 257 breast cancer patients who underwent breast-conserving surgery with OPS techniques were examined. Surgical complications, cosmetic outcome, recurrence and survival rates were assessed. The mean age was 47.6±9.4 years, most patients had breast cup sizes B and C. The mean tumor size upon pathological examination was 2.00 ± 0.74 cm. Only 7 cases required reoperation, resulting in a mastectomy rate of 1.17%. The overall complication rate was low at 11.46%, with 9 cases (3.56%) experiencing delayed complications. Cosmetic results were rated as "excellent" in 20.6% and "good" in 60.5%, with a statistically significant difference. The rates of local recurrence, regional recurrence, and distant metastasis at five years were 2.78%, 1.19%, and 2.36%, respectively. The level 2 oncoplastic techniques had low complication rates, favorable oncological outcomes, and cosmetically satisfying results.

927 The impact of cup size on complications in vacuum-assisted deliveries: A retrospective case-control matching analysis

927 The impact of cup size on complications in vacuum-assisted deliveries: A retrospective case-control matching analysis

Variasi Ukuran Payudara sebagai Daya Tarik Fisik Perempuan di Masyarakat Lampung

Sexual selection occurs when living organisms, including humans, exhibit specific preferences for morphological traits related to health and fertility when choosing a mate. Various physical characteristics such as body size and shape, leg length, skin color, hair length and color, facial features, and breast size contribute to the physical attractiveness of females in mate selection. Breasts can serve as a particular attraction for males, as they are believed to be associated with health and fertility for reproductive purposes. Sexual selection leads to a range of breast sizes, from small to large, within a population. The aim of this research is to investigate the variation in breast size preferences among females in the Indonesian society, specifically in Lampung. The study was conducted by distributing both online and offline questionnaires randomly with breast size stimuli in the form of images. Descriptive data analysis was employed to examine the variation in breast size preferences. Very large breast sizes were considered healthy and feminine by respondents, while medium sizes were deemed attractive. Married male respondents preferred larger breast sizes on average compared to unmarried respondents. Higher-income respondents tended to select larger breast sizes. Respondents with lower educational backgrounds tended to prefer smaller breast sizes. Respondents residing in rural areas preferred larger breast sizes compared to those living in urban areas. In conclusion, sexual selection applied among the population of Lampung in the context of breast size preferences.

Alpelisib Efficacy in Advanced Breast Cancer

Breast cancer is one of the popular problems related to the medical field. Breast cancer become more aggressive, and the incidence rate keeps increasing yearly. The incidence indicates the slow progression of the disease. Yearly, there are more than one million new cases that get worse. Probably the incidence rate will increase significantly in the next years. Breast cancer develops silently without medical attention, and most cases are discovered during a routine clinic visit. While other cases may accidentally discover breast lumps, changes in breast shape or size, and nipple discharge. Breast cancer highly affects women worldwide. Mortality rates of breast cancer are improving, but still, the survival rate in the advanced stage is decreasing. Nowadays, Chemotherapy is considered the gold-standard approach for most cancer types and a modest improvement in both survival rates and toxicity reduction. Therefore, this article aims to focus on the use of one of the modest drugs that treat advanced breast cancer, which is Alpelisib, and highlight the mechanism of action, indication, contraindication, pharmacodynamic, pharmacokinetic, dose, and its side effects. Alpelisib is being developed by Novartis company. The first clinical trials started in Oct 2010. It was approved in the USA on May 24th, 2019. Alpelisib works by inhibiting the phosphatidylinositol 3-kinase (PI3K) which leads to inhibiting the activation of some signaling pathways. Alpelisib is used in combination with fulvestrant to treat advanced breast cancer in postmenopausal women with some genetic mutations.

Breast morphology classification method based on generalized neural network

In order to establish a breast shape classification method with general indicators, this paper selects six measurement indicators that can characterize the three-dimensional shape of the breast, such as circumference, length, width, and height. The relevant data of the measurement indicators are used to establish a generalized neural network model, and the generalized neural network is applied to the evaluation of breast shape classification recognition. The MATLAB software toolbox is used, based on training sample data, We have established a generalized neural network (GRNN) model, which involves establishing corresponding functional relationships through training to approximate the training data. After obtaining the function relationship through training, the predicted values were obtained, and the prediction results reflected that the established generalized neural network GRNN model is quite reliable for predicting the category of breast shape. By establishing a mapping relationship between the input quantity of breast feature parameters and the output quantity of categories, training samples can be established. When encountering new test data, these data can also be used as test samples. Based on the established model, appropriate spreads can be adjusted to predict the output quantity, providing relevant personnel with basic and simple basis for judgment and evaluation. It can also provide convenience for customers in various consumption channels Accurate bra size recommendations can help consumers purchase bras that fit well and are comfortable.

Multiscale Monte Carlo simulations for dosimetry in x-ray breast imaging: Part I - Macroscopic scales.

X-ray breast imaging modalities are commonly employed for breast cancer detection, from screening programs to diagnosis. Thus, dosimetry studies are important for quality control and risk estimation since ionizing radiation is used. To perform multiscale dosimetry assessments for different breast imaging modalities and for a variety of breast sizes and compositions. The first part of our study is focused on macroscopic scales (down to millimeters). Nine anthropomorphic breast phantoms with a voxel resolution of 0.5mm were computationally generated using the BreastPhantom software, representing three breast sizes with three distinct values of volume glandular fraction (VGF) for each size. Four breast imaging modalities were studied: digital mammography (DM), contrast-enhanced digital mammography (CEDM), digital breast tomosynthesis (DBT) and dedicated breast computed tomography (BCT). Additionally, the impact of tissue elemental compositions from two databases were compared. Monte Carlo (MC) simulations were performed with the MC-GPU code to obtain the 3D glandular dose distribution (GDD) for each case considered with the mean glandular dose (MGD) fixed at 4mGy (to facilitate comparisons). The GDD within the breast is more uniform for CEDM and BCT compared to DM and DBT. For large breasts and high VGF, the ratio between the minimum/maximum glandular dose to MGD is 0.12/4.02 for DM and 0.46/1.77 for BCT; the corresponding results for a small breast and low VGF are 0.35/1.98 (DM) and 0.63/1.42 (BCT). The elemental compositions of skin, adipose and glandular tissue have a considerable impact on the MGD, with variations up to 30% compared to the baseline. The inclusion of tissues other than glandular and adipose within the breast has a minor impact on MGD, with differences below 2%. Variations in the final compressed breast thickness alter the shape of the GDD, with a higher compression resulting in a more uniformGDD. For a constant MGD, the GDD varies with imaging modality and breast compression. Elemental tissue compositions are an important factor for obtaining MGD values, being a source of systematic uncertainties in MC simulations and, consequently, in breastdosimetry.

Reduction of Radiation Risk to Cardiologists and Patients during Coronary Angiography: Effect of Exposure Angulation and Composite Shields

Purpose: This study aimed to design an improved form of a composite shield with different materials and shapes and simultaneously reduce the radiation dose to both the patient and operator.&#x0D; Materials and Methods: A female phantom study was performed with and without bismuth belt-shaped composite shields on the breast region at different beam projections used in coronary angiography. Dose measurements were conducted using GR-200 thermo-luminescence dosimeters, dose area product (DAP), and air kerma (AK) over regular and large breast locations, with and without using bismuth shields. An electronic personal dosimeter was used for operator dose assessment. Patients received doses between 2.27 mSv and 3.38 mSv, depending on the size and strength of beam projections.&#x0D; Results: The use of the developed shields caused a dose reduction of 18%–25% of sensitive breast tissue due to breast size and shield type. During coronary angiography, the mean values of DAP and AK were 2.02 (1.24-2.80) mGy.m2 and 314.1 (202.8-500) mGy, respectively. The highest recorded dose was at the LAO/CRA and LAO/CAU beam projections for both the patient and operator. After applying a belt shield, the operator's radiation dose was decreased by approximately 32%. We found a statistically significant correlation between the radiation dose received by the operator and the patient's breast radiation exposure dose (p&lt;0.001, r2=0.93).&#x0D; Conclusion: The designed belt shield can be a potentially promising protective device for decreasing the radiation risk to the patient's breast and the operator during coronary angiography. However, further studies will be considered before the application of this shield in standard clinical practice.

Oncogenic BRCA1,2 Mutations in the Human Lineage-A By-Product of Sexual Selection?

In this review, we discuss the long-known problem of tissue-specific carcinogenesis in BRCA1 and BRCA2 mutation carriers: while the genes are expressed ubiquitously, increased cancer risk is observed mostly in the breast and ovaries, and to a much lesser extent, in some other tissues such as the prostate or pancreas. We reevaluate hypotheses on the evolutionary origin of these mutations in humans. Also, we align together the reports that at least some great apes have much lower risks of epithelial cancers in general and breast cancer in particular with the fact that humans have more voluminous breast tissue as compared to their closest extant relatives, particularly chimpanzees and bonobos. We conjecture that this disparity may be a consequence of sexual selection, augmented via selection for enhanced lactation. Further, we argue that there is an organ-specific enigma similar to the Peto paradox: breast cancer risk in humans is only minimally correlated with breast size. These considerations lead to the hypothesis that, along with the evolutionary development of larger breasts in humans, additional changes have played a balancing role in suppressing breast cancer. These yet-to-be-discovered mechanisms, while purely speculative, may be valuable to understanding human breast cancer, though they may not be exclusive to the mammary gland epithelial cells. Combining these themes, we review some anti-carcinogenesis preventive strategies and prospects of new interventions against breast cancer.

Addition of progesterone to feminizing gender-affirming hormone therapy in transgender individuals for breast development: a randomized controlled trial

BackgroundFeminizing gender-affirming hormone therapy (GAHT) for transgender individuals traditionally includes estradiol and androgen deprivation. Research has demonstrated that breast size as a result of GAHT in transgender women is often limited. Therefore, transgender women often choose to undergo breast augmentation surgery. Progesterone is important for breast development in cisgender women during puberty. A potential role for progesterone in breast development in transgender women has not been investigated in a randomized controlled experimental set-up. The primary objective of this study is to explore the effects on breast volume of addition of oral progesterone to GAHT with estradiol in transgender women after vaginoplasty or orchiectomy. Secondary objectives include assessment of safety, satisfaction, mood, sleep and sexual pleasure.MethodsThis is a non-blinded, non-placebo, randomized controlled trial using a factorial design in adult transgender individuals assigned male sex at birth who have undergone GAHT for at least one year and underwent vaginoplasty or orchiectomy. The study design allows for rapid assessment of potential synergistic effects of various dose combinations of estradiol and progesterone on breast volume change: Ninety participants will be randomized into six groups of 15 subjects each, receiving either the baseline dose of estradiol, the baseline dose of estradiol and progesterone 200 mg daily, the baseline dose of estradiol and progesterone 400 mg daily, twice the baseline dose of estradiol, twice the baseline dose of estradiol and progesterone 200 mg daily or twice the baseline dose of estradiol and progesterone 400 mg daily, all for a duration of 12 months. The main study parameters include changes in breast volume as determined by 3D measurements. Participants will be followed-up with laboratory testing including serum progesterone concentrations as well as surveys for satisfaction, mood, sleep quality and sexual pleasure.DiscussionThis study will indicate whether progesterone is safe and of additional value with regard to breast volume change in transgender individuals receiving feminizing GAHT. The results of this study will be useful for innovation of feminizing GAHT.Trial registrationWHO International Clinical Trials Registry Platform: EUCTR2020-001952-16-NL; date of registration: 12 December 2020 https://trialsearch.who.int/Trial2.aspx?TrialID=EUCTR2020-001952-16-NL.

Main Factors Influencing Patient Satisfaction After Primary Breast Augmentation: A Prospective Study Based on Patient-Reported Outcome Measures.

Primary breast augmentation is one of the most sought-after procedures in cosmetic surgery. It is generally related to a high degree of patient satisfaction, but it is not always obvious which factors have greater influence on patient satisfaction. The aim of this prospective study was to evaluate how anthropometric, psychological, and social parameters, in association with the main surgical variables, influenced patients' satisfaction with their breasts after surgery. Patients undergoing primary breast augmentation between October 2018 and February 2022, who completed a 12-month follow-up without complications, were enrolled in the study. For each patient we recorded: BMI, pinch test (upper pole of the breast), surgical access, implant pocket, implant volume, bra size increase, age, smoking habit, civil status, education level, pregnancies, and psychiatric disorders. Each variable was statistically correlated with patient's satisfaction, assessed by BREAST-Q questionnaire preoperatively and 12 months postoperatively. Analyzing the data of the 131 patients, we found 3 factors affecting their satisfaction (P<.05); BMI: underweight patients were less satisfied than normal and overweight patients; pinch test: patients with a pinch test >2 cm were more satisfied; volume of the implant and bra size increase: patients with implant volume <300 cc and a less than 2 bra size increase were less satisfied than patients with larger augmentation. BMI, pinch test, implant volume, and extent of volumetric enhancement should be taken into careful consideration by the surgeon during preoperative consultation and surgical planning, because they can be critical to patient satisfaction.

Breast lymphedema following breast-conserving treatment for breast cancer: current status and future directions.

To examine the current evidence on breast lymphedema (BL) diagnosis and treatment after breast-conserving surgery, identify gaps in the literature, and propose future research directions. A comprehensive literature review was conducted using Ovid, PubMed, and Cochrane, including studies published between 2000 and 2023. References were reviewed manually for eligible studies. Inclusion criteria were as follows: patients who underwent breast conserving treatment (surgery ± radiation) for breast cancer, goals of the paper included analyzing or reviewing BL measurement with ultrasound or tissue dielectric constant, or BL treatment. Twenty-seven manuscripts were included in the review. There is variation in incidence, time course, and risk factors for BL. Risk factors for BL included breast size, primary and axillary surgery extent, radiation, and chemotherapy but require further investigation. Diagnostic methods for BL currently rely on patient report and lack standardized criteria. Tissue dielectric constant (TDC) and ultrasound (US) emerged as promising ambulatory BL assessment tools; however, diagnostic thresholds and validation studies with ICG lymphography are needed to establish clinical utility. The evidence base for treatment of BL is weak, lacking high-quality studies. The natural history of BL is not well defined. TDC and US show promise as ambulatory assessment tools for BL; however, further validation with lymphatic imaging is required. BL treatment is not established in the literature. Longitudinal, prospective studies including pre-radiation measurements and validating with lymphatic imaging are required. These data will inform screening, diagnostic criteria, and evidence-based treatment parameters for patients with BL after breast-conserving surgery and radiation.

The Feasibility of Tube Current Modulation (TCM) to Reduce dose of the Surface Breast in Various Breast Sizes

This study aims to develop three sizes of breast phantoms from silicone rubber (SR) material and evaluate tube current modulation (TCM) to reduce surface doses of the developed breast phantoms. The in-house breast phantom has three sizes: small (cup 34), medium (cup 36), and large (cup 38). The cross-sectional areas of cup 34, 36, and 38 are 78.5, 113.04, and 153.87 cm2, respectively. The in-house phantom was attached to the adult anthropomorphic phantom for dose measurement. Dose measurement was performed using an Optically Stimulated Luminescence (OSL) dosimeter. Scans were performed with and without TCM technique. It was found that the TCM effectively reduce the radiation dose to the breast surface up to approximately 60%. However, the dose reduction was accompanied by a 66% increase in noise when using the TCM technique.

Early outcomes of total hip arthroplasty using point-of-care manufactured patient-specific instruments: a single university hospital’s initial experience

BackgroundThe use of 3D-printed Patient-Specific Instruments (PSI) has been investigated to enhance the postoperative functional results in total hip arthroplasty (THA) and has been recognized as an innovative approach for the optimal alignment of hip implant components. Point-of-care production is gradually becoming the norm for PSI manufacturing. The purpose of this article is to assess the accuracy and safety of PSI for total hip arthroplasty performed at the point-of-care in Vietnam.Methods34 THA cases were assessed in this prospective study. A template for the size and orientation of the implant and the design of the PSI was generated using data from preoperative 3D computed tomography (CT) scanning of the lower limb. The principal surgeon determined the implants’ position and PSI design directly using the software. The PSI is then produced using a 3D-compatible resin printer in our manufacturing hospital. The PSI, consisting of an acetabulum and a femoral component placed press-fit on the bony surface, guided surgeons to precisely ream the acetabulum and cut the femoral neck according to the pre-planned plane. Postoperative CT scanning was obtained and superimposed onto the 3D model of the implant to evaluate the accuracy of the procedure by comparing the orientation values of the cup and the alignment of the stem between the planned and the actual results. Intra- and postoperative clinical parameters of surgery, including surgical time, intra-operative blood loss, complications, and the first ambulation, were also recorded to evaluate the safety of the surgery.ResultsThe preparation for PSI required an average of 3 days. 94% of cup size and 91% of stem size were correctly selected. The mean values of postoperative inclination and anteversion were 44.2° ± 4.1° and 19.2° ± 5.6°, respectively. 64.7% of cases deviated from planned within the ± 50 range and 94.1% within the ± 10° range. There was no significant statistical difference between the planned and the achieved values of stem anteversion, osteotomy height, and leg length discrepancy (p > 0.05). The average surgical time was 82.5° ± 10.8 min, and the intraoperative blood loss was estimated at 317.7° ± 57.6 ml. 64.7% of patients could walk on the day of surgery. There were no complications reported.ConclusionsThe point-of-care manufactured PSI is a useful solution for improving the accuracy of total hip arthroplasty surgery, especially in restoring implant orientation and reducing leg length discrepancy. However, long-term clinical follow-up evaluation is needed to confirm the efficacy and safety of this approach.

Current status of autologous breast reconstruction in Europe: how to reduce donor site morbidity.

Autologous reconstruction techniques for breast reconstruction have significantly evolved in the last few decades in Europe. In the search of reducing the donor site morbidity, surgeons explored the possibilities to preserve the rectus muscle and its function, and a transition to deep inferior epigastric perforator (DIEP) flaps was started in the nineties. Throughout the years, and especially in the last decade, we have increasingly implemented aesthetic refinements for donor site handling in DIEP flap breast reconstruction. In our practice, autologous breast reconstruction provides an opportunity to effectively remodel the donor site, minimising functional morbidity, and maximising aesthetic satisfaction. To achieve this, careful patient selection, pre-operative preparation, meticulous intra-operative dissection, and a clear post-operative protocol are essential. The main goal in autologous breast reconstruction, and its biggest advantage, is to offer the patient a natural look and feel of the reconstructed breast. A second goal is to minimize the number of procedures needed to reach the desired breast shape, size, and volume. In most patients, the number of operations ranges between one and three. The third main goal is to minimize the donor site morbidity, both functionally and aesthetically. Functionally, this implies preserving as much of the rectus abdominis muscle as possible, limiting the fascia incision, preserving the motor branches to the muscle, ensuring an adequate fascial closure, and repairing the rectus diastasis is present. Aesthetically, we aim to have a low position of the scar, an aesthetically pleasing location of the umbilicus, and limited or no lateral skin excess or so called "dogears". In this clinical practice review article, we provide an overview of current autologous reconstruction methods, with a focus on minimising donor site morbidity and enhancing the aesthetic result of the donor site. We discuss key concepts in autologous reconstruction and provide surgical pearls for performing the procedure effectively with optimal reconstructive and aesthetic result.

Abstract C118: Racial disparities in insurance coverage for supplemental breast cancer screening

Abstract Introduction and Purpose: Women with dense breasts have increased risk both for developing breast cancer and false-negative mammograms. Supplemental screening with breast MRI has been shown to shown to significantly increase cancer detection among women with dense breasts. In May 2023, Pennsylvania (PA) mandated insurance coverage of one supplemental screening study (breast MRI or ultrasound ) annually for women with dense breasts. Prior research suggests that Black women have lower breast density on average than white women based on subjective grading from the American College of Radiology Breast Imaging and Reporting Data System (BI-RADS), partially due to larger average breast size and higher body mass index (BMI) than white women. The purpose of this study was to estimate the potential impact of this supplemental screening law on different patient populations in a large health system. Methods: Women without prior breast cancer or known BRCA1/2 mutations who underwent mammographic screening at a large PA health system from April 2015-December 2017and completed a risk factor questionnaire were included (N=83,579). Under PA law, women must have either heterogeneously dense breasts plus &amp;gt;20% lifetime risk of breast cancer or extremely dense breasts to be eligible for insurance coverage for supplemental screening, both of which involve subjectively graded breast measurements. Breast cancer risk for each patient was estimated using the Gail model. The cancer detection rate (CDR) for mammographic screening was calculated as the number of cancers diagnosed within one year of a positive mammographic screen; the interval cancer rate was calculated as the number of cancers diagnosed within one year of a non-actionable screening mammogram per 1000 women. Logistic regression was used to calculate the odds of eligibility adjusted for age and BMI. Results: Black women were less likely to have extremely or heterogeneously dense breasts than white women (23.7% vs. 45.0%, p&amp;lt;0.001). Under PA law, 2.5% of Black women and 9.9% of white women would qualify for insurance coverage for supplemental screening (p&amp;lt;0.001). Only 0.2% of Black women and 2.3% of white women had heterogeneously dense breasts and &amp;gt;20% lifetime risk. Black women were more likely to have triple-negative breast cancer (TNBC) than white women (p&amp;lt;0.001). After adjusting for age and BMI, Black women remained 54% less likely to be eligible for supplemental screening than white women (OR=0.46, 95% 0.42-0.51, p&amp;lt;0.001).Conclusions: Black women are less likely to qualify for insurance coverage for supplemental breast cancer screening than white women under PA law. Given that Black women have lower prevalence of subjectively graded dense breasts and higher prevalence of TNBC, the new supplemental screening law is unlikely to meaningfully reduce racial disparities in breast cancer mortality. Methods to better assess breast cancer risk among Black women, particularly the risk of TNBC, are urgently needed to identify Black women that may benefit from supplemental screening. Citation Format: Mattia A. Mahmoud, Sarah Ehsan, Oluwadamilola M. Fayanju, Susan M. Domchek, Katherine L. Nathanson, Despina Kontos, Emily F. Conant, Anne Marie McCarthy. Racial disparities in insurance coverage for supplemental breast cancer screening [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C118.