Intermammary Distance Research Articles

Factors influencing intraoperative conversion from double- to single-incision mastectomy with free nipple grafts in 352 transgender and non-binary patients

BackgroundDouble-incision mastectomy (DIM) with free nipple grafts (FNG) is a common technique employed in gender-affirming mastectomy (GAM), but is associated with a high scar burden. Intraoperatively, the surgeon may opt for a single-incision mastectomy (SIM) along the inframammary folds (IMF) to optimize aesthetic outcomes. This study sought to identify factors predictive of intraoperative conversion. MethodsFrom February 2018 to November 2022, TGNB patients who underwent GAM at a single institution were retrospectively reviewed. Data regarding patient characteristics, perioperative details, postoperative complications, and aesthetic satisfaction were collected. ResultsA total of 352 patients were identified. Median age and body mass index (BMI) were 25.0 years (IQR: 9.0) and 28.5 kg/m2 (IQR: 8.5), respectively. Most patients received IMF incisions (n = 331, 94.0%); of whom, 66 (19.9%) underwent intraoperative conversion from DIM to SIM with FNG. Larger breast cup-size (p < 0.001) and a greater degree of ptosis (p = 0.002) preoperatively were significantly associated with intraoperative conversion to SIM. There was no significant association between intraoperative conversion and the ratio of intermammary distance to the width of the chest wall (p = 0.086). Overall complication rates were significantly higher among patients with diabetes mellitus (p = 0.015) and a greater degree of ptosis (p = 0.018). 77.8% (n = 274) of patients were satisfied with their aesthetic outcome. NPWT usage was associated with higher rates of aesthetic satisfaction (83.6% vs. 77.8%; p = 0.005). ConclusionPatients with larger breast cup size and greater degree of ptosis should be counseled preoperatively that they may be at a higher risk of conversion to a singular incision.

Safe Reduction of Intermammary Distance in Implant Breast Augmentation Without Fat Grafting.

Over the latest 15 years, breast augmentation with implant has been progressively refined technically and artistically. However, little attention is usually given to the intermammary space. The aim of this article is to report author's experience and technique in the safe reduction of the intermammary space in breast augmentation with implants without fat grafting. From July 2019 to July 2021, 62 consecutive patients undergoing cosmetic breast enhancement with implant and requesting a reduction of the intermammary space were retrospectively evaluated. Preoperatively, breast features were registered for all patients. Preoperative intermammary distance ranged from 2.3 to 7 cm (5.4 ± 0.74). The average follow-up time was 20 months (range 12 to 36 months). All implants were anatomical silicon-gel filled implants with micropolyurethane foam shell. No major early and late complications were experienced. The outcomes were graded as excellent in 45 breasts (72.6 %), very good in 15 (24.2%), good in the two cases (3.2%) with minor delayed wound healing (less than 1 cm) which solved conservatively within 1 month. Patients' satisfaction was high to very high. Postoperative intermammary distance was reduced in all cases and ranged from 1 to 4.5 (mean 2.6 ± 0.52 cm) CONCLUSION: The intermammary distance can be safely reduced with implant only in all cases who seek it, both via submuscular and via subfascial approach by a precise medial pocket dissection and implantation of micropolyurethane foam-coated implant, which guarantee device's stability during the healing process avoiding malposition. 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 .

Hybrid Augmentation Mastopexy with New Generation of Smooth Surface Implants: Combining the Benefits of Fat Grafting, Inferior Muscle Support, and an L-Shaped Scar.

Augmentation mastopexy (AM) is a challenging procedure. Complications include implant displacement and visibility, which can be addressed, but the stability of the smooth implant surface and poor soft-tissue coverage may present limitations. This article describes a surgical technique for AM using a composite reverse inferior muscle sling associated with autogenous fat grafting. Forty-five patients (90 breasts; mean age, 37.7 ± 7.2 years) underwent hybrid composite reverse inferior muscular sling AM. An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive fat grafting and divided into three zones. Three-dimensional imaging was used to evaluate lower pole stretch and intermammary distance. The average implant volume was 265 cc (range, 175 to 335 cc). The average fat volumes in zones I/II and III were 80.1 (range, 61.6 to 95.2 cc) and 39.3 (range, 25.2 to 47.3 cc), respectively. Five complications were observed in three patients (6.6%)-minor dehiscence in two (4.4%) and nipple-areola asymmetry in one (2.2%). The lower pole stretched 11.51% (9.9 mm) and 9.8% (8.5 mm) on the right and left sides, respectively ( P < 0.0001), between 10 days and 1 year postoperatively. The intermammary distance was reduced, on average, 49.9% (25.1 mm) ( P < 0.001) between the preoperative value and 1 year postoperatively. Hybrid composite reverse inferior muscular sling has led to improved aesthetic results for patients with breast ptosis and poor tissue coverage. Fat grafting and recognizing cleavage zones are still important to obtain satisfactory results. This procedure offers a good alternative for AM candidates, providing an adequate smooth surface for implant stabilization.

Intrasexual Competition in Women’s Likelihood of Self-Enhancement and Perceptions of Breast Morphology: A Hispanic Sample

Women’s breasts are considered sexually attractive because they may infer a woman’s residual reproductive value. Given that men find women’s breasts attractive, women may compete with other women to enhance their physical attractiveness when primed with an intrasexual competitive cue. The current study investigated women’s intrasexual competition when viewing variations in breast morphology. Women (N = 189) were randomly assigned to a partner threat condition and shown images of women’s breasts that included variations in breast size, ptosis (i.e., sagginess), and intermammary distance (i.e., cleavage). Women were more likely to report an increase in enhancing their appearance, wearing revealing clothing, dieting and exercising, and perceiving the breasts as a sexual threat as a function of larger breast sizes with low ptosis and intermediate distances. The partner threat prime did not play a role in ratings. Interestingly, there was a moderating role for women’s dispositional levels in intrasexual competition. Women with higher levels of intrasexual competition were more likely to enhance their appearance when viewing large breast sizes. The study points to the role that breast morphology indicative of residual reproductive value has on increasing enhancement strategies.

Women’s perceptions of breast size, ptosis, and intermammary distance: Does breast morphology play a role in women’s intrasexual competition?

Women’s perceptions of breast size, ptosis, and intermammary distance: Does breast morphology play a role in women’s intrasexual competition?

Reoperative Augmentation Mammoplasty: An Algorithm to Optimize Soft-Tissue Support, Pocket Control, and Smooth Implant Stability with Composite Reverse Inferior Muscle Sling (CRIMS) and its Technical Variations.

Reoperative augmentation mammoplasty (RAM) is a challenging procedure, with the highest rates of complications and revision. Complications include implant malposition, lateral displacement, bottoming out, and rotation. These deformities can be addressed with various procedures, but the pocket control and stability of the new smooth implant surface may present limitations. This study revisits a previously described predictable approach in primary breast augmentation and defines a surgical treatmentalgorithmfor RAM technique selection. Between 2017 and 2021, 72 patients (144 breasts) underwent RAM with composite reverse inferior muscle sling (CRIMS) technique and its technical variations (types I-IV). CRIMS technique involves placing a silicone gel implant into the submuscular (SM) pocket with an inferior sling of the pectoralis major muscle based on the dimensions of the implant, in combination with support points/dermal bridge sutures to stabilize the implant and glandular tissue at the lower breast pole (LBP). Reasons for surgery were ptosis (92%), implant and malposition (59.6%). Patients were followed for at least 6 months in 5 cases (6.9%), at least 12 months in 50 cases (69.4%), for at least 36 months in 10 cases (13.8%), and more than 36 months in 7 cases (9.7%) (mean 34 months; range 6-48 months). Patients were evaluated in terms of resolution of symptoms, satisfaction, and complications. Three-dimensional imaging (3DI) obtained from the Divina scanner system was used and followed up for 1 year to evaluate breast position, lower pole stretch (LPS), and intermammary distance (IMD). Eleven cases of minor complications were observed in 9 patients (12.5%): hypertrophic scarring in 4 (5.5%), wound dehiscence in 4 (5.5%), Baker II/III capsular contracture in 1 (1.3%). SmoothSilk surface silicone implants were used in all cases, with an average volume decrease of 120 cc. Sixty-eight patients (94.4%) were either very satisfied/satisfied with their aesthetic result. Breast images were performed in a group of 65 patients (90.2%), and in 7 breasts (10.7%), localized oil cysts were observed. The value for LPS was 7.87% (p &lt;0.0001) between 10 days and 1 year, with the majority occurring early in the first 3 months, indicating that the LBP/implant remains steady during the last months of follow-up. No cases of fat necrosis/seroma were observed. There were no signs of intra/extracapsular ruptures, capsular contracture. There were 2 cases (3%) of minimal implant displacement and no cases of rotation. CRIMS and its variations can be performed successfully in RAM. An algorithmic approach can facilitate the pre- and intraoperative decision-making process and provide the new pocket control and implant stability with acceptable complication rates. Further accurate evaluation is recommended to understand the benefits or disadvantages of CRIMS compared to other RAM techniques. 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 .

Optimizing Surgical Outcomes with Small-Volume Silicone Implants Associated with Autogenous Fat Grafting in Primary and Revision Breast Augmentation Surgery: Soft Weight Hybrid (SWEH) Concept.

Simultaneous association of autologous fat grafting (AFG) with silicone implants, defined as a hybrid procedure, has been proposed for breast augmentation (BA). In some patients, larger-volume implants may result in larger incisions, with long-term effects including implant palpability, soft tissue atrophy, and secondary ptosis. Some patients do not want large volume implants, or have insufficient soft tissue coverage. Recent improvements in AFG have led to new surgical options in BA for addressing these cases. This study combines AFG in BA using small-volume implants, known as the SWEH (soft weight hybrid) approach, and evaluates aesthetic advantages and outcomes following primary/secondary BA. 25 patients (50 breasts) underwent SWEH procedures; this approach was indicated when the overlying tissue was insufficient to adequately cover the implant and patients refused large-volume implants. Three-dimensional images were obtained using a Divina 3D scanner system (AX3 Technologies, Miami, USA) to assess breast volume (BV) and intermammary distance (IMD) during follow-up. Mean patient age was 29.3 years (range: 21-42) and mean body mass index was 19.3 kg/m2 (15.3-27.2). The most common implant (SmoothSilk surface Round/Ergonomix style) volume was 180 cc (175-215), and patients received a mean volume of 125 cc of fat (89-168)/breast in the subcutaneous tissue. Preoperative average BV measurements were 236.85 cc (170-335). At 3 and 12 months post-procedure, the average BV values were 488.82 and 478.73cc, respectively (p=0.475). The average preoperative IMD was 31.76 mm (range, 22-43); at 3 and 12 months post-procedure, the average IMD was 20.47 and 20.94 mm, respectively (p=0.61). Postoperative complications included subcutaneous banding in the axilla (n = 1; 4%) and hypertrophic scarring (n = 1; 4%). Breast imaging exams were performed; in 2 breasts (8%) localized oil cysts were observed; no cases of suspicious calcifications, fat necrosis, or lumps were seen. Fat retention rate (1 year) was calculated by the difference between the BV expected with 100% fat intake and the real BV observed. In our sample we observed an average of 72.7 (range: 69.2-77.3, SD: 2.63) and 76.7 (range: 72.3-79.9, SD: 2.18) percent of fat intake on the right and the left breast respectively. No rippling, implant malposition, or infection was observed during a mean follow-up of 22 months (6-40). SWEH is a useful surgical alternative that combines the benefits of AFG and implant-based augmentation, particularly with regard to soft tissue coverage, and avoids the limitations of larger-volume implants. The association of small-volume gel implants and smaller scars can yield satisfactory aesthetic outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

Anthropometric and topometric characterization of patients with breast cancer

Background: Anthropometry is one of the simplest and most accessible methods. Breast cancer is largely associated with anthropometric indicators, such as weight, body mass index, waist-to-hip ratio, and waist circumference.&#x0D; Aims: To examine the anthropometric and topometric characteristics of the mammary glands of patients with breast cancer.&#x0D; Materials and Methods: A total of 260 patients with breast cancer were examined from 2019 to 2021 in the Department of Onco-mammological Surgery of the A.I. Kryzhanovsky Krasnoyarsk Regional Oncological Dispensary. Anthropometric examination was conducted according to the classical method, and parameters such as height and weight were obtained. Organometric measurements were conducted according to the Body Logic System (Mentor Medical Systems B. V., USA), developed by Professor Dr. Hammond for Mentor, a silicone implant manufacturer.&#x0D; Results: In the study group, the average height, weight, and body mass index were 163 (158168) cm, 75 (6586) kg, and 28.96 (2432.87) kg/m2, respectively. A comparative analysis of the main anthropometric data of patients with breast cancer showed relatively higher body length values in the young adult group and conversely smaller values in women in the senile period, as well as the average body mass index and body mass index in the older group. In women, the average chest circumference of the mammary gland in the middle-aged group decreased by 9 cm in the older period and by 6 cm in the senile period. Similar changes were found in the chest circumference at the level of the nipples. In women, the average values in the middle-aged group decreased by 9.5 cm in the older period and by 4 cm in the senile period. The distance from the jugular notch to the nipple of the right breast showed significantly (p 0.05) higher values in the older group (by 6 cm) and senile group (by 4.7 cm) than in the young adult group and between the middle-aged group and older group (by 4 cm) and in the senile (by 2.7 cm) group. Similar changes were found on the left breast in the older group (by 5.75 cm) and senile group (by 5.25 cm) compared with young adult group and between the middle-aged group and older group (by 4 cm) and senile (by 3.5 cm) group. The distance from the level of the middle of the clavicle to the nipples showed significantly (p 0.05) lower values of the right and left mammary glands in the your adult group than in other age groups. The intermammary distance was significantly (p 0.05) greater in the middle-aged group (by 0.5 cm) than in the older and senile groups.&#x0D; Conclusion: Most studies on breast anthropometry focus on plastic surgery because clear anthropometric measurements of the breasts and their relative positions based on fixed skeletal and soft tissue landmarks are useful for assessing the condition of the patients preoperatively and for evaluating breast aesthetics postoperatively. Future studies in clinical practice should identify women with a high risk of breast cancer based on anthropometric parameters.

Prediction of Birth Weight by Using Neonatal Anthropometric Parameters at Birth in Finote Selam Hospital, Ethiopia.

IntroductionBirth weight is an indicator of a newborn’s chances for survival and growth. However, developing countries lack enough weighing scales to identify low birth weight babies. Therefore, finding an alternative to weighing scales is vital.ObjectiveTo predict birth weight from neonatal anthropometric parameters at birth in Finote Selam Hospital, Ethiopia.MethodsA hospital-based cross-sectional study was carried out from July 13 to October 27, 2020. A total of 424 live-delivered neonates were enrolled. Based on eligibility, birth weight and neonatal anthropometric parameters like crown–heel length, foot length, hand length, mid-upper arm circumference, umbilical–nipple distance, intermammary distance and head circumference were measured within 24 hours of birth. The association between birth weight and neonatal anthropometric parameters was evaluated using correlation analysis. Birth weight predictive regression models were formulated by using simple and multiple linear regression analysis.ResultsAll neonatal anthropometric parameters had positive significant correlation with birth weight at p<0.05. Amongst the neonatal anthropometric parameters, the highest significant correlation with birth weight was observed on mid-upper arm circumference (MUAC) followed by foot length (FL), each being r=0.474 and r=0.461, respectively. The best predictive regression models were formulated as birth weight (kg)=0.117+[0.284×MUAC (cm)] and birth weight (kg)=1.137+[0.254×FL (cm)]. As compared to individual neonatal anthropometric parameters, a combination of MUAC, hand length (HL), FL and crown–heel length (CHL) had the highest significant correlation (r=0.661), and a multiple regression equation used to estimate birth weight was formulated as birth weight (kg)=−2.489+[0.192×MUAC(cm)]+[0.078×HL(cm)]+[0.11×FL (cm)]+[0.036×CHL(cm)].ConclusionUsing a combination of MUAC, HL, FL and CHL followed by individual MUAC neonatal anthropometric parameters has high significance to identify low birth weight. Prediction of neonatal birth weight from neonatal anthropometric parameters is crucial to minimize the death of neonates due to low birth weight.

Estimation of Gestational Age Using Neonatal Anatomical Anthropometric Parameters in Dessie Referral Hospital, Northeast Ethiopia.

IntroductionEstimation of gestational age is a key for the identification of a given low birth weight neonate is either preterm or growth retarded.ObjectiveTo estimate gestational age from neonatal anatomical anthropometric parameters in Dessie Referral Hospital, Ethiopia.MethodsInstitutional-based cross-sectional study design was employed in Dessie Referral Hospital from October 2019 to April 2020, with 424 consecutively live-born of 28–42 weeks of gestation. After considering the inclusion criteria, neonatal anthropometric parameters were measured within 3 days of birth. Foot length, hand length, mid-upper arm circumference, head circumference, crown-heel length, intermammary distance, umbilical nipple distance, and birth weight were measured and summarized using descriptive statistics, and the power of association was evaluated using correlation analysis. Regression equations of gestational age (GA) in completed weeks with anthropometric parameters were formulated using simple and multiple linear regression analysis.ResultsExcept for hand length, all other neonatal anthropometric measurements were positively correlated with GA in completed weeks at p< 0.05. Anthropometric parameters individually, mid-upper arm circumference (MUAC) and BW (birth weight) were correlated well with GA at correlation coefficient (r) of 0.406 and 0.334, respectively. Regression formula was formulated as GA (weeks) = 26.12+ [1.11×MUAC (cm)] and GA (Weeks) = 33.19 + [1.53×BW (kg)]. Multiple regression contributed correlation with GA and used for prediction of GA as GA (weeks) = 28.12 – [0.393×HL (cm)] + [1.07×BW (kg)] + [0.87×MUAC (cm)] (r= 0.458).ConclusionThe overall relative better correlation for prediction of GA, alone and in combination, is found by combined parameters (HL, MUAC, and BW). The relatively better individual anthropometric parameter for GA assessment is MUAC. Hence, using this neonatal parameter as a prediction of gestational age, the death of neonate due to preterm can be minimized.

Does Ecological Harshness Influence Men’s Perceptions of Women’s Breast Size, Ptosis, and Intermammary Distance?

Breasts are sexually dimorphic physical characteristics, and they are enlarged post-puberty suggesting that they have been driven by sexual selection to signal fertility and residual reproductive value. Although different hypotheses have attempted to explain why men are attracted to women’s breasts, the role that ecology plays in men’s perceptions of women’s breasts has been limited. The current study used an ecologically harsh prime to investigate if ecological harshness influenced men’s perceptions of women’s breast size, ptosis (i.e., sagginess), and intermammary distance. Men were primed with an ecological harsh prime (i.e., economy uncertainty) and asked to rate women whose breast size, ptosis, and intermammary distance (i.e., cleavage) had been manipulated. Ecological harshness only influenced men’s perceptions of women’s breasts for reproductive success. Overall, men rated women with larger breasts as more attractive, fertile, healthier, reproductively successful, and likely to befriend. The study contributes to the overall literature on men’s perceptions of women’s breasts and suggests that ecological harshness may influence men's perceptions of women's reproductive success.

An Aesthetic Factor Priority List of the Female Breast in Scandinavian Subjects.

Background:There is little consensus about the relative determinative value of each individual factor in female breast aesthetics. When performing breast surgery with an aesthetic goal, certain factors will be more important than others. The purpose of this study was to make an aesthetic factor rank list to determine the relative contributions to overall breast aesthetics.Method:Volunteers were scanned using the 3-dimensional Vectra system. Ten Scandinavian plastic surgeons rated 37 subjects, using a validated scoring system with 49 scoring items. The correlation between specific aesthetic factors and overall breast aesthetic scores of the subjects were calculated using Pearson’s r, Spearman’s ρ, and Kendall’s τ.Results:A very strong correlation was found between overall breast aesthetic score and lower pole shape (0.876, P < 0.0001). This was also true for upper pole shape (0.826, P < 0.0001) and breast height (0.821, P < 0.0001). A strong correlation was found between overall breast aesthetic score and nipple position (0.733, P < 0.0001), breast size (0.644, P < 0.0001), and breast width (0.632, P < 0.0001). Factors that were only moderately correlated with aesthetic score were intermammary distance (0.496, P = 0.002), nipple size and projection (0.588, P < 0.0001), areolar diameter (0.484, P < 0.0001), and areolar shape (0.403, P < 0.0001). Perceived symmetry was a weak factor (0.363, P = 0.027).Conclusions:Aesthetic factors of the female breast can be ranked in a priority list. Shape of the lower pole and upper pole and breast height are primary factors of female breast aesthetics. These should be prioritized in any aesthetic breast surgery. Vertical dimensional factors seem to be more determinative than horizontal factors.

Periareolar Approach for Correction of Bilateral Asymmetric Tuberous Breasts

Background: Patients with tuberous breasts suffer ofpsychosocial problems which may be aggravated with presenceof asymmetry. Plastic surgeons should fully understand thedevelopmental and anatomical basis of such deformity. Thesurgical plan is individualized according to the severity ofdeformity, presence of ptosis and degree of asymmetry. Inthis study we aim to correct the whole pathology and improvebreast aesthetics in patients with bilateral asymmetric tuberousbreasts.Methods: 8 female patients with bilateral asymmetrictuberous breasts presented to outpatient clinic. Breast examinationand measurements were done. Surgical correction withperiareolar mastopexy and differential augmentation mammoplastywere done in all cases.Results: Patients' mean age was (28.7) years. All patientshad asymmetric breasts as regards; tuberous type, breastvolume, projection, areola diameter, nipple and areolar complexposition and degree of ptosis. Postoperatively, tuberous deformitywas corrected in all cases. Good symmetry, andenhancement of breast volume and projection with naturallylookingbreasts are achieved. Intermammary distance wastremendously decreased. Seven patients were highly satisfied,(87.5%) one patient (12.5%) as only satisfied.Conclusion: Periareolar mastopexy approach, efficientrelease of constricting ring, repositioning of inframammarycrease and differential breast augmentation are keys to achievethe best possible aesthetic outcome in managing tuberousbreast asymmetry.“Level of Evidence: Level IV”.

Simple measurements to place umbilical catheters using surface anatomy.

To use external anatomical landmarks to determine a new method for the estimation of appropriate insertion length of umbilical catheters, suitable for newborn infants of varying birth weight (BW) and gestational age. Neonates who had umbilical venous (UVC) or arterial (UAC) catheters placed soon after birth were included in the study. Catheters were placed using formulas derived by Shukla (1986) and/or Wright (2007), and adjusted to appropriate positions confirmed radiologically: UAC tip between T6-T10 vertebral bodies and UVC at the level of the diaphragm±0.5 cms. Final catheter length was compared with the length estimated by Shukla/Wright formulas and to four additional morphometric measurements: umbilicus to nipple (UN), umbilicus to midpoint of inter-mammary distance, umbilicus to xiphoid process and umbilicus to symphysis pubis (USp). Of 216 infants, 32 were excluded; UVC was placed in 170 infants and UAC in 125 infants. Among the morphometric measurements, UN-1 cm ( UN distance minus 1 cm) provided the best estimate of accurate insertion length of UVC, (r=0.984, P<0.001) and estimated correct insertion length of 94% of UVCs compared with 57% accuracy with Shukla formula for all BW categories (P<0.001). Morphometric measurement UN-1+2 USp (UN distance minus 1 cm plus twice the distance from umbilicus to symphysis pubis) showed significantly better correlation with appropriate insertion length of UAC (r=0.985, P<0.001) and estimated correct insertion length of 92% of UACs in all infants as compared with 57% accuracy with Shukla formula (P<0.001), and the correct insertion length in 94% of very low BW infants as compared with 68% accuracy with Wright formula (P<0.001). Simple and intuitive morphometric measurements UN and USp provide more accurate estimates of appropriate insertion lengths for umbilical catheters in infants with all BWs than commonly used BW-based formulas.

Estimation of Gestational Age, Using Neonatal Anthropometry: A Cross-sectional Study in India

Prematurity is a significant contributor to neonatal mortality in India. Conventionally, assessment of gestational age of newborns is based on New Ballard Technique, for which a paediatric specialist is needed. Anthropometry of the newborn, especially birthweight, has been used in the past to predict the gestational age of the neonate in peripheral health facilities where a trained paediatrician is often not available. We aimed to determine if neonatal anthropometric parameters, viz. birthweight, crown heel-length, head-circumference, mid-upper arm-circumference, lower segment-length, foot-length, umbilical nipple distance, calf-circumference, intermammary distance, and hand-length, can reliably predict the gestational age. The study also aimed to derive an equation for the same. We also assessed if these neonatal anthropometric parameters had a better prediction of gestational age when used in combination compared to individual parameters. We evaluated 1,000 newborns in a cross-sectional study conducted in Guru Teg Bahadur Hospital in Delhi. Detailed anthropometric estimation of the neonates was done within 48 hours after birth, using standard techniques. Gestational age was estimated using New Ballard Scoring. Out of 1,250 consecutive neonates, 1,000 were included in the study. Of them, 800 randomly-selected newborns were used in devising the model, and the remaining 200 newborns were used in validating the final model. Quadratic regression analysis using stepwise selection was used in building the predictive model. Birthweight (R=0.72), head-circumference (R = 0.60), and mid-upper arm-circumference (R = 0.67) were found highly correlated with gestation. The final equation to assess gestational age was as follows: Gestational age (weeks) = 5.437 x W-0.781 x W(2) + 2.815 x HC-0.041 x HC(2) + 0.285 x MUAC-22.745 where W=Weight, HC=Head-circumference and MUAC=Mid-upper arm-circumference; Adjusted R = 0.76. On validation, the predictability of this equation is 46% (+/-1 week), 75.5% (+/- 2 weeks), and 91.5% (+/- 3 weeks). This mathematical model may be used in identifying preterm neonates.

First Observation of the Parturition and Peripartum Events in a Harbor Porpoise (&lt;I&gt;Phocoena phocoena&lt;/I&gt;)

Parturition events in cetaceans are difficult to observe in nature and scarcely described in detail. Observations from animals in captivity offer the possibility to follow complete gestations and to obtain a precise description of the series of events pertaining to pregnancy and parturition. After a gestation period of 11 mo, the parturition of a harbor porpoise (Phocoena phocoena) was observed for the first time at the Danish research facility Fjord & Bœlt on 8 August 2007. Five prepartum signs useful to predict the onset of parturition were identified: (1) decrease in appetite (from 5,064 Kcal/d to 907 Kcal/d at 2 d before birth [B-2]), (2) unusual behavior (disinterest in training sessions, seeking of physical contact with the trainers, restlessness), (3) decrease in body temperature of 1.6o C at B-1, (4) swollenness in the genital area, and (5) increase in the inter-mammary distance (from 5 to 8 cm at B-1). During labor, three stages described for other mammals in literature were observed and each stage’s duration recorded: Stage 1 was characterized by uterine contractions and dilation of the cervix (between 2 h 19 min and 7 h 39 min), Stage 2 started with the rupture of fetal membranes (1 h 42 min at least), and Stage 3 comprised the expulsion of the fetus and its membranes (7 h). The total duration of the parturition was at least 16 h 21 min as there is an uncertainty in regards to the exact beginning of the labor. The sequence of visible events occurring during parturition was as follows: apparition of the amniotic sac, apparition of the calf’s flukes, apparition of the peduncle, delivery of the calf, and expulsion of the left horn of the placenta followed by the right horn. As described for other cetaceans, the delivery was caudal. Contractions seemed to be longer and more frequent during the first stage and during the beginning of the second stage of labor. The contractions then shortened and became more regular during the expulsion of the calf. We observed that the expulsion of the calf was not provoked only by contractions but helped at the end by a violent rotational movement of the mother that broke the umbilical cord. The female’s breathing rate increased dramatically towards the end of the expulsion of the calf.

Breast Augmentation in Asymmetrically Placed Nipple-Areola Complex in the Horizontal Axis: Lateralisation of Implant Pocket to Offset Lateralised Nipples

Nipple-areola complex (NAC) lateralisation in the horizontal axis is understudied with respect to its potential effects on the outcome of augmentation mammoplasty. An implant pocket dissected slightly laterally on the affected side offsets the lateralised nipple and improves the quality of breast enhancement in the lateral quadrant with an aesthetically positioned NAC. It also prevents the appearance of medially malplaced implants. Medial and lateral halves of breasts were measured in 312 mammaplasties performed by the author in 2007; of these, 39 (12%) had NAC asymmetrically positioned in the horizontal plane, 29 (9%) were right lateralised, 4 (1.2%) left lateralised, 5 (1.5%) bilaterally lateralised, and 1 (0.3%) was bilaterally medialised. In the more common right-lateralised group (n = 25), the mean medial half measurement was 8.76 +/- 1.22 cm compared with 8.96 cm in the control group (n = 170), with no statistical significance (P = 0.45). However, the lateral half measurement in the lateralised nipple group (n = 25) was 9.06 +/- 1.53 cm compared with 9.7 +/- 1.67 cm in the control group (n = 169) and it showed a borderline significant value (P = 0.06). On the affected side, the medial boundary of the breast pocket is marked 0.25-0.5 cm further away from the routine 2.5-cm intermammary distance with the goal of offsetting the lateralised NAC and to improve its visual aesthetic position on the breast. Lateralisation of the breast pocket in a breast with a lateralised nipple improves the aesthetic position of the NAC. In compensated augmentation mammaplasties, lateral quadrant enhancement of the breast is aesthetically superior to uncompensated cases and prevents the appearance of medially malplaced implants. The intermammary distance in compensated cases was acceptable without any compromise to the aesthetic outcome.