Breast Size Research Articles

Breast Implant Rupture: Causes, Diagnosis and Treatment

Breast implant rupture is a rare event that can occur at any time after breast augmentation surgery. The most common causes of rupture are natural aging of the implant, traumatic injury, and failure of the implant material. Symptoms of breast implant rupture can range from mild discomfort to total loss of breast shape and size. Diagnosing a ruptured breast implant can be challenging, as the condition can be asymptomatic in some cases. However, imaging tests such as MRI and ultrasound can help detect the presence of ruptured implants. Treatment options for ruptured breast implants vary depending on the type of implant, the duration of rupture and the presence of symptoms. In general, treatment involves surgical removal of the ruptured implant and replacement with a new one or complete removal of the implant and surrounding silicone material. Regular checkups with a board-certified plastic surgeon and being aware of any changes in the shape or feel of the breasts are crucial for early detection and treatment of breast implant rupture. Women considering breast augmentation surgery should carefully weigh the potential risks and benefits of the procedure before undergoing surgery. Breast implant rupture is a rare but important complication that requires prompt diagnosis and treatment to avoid potential complications. Understanding the causes, symptoms, diagnosis and treatment options for breast implant rupture can help women make informed decisions about breast augmentation surgery and maintain the health of their breasts.

Mastopexy: a means to correct breast ptosis

The demand for aesthetic procedures is at an all-time high, and nowhere is this more prevalent than in the practice of mammoplasties (i.e., procedures to modify shapes and sizes of breasts), particularly mastopexies (commonly known as breast-lift surgeries). This clinical article introduces different types of ptosis (i.e., breast sagging or uneveness) and maxtopexies, delving further into the relationship between them. The management of ptosis recurrence is also discussed.

Efficiency and impact factors of anatomical intelligence for breast and hand-held ultrasound in lesion detection.

To investigate the efficiency and impact factors of anatomical intelligence for breast (AI-Breast) and hand-held ultrasound (HHUS) in lesion detection. A total of 172 outpatient women were randomly selected, underwent AI-Breast ultrasound (Group AI) once and HHUS twice. HHUS was performed by breast imaging radiologists (Group A) and general radiologists (Group B). For the AI-Breast examination, a trained technician performed the whole-breast scan and data acquisition, while other general radiologists performed image interpretation. The examination time and lesion detection rate were recorded. The impact factors for breast lesion detection, including breast cup size, number of lesions, and benign or malignant lesions were analyzed. The detection rates of Group AI, A, and B were 92.8 ± 17.0%, 95.0 ± 13.6%, and 85.0 ± 22.9%, respectively. Comparable lesion detection rates were observed in Group AI and Group A (P > 0.05), but a significantly lower lesion detection rate was observed in Group B compared to the other two (both P < 0.05). Regarding missed diagnosis rates of malignant lesions, comparable performance was observed in Group AI, Group A, and Group B (8% vs. 4% vs. 14%, all P > 0.05). Scan times of Groups AI, A, and B were 262.15 ± 40.4 s, 237.5 ± 110.3 s, 281.2 ± 86.1 s, respectively. The scan time of Group AI was significantly higher than Group A (P < 0.01), but was slightly lower than Group B (P > 0.05). We found a strong linear correlation between scan time and cup size in Group AI (r = 0.745). No impacts of cup size and number of lesions were found on the lesion detection rate in Group AI (P > 0.05). With the assist of AI-Breast system, the lesion detection rate of AI-Breast ultrasound was comparable to that of a breast imaging radiologist and superior to that of the general radiologist. AI-Breast ultrasound may be used as a potential approach for breast lesions surveillance.

YOUNG GENERATION PURCHASE PATTERNS OF BOBA AND COFFEE DRINKS IN BANYUMAS REGENCY, INDONESIA

Changes in consumption patterns, especially in the millennial generation, are driving the emergence of contemporary drinks. Among the contemporary drinks that are currently popular among the younger generation are Boba and coffee drinks. The research aims to determine consumer characteristics and purchasing patterns of boba and coffee drinks in Banyumas Regency. The research method uses qualitative methods with descriptive analysis. Data were collected through a web-based method (G-Forms) with a total of 188 consumers as respondents. The research results show that consumer purchasing patterns are related to preferences for the type of drink, the number of transactions and the number of cups purchased per transaction, cup size preferences, and time of purchase.

Differential Preferences in Breast Aesthetics by Self-identified Racial Demographics Assessed on a National Survey

Abstract Goals/Purpose Breast aesthetics are a highly discussed topic within plastic surgery. However, there is a paucity of literature examining how preferences differ amongst various demographic groups. The objective of this study was to assess how perceptions of the ideal breast differ between respondents stratified by self-identified race. Methods/Technique A cohort of 25 patients from the senior surgeons’ practices presenting for aesthetic or reconstructive breast surgery was assembled. This cohort was selected with the aim of choosing a sample that maximized diversity on the basis of breast size and shape, skin tone, and nipple-areola complex size and position. Pre-operative anteroposterior photographs from these patients were distributed via Qualtrics (Seattle, WA) to a large sample designed to be representative of the demographics of the United States. Survey questions aimed to measure respondents’ impressions of “breast attractiveness.” Respondents were asked to rate breasts on a Likert scale of 1 to 5, with 1 being not at all attractive and 5 being most attractive. Survey responses were analyzed for differences in breast aesthetic preferences by race using ANOVA and t-tests where appropriate. Results/Complications A total of 1,021 survey responses were collected. The majority of survey respondents identified as White or Caucasian (73%). A total of 18% of individuals self-identified as Black or African-American, while 5% identified as Asian. The remaining 3% of respondents identified as Other, Native American, or selected multiple categories and groups were too small for cross-group comparison and were thus excluded. On average, individuals in the White or Caucasian group rated any given pair of breasts 8% more attractive than Black or African-American individuals and 14% more attractive than Asian individuals. ANOVA testing revealed significant differences amongst groups (p=0.014). Subgroup comparison revealed a significant difference between ratings of breast attractiveness between White or Caucasian individuals and Asian respondents (2.61 vs 2.25; p=0.002). Comparisons between White or Caucasian respondents and Black or African-American individuals were not significant (2.61 vs 2.40; p=0.06) as was the analysis between Black or African-American respondents and Asian individuals (2.40 vs 2.25; p=0.08). While these intergroup comparisons did not reach significance in the current sample, perhaps with a larger sample size a difference between these groups might be elucidated. Despite these racial discrepancies in breast attractiveness, regression analysis revealed that the ratings amongst each of the groups were highly correlated with one another: White or Caucasian and Black and African-American (R=0.68; R2=0.46; p&amp;lt;0.001), Black or African-American and Asian (R=0.72; R2=0.52; p&amp;lt;0.001), and White or Caucasian and Asian (R=0.86; R2=0.73; p&amp;lt;0.001). Conclusion In a sample representative of the United States, a difference in breast aesthetic appraisal was observed by race. On average, White or Caucasian respondents rated a given pair of breasts as more aesthetically pleasing than Black or African-American and Asian counterparts. While this difference was observed, it is important to note that ratings amongst racial groups were highly correlated with one another across all photographs presented. In other words, while Black or African-American and Asians rated breasts lower than their White or Caucasian counterparts, relative attractiveness for the breasts amongst groups paralleled one another. While self-identified racial groups rated the breasts similar relative to one another, there were distinct differences in numerical ratings that may be reflective of broader, more generalized sentiments and preferences that were not able to be captured by our survey instrument. These findings merit further investigation to understand these trends and observations. Doing so will enable plastic surgeons to have a better understanding of patient preferences and expectations when seeking reconstructive or aesthetic breast surgery and thereby improve patient satisfaction.

Towards a biomechanical breast model to simulate and investigate breast compression and its effects in mammography and tomosynthesis

Objective. In mammography, breast compression forms an essential part of the examination and is achieved by lowering a compression paddle on the breast. Compression force is mainly used as parameter to estimate the degree of compression. As the force does not consider variations of breast size or tissue composition, over- and undercompression are a frequent result. This causes a highly varying perception of discomfort or even pain in the case of overcompression during the procedure. To develop a holistic, patient specific workflow, as a first step, breast compression needs to be thoroughly understood. The aim is to develop a biomechanical finite element breast model that accurately replicates breast compression in mammography and tomosynthesis and allows in-depth investigation. The current work focuses thereby, as a first step, to replicate especially the correct breast thickness under compression. Approach. A dedicated method for acquiring ground truth data of uncompressed and compressed breasts within magnetic resonance (MR) imaging is introduced and transferred to the compression within x-ray mammography. Additionally, we created a simulation framework where individual breast models were generated based on MR images. Main results. By fitting the finite element model to the results of the ground truth images, a universal set of material parameters for fat and fibroglandular tissue could be determined. Overall, the breast models showed high agreement in compression thickness with a deviation of less than ten percent from the ground truth. Significance. The introduced breast models show a huge potential for a better understanding of the breast compression process.

Associations of age, body mass index, and breast size with mammographic breast density in Korean women

We aimed (a) to investigate the associations between age, body mass index (BMI), and breast size with mammographic density based on the breast imaging reporting and data system (BI-RADS) and volumetric breast density measurement (VBDM) with Volpara, (b) to evaluate the associations of age, BMI, and breast size with fibroglandular tissue volume (FGV), and (c) to demonstrate the association of mammographic density grade with FGV. From April 2012 to May 2012, 1,203 women consecutively underwent mammography, and their breast density was calculated using the density grade and volume determined by Volpara. In total, 427 women were included in this study. The BMI and breast size of the 427 women were determined. The associations between mammographic density and age, BMI, and bra cup size were assessed. In addition, the associations between FGV and age, BMI, bra cup size, and mammographic density were assessed. The mean age of the women was 51 years (range, 27−83). Age was associated with mammographic density based on BI-RADS (&lt;i&gt;P&lt;/i&gt;&lt;0.0001), and both age and BMI were associated with mammographic density based on Volpara (&lt;i&gt;P&lt;/i&gt;&lt;0.0001). The mean FGV significantly decreased as age increased (&lt;i&gt;P&lt;/i&gt;&lt;0.0001) and increased as BMI and bra cup size increased (&lt;i&gt;P&lt;/i&gt;&lt;0.0001 and &lt;i&gt;P&lt;/i&gt;=0.0007, respectively). Age was associated with mammographic density, according to both the BI-RADS and VBDM; however, BMI was only associated with mammographic density based on the VBDM. Larger FGV was associated with younger age, higher BMI, larger bra cup size, and higher mammographic density

The Free Superficially Based Low-Abdominal Mini Flap for Oncoplastic Breast Reconstruction.

Volume replacement in oncoplastic breast reconstruction most commonly uses pedicled flaps. In thin patients with small breasts, free-tissue transfer may be better suited to preserve breast size. Evidence on microvascular oncoplastic reconstruction is limited, and reconstruction has often required sacrifice of potential future donor sites. The free superficially based low-abdominal mini (SLAM) flap uses a narrow strip of lower abdominal tissue based on superficial perfusion of the abdominal wall that is anastomosed to chest wall perforators to preserve the ability to perform future abdominally based autologous breast reconstruction. Five patients underwent reconstruction with SLAM flaps for immediate oncoplastic reconstruction. Their mean age was 49.8 years, and their mean body mass index was 23.5. Tumor location was most commonly in the lower outer quadrant (40%). Average lumpectomy weight was 30 g. Two flaps were based on the superficial inferior epigastric artery, and three, on the superficial circumflex iliac artery. Recipient vessels included internal mammary perforators (40%), serratus branch (20%), lateral thoracic vessel branch (20%), and lateral intercostal perforators (20%). All patients underwent radiation therapy without delay and maintained volume, symmetry, and contour at an average period of 11.7 months after surgery. There were no cases of flap loss, fat necrosis, or delayed wound healing. The free SLAM flap allows for immediate oncoplastic breast reconstruction in thin, small-breasted patients with limited regional tissue without sacrificing future potential donor sites for autologous breast reconstruction. Therapeutic, IV.

Technical difficulties of adequate assessment of intraocular pressure in a patient with glaucoma in the long term after corneal refractive surgery (clinical case)

PURPOSE. To demonstrate a clinical case involving difficulties in adequate assessment of intraocular pressure (IOP) in a patient with glaucoma in the long term after LASIK.METHODS. The study describes the case of patient M. of 58 years old with complaints about decreased distance vision in the right eye during the last year. In 2004 the patient underwent LASIK for moderate myopia. In 2018, asymmetry in the parameters of optic nerve head (size of the optic cup to the optic disc ratio (C/D ratio) was revealed: in the right eye — up to 0.7, narrowing of the visual field from nasal to fixation point; in the left eye — 0.5, visual fields without abnormalities. The IOP measured using the Maklakov method in both eyes corresponded to the average statistical norm — 22 mm Hg. The following diagnosis was established: IIA primary open-angle glaucoma in the right eye, IA primary open-angle glaucoma in the left eye. One-time instillations of latanoprost 0.005% eye drops solution was indicated for both eyes. In subsequent years the IOP was 18–20 mm Hg. After 4 years, the IOP according to the Maklakov method: OD — 18 mm Hg; OS — 21 mm Hg (on the hypotensive regimen — instillations of latanoprost 0.005% eye drops solution). In the right eye: C/D ratio 0.85–0.9 with absolute scotoma in the Bjerrum area 5–15° from fixation; in the left eye: C/D ratio 0.9 with neuro retinal rim loss from below, with absolute scotoma in the blind spot area. The stages of primary open-angle glaucoma were ascertained: IIIA in the right eye, IIA in the left eye.RESULTS. Selective laser trabeculoplasty was performed. Brimonidine 0.1% solution was added due to the lack of complete stabilization of the IOP level on a single instillation of latanoprost 0.005%, after that IOP decreased to 19 mm Hg in both eyes.CONCLUSION. It is necessary to carefully assess the condition of the structures of the optic nerve head in patients after LASIK, regardless of the statistically normal IOP values.

Glaucoma Detection Using Fundus Images of the Retina

In the paper that we are proposing we make use of the image processing technique that can be further used to detect or predict whether the eye is glaucomatic which leads to increase in the size of the optic cup in turn affecting the optic disc. Glaucoma being the second major reason for blindness was very difficult to detect in the early stages. Here in this paper, we make use of the retinal fundus images and glaucoma is being detected using the features that we extract from the fundus images. The first feature that we extract includes one of the basic physiological parameters which is the Cup to Disc ratio (CDR) and the second feature that we extract is the neuro retinal rim which has the inferior, superior, nasal and the temporal quadrants often called the ISNT quadrants which can be used to detect glaucoma in the fundus image of the eye.

Adverse Outcome of Two-Staged Breast Reconstruction: More Than One Culprit

BackgroundTwo-stage prosthetic breast reconstruction with initial insertion of a tissue expander followed by change-over to an implant after a period of inflation has become a well-established option in breast reconstruction. Our aim was to analyze the feasibility of two-stage breast reconstruction in our center by following the surgical technique, number of complications and associated risk factors. Patients and methodsWe studied 91 patients who underwent skin sparring mastectomy and tissue expander placement in our surgical unit, between January 2017 and December 2021. Axillary surgery was performed in all patients. We collected data on age, smoker status, breast size, comorbidities, tumor characteristics, neoadjuvant treatment and surgical intervention details. ResultsSkin necrosis (12.08%) and seroma (16.48%) were the most common complications. 7.69% of the patients required reintervention. Patients underwent delayed reconstruction after more than 6 months in 69.7% of the cases, while the overall reconstruction rate was 86.08%. Smoker status, an increased body mass index, comorbidities, neoadjuvant treatment, type of incision and location of the implant were the main factors that led to adverse outcomes. ConclusionsTissue expanders are a viable option for reconstruction; however, we observed a higher incidence of skin complications in smokers and in cases where periareolar incision was used.

An Evaluation of Native Breast Dimension and Tissue Expander Inflation Rate on the Risk of Capsular Contracture Development in Postmastectomy Reconstruction.

Capsular contracture is a common complication after 2-stage breast reconstruction. The relationships between native breast size, the rate of tissue expander expansion, and capsule formation have not been elucidated. This study aims to evaluate how these factors contribute to capsular contracture and establish cutoff values for increased risk. A data set consisting of 229 patients who underwent 2-stage breast reconstruction between 2012 and 2021 was included in the study. The rate of expansion is estimated as the final expanded volume subtracted by the initial filling volume of the tissue expander over time elapsed. The native breast size was estimated using various preoperative breast measurements and the weight of mastectomy specimen (grams). Further stratified analysis evaluated patients separately based on postoperative radiation status. Greater nipple-inframammary fold distance and faster tissue expander enlargement rate conferred decreased odds of developing capsular contracture ( P < 0.05). On stratified analysis, faster tissue expansion rate was not significant in the nonradiated cohort but remained a significant negative predictor in the radiation group (odds ratio, 0.996; P < 0.05). Cut-point analysis showed an expansion rate of <240 mL/mo and a nipple-inframammary fold value of <10.5 cm as conferring a greater risk of capsular contracture. Smaller inframammary fold distance may be associated with a higher risk of capsular contracture. Slower expansion rates correlate with increased odds of contracture in patients undergoing adjuvant radiation. Breast geometry should be considered when risk stratifying various reconstruction approaches (implant vs autologous). In addition, longer delays between implant exchange and initial tissue expansion should be avoided if clinically feasible.

Radiologists' performance in reading digital breast tomosynthesis with and without synthesized views for cancer detection.

The study aims to evaluate the diagnostic efficacy of radiologists and radiology trainees in digital breast tomosynthesis (DBT) alone vs DBT plus synthesized view (SV) for an understanding of the adequacy of DBT images to identify cancer lesions. Fifty-five observers (30 radiologists and 25 radiology trainees) participated in reading a set of 35 cases (15 cancer) with 28 readers reading DBT and 27 readers reading DBT plus SV. Two groups of readers had similar experience in interpreting mammograms. The performances of participants in each reading mode were compared with the ground truth and calculated in term of specificity, sensitivity, and ROC AUC. The cancer detection rate in various levels of breast density, lesion types and lesion sizes between 'DBT' and 'DBT + SV' were also analyzed. The difference in diagnostic accuracy of readers between two reading modes was assessed using Man-Whitney U test. p < 0.05 indicated a significant result. There was no significant difference in specificity (0.67-vs-0.65; p = 0.69), sensitivity (0.77-vs-0.71; p = 0.09), ROC AUC (0.77-vs-0.73; p = 0.19) of radiologists reading DBT plus SV compared with radiologists reading DBT. Similar result was found in radiology trainees with no significant difference in specificity (0.70-vs-0.63; p = 0.29), sensitivity (0.44-vs-0.55; p = 0.19), ROC AUC (0.59-vs-0.62; p = 0.60) between two reading modes. Radiologists and trainees obtained similar results in two reading modes for cancer detection rate with different levels of breast density, cancer types and sizes of lesions (p > 0.05). Findings show that the diagnostic performances of radiologists and radiology trainees in DBT alone and DBT plus SV were equivalent in identifying cancer and normal cases. DBT alone had equivalent diagnostic accuracy as DBT plus SV which could imply the consideration of using DBT as a sole modality without SV.

A Practical Guide to Measuring Optic Disc Size and its Clinical Correlation in Diagnosing Glaucoma for the Eye Care Professional

This study examines the connection between glaucoma and the optic disc, cup, and neuroretinal rim size. The use of a slit-lamp and funduscopy lens as a technique for determining and estimating the optic disc size is particularly emphasized. Through this study, a clinical manual for working clinicians will be developed by summarizing this information and making it easily accessible for in-office use. PubMed, Science Direct, Ovid, Medline journals, and inter-library journals were used to find papers and abstracts of relevant studies for this review. The most common search terms were: procedures for assessing optic disc size, variance in optic disc size between populations, and ophthalmoscopic methods for measuring optic discs. The search period spanned 2020 to 2022. The following criteria were used to determine whether an article should be included or excluded: a critical evaluation of the various methods used to measure the optic disc, the significance of including population-specific variations in the size of the optic disc, and justifications for the relative risk of glaucoma associated with the size of both the optic disc and the optic cup. According to numerous studies, a slit lamp and funduscopy lens can be used to estimate the size of the optic disc. Additionally, this review discovered a weak association between measures taken at a slit lamp and those taken with more exact office tools, including fundus photography. Using fundoscopic technologies is an effective and affordable method for measuring the optic nerve head while retaining a high level of accuracy. These dimensions can be used to divide the sizes of optic discs into three groups: small, average, and large.

Improving the Assessment and Diagnosis of Breast Lymphedema after Treatment for Breast Cancer.

Lymphedema can develop after treatment for breast cancer (BCRL). Lymphedema of the breast is not well studied. Currently, the main techniques used to diagnose and monitor the effectiveness of treatment are subjective clinician assessment and patient reports. Eighty-nine women who had undergone breast cancer treatment were recruited with and without breast lymphedema. Blinded clinical assessment determined the presence or absence of breast lymphedema. Measurement of skin thickness by ultrasound scanning, local tissue water by tissue dielectric constant (TDC) and tissue indentation by tonometry was recorded. Breast cancer treatment and demographic details were documented. Descriptive statistics were undertaken to compare sample characteristics, including the Chi-squared test, Odds Ratio (OR) and Relative Risks (RR) calculated. Increased body mass index (BMI), larger bra size, increased number of positive lymph nodes, axillary surgery, chemotherapy and increased Nottingham Prognostic Index (NPI) were all associated with breast lymphedema (p < 0.05). Ultrasound and TDC measurements were significantly higher in the lymphedema group (p < 0.05). Receiver Operator Characteristic (ROC) curves demonstrated that ultrasound and TDC measurements could distinguish between edematous and non-edematous breasts. Threshold levels were produced, which demonstrated good levels of sensitivity and specificity. These findings have the potential to improve the diagnosis of breast lymphedema.

P093 Impact of breast size on partial breast radiotherapy planning and short term outcome: a single institution experience at University Hospital of North Midlands (UHNM) UK

P093 Impact of breast size on partial breast radiotherapy planning and short term outcome: a single institution experience at University Hospital of North Midlands (UHNM) UK

Less groin pain with dual-mobility bearings versus fixed bearings in total hip arthroplasty.

The relationship between implant type, dual mobility (DM) or fixed bearing (FB), and postoperative groin pain remains unexplored. We examined the incidence of groin pain in DM implants and compare this to a cohort of FB THA patients. From 2006 to 2018, a single surgeon performed 875 DM THA and 856 FB THA procedures with 2.8-year and 3.1-year follow-up, respectively. Each patient received a questionnaire postoperatively and was asked if they had any groin pain (yes/no). Secondary measurements were implant characteristics such as head size, head offset, cup size, and cup-to-head ratio. Additional PROMs that were collected included: Veterans RAND 12 (VR-12), University of California Los Angeles (UCLA) activity score, Pain visual analogue scale (Pain VAS), and range of motion (ROM). The incidence of groin pain was 2.3% in the DM THA cohort and 6.3% in the FB THA group (p < 0.001). Also, low head offset (⩽0 mm) had a significant odds ratio (1.61) for groin pain in both cohorts. There was no significant difference in terms of revision rate between the cohorts (2.5% vs. 3.3%, p = 0.39) at the latest follow up. This study demonstrated a lower incidence of groin pain (2.3%) in patients with a DM bearing compared to a FB (6.3%) and a greater risk of groin pain with low head offset (<0 mm). As such, surgeons should try to recreate offset of the hip compared to the contralateral side to avoid groin pain.

Digital Breast Tomosynthesis: Three-Dimensional Measurement of Breast-Absorbed Dose Distribution.

The dose exposure associated with digital breast tomosynthesis (DBT) is evaluated by multiplying the mean glandular dose (MGD) of mammography (MMG) with the correction coefficient of the angle of X-ray incidence. However, it has been pointed out that there are various problems when using the MGD as a standard for risk assessment in breast cancer screening. Therefore, the aim of this study was to assess the breast-absorbed dose for different breast sizes for dose assessment. Furthermore, in this study, by measuring the dose distribution three-dimensionally, we aimed to examine the MGD correction method using the breast size as a factor. A simulated breast phantom with a diameter of 40-160 mm and a total thickness of 40 mm, made with polymethyl methacrylate, was created by simulating the phantom shape used in the simulation calculation for calculating the MGD. It was made with polymethyl methacrylate. Radiochromic films were placed at different depths, which measured the breast-absorbed dose distribution three-dimensionally. The MGD was calculated from the breast-absorbed dose distribution obtained. The three-dimensional dose distribution revealed that there was a difference in the distribution of MMG and DBT with increasing depth. In addition, a lower X-ray energy and a smaller breast size resulted in a greater difference in the absorbed dose between DBT and MMG. Incorporating the DBT correction according to the breast size into the MGD improves the accuracy of dose evaluation by the MGD. Additionally, a corrected MGD provides useful information for risk assessment when DBT is used for breast cancer screening.

Abstract P1-09-05: Effect of Wire vs Magnetic Seed Localization on Lumpectomy Cavity Size

Abstract Purpose/Objectives To assess whether an association exists between surgical localization technique and size of lumpectomy cavity on radiation (RT) planning CT scan. Adjuvant RT with boost to lumpectomy cavity has been shown to improve local control compared to adjuvant whole breast radiation alone, but larger cavity sizes can lead to worse cosmetic outcomes following boost administration, which could lead providers to omit boost. Therefore, decreasing cavity size could increase guideline-concordant boost administration and minimize adverse cosmetic outcomes. Materials/Methods A retrospective review was conducted of all patients undergoing breast conserving surgery with either wire- or magnetic seed -guided lumpectomy followed by adjuvant RT at a single institution from 2018 to 2021. Data were collected from pre-surgical work-up, surgical pathology, and radiation planning. Women undergoing bracketed wire localization and patients treated by a surgeon who only performed wire localized procedures were excluded. The primary outcome was lumpectomy cavity size as measured on planning CT. We first conducted an overlapping weights propensity score analysis to account for imbalance between groups in age, BMI, breast size as measured on planning CT scan, pre-operative imaging tumor volume, neoadjuvant therapies, lumpectomy histology (DCIS alone vs DCIS + invasive vs invasive alone vs invasive with lobular features vs no residual), and multifocality. Multivariable analysis (MVA) of CT cavity volume included the above weighted variables as well as surgeon and radiation oncologist. Secondary analyses included MVA of total pathologic volume, bivariable analysis of boost delivery, bivariable analysis of electron vs photon boost, stratification by surgeon, and fixed effect model for year of surgery. Results Of 617 women who received lumpectomy during the study period, 387 were included in final analysis. Patients who underwent seed localization were less likely to have multifocal disease, less likely to have calcifications on mammogram, more likely to have ultrasound measurements for pre-op imaging, and had smaller tumor size on pre-op imaging. Four surgeons performed all cases, with rates of seed use per surgeon ranging from 27.7% to 70.7% but generally increasing throughout the study period. There was no difference between wire and seed localization in the need for additional margins based on intra-operative margin analysis (58.4 vs 62.7%, p = 0.5). There was no difference in positive margins (6.4 vs 5.4%, p = 0.81) or second surgeries (9.4 vs 8.1%, p = 0.79). Rates of close margins were the same for DCIS (23.4 vs 17.3%, p = 0.35) and invasive carcinoma (7.6 vs 6.8%, p = 0.97) between techniques. Initial uncorrected bivariable analysis shows wire localization has a non-significant trend toward increased CT cavity volume (4.56cc, p = 0.15) and a significant association with total pathology volume (21.7cc, p = 0.004). For the primary outcome, breast size, time from surgery to simulation, and surgeon were all significantly associated with CT cavity volume but there was no significant difference by localization technique (p=0.38). For pathology volume, there was a non-significant trend toward increased specimen volume with wire localization (p = 0.07), and significant associations with BMI, histology, and pre-op imaging volume. When stratified by surgeon, there was no surgeon for whom one localization technique led to significantly different CT or pathology volume over the other. There were no significant changes of the treatment effect over time (p = 0.79). There was no significant difference between wire and seed localization in indicated boost delivery (85% vs 79%, p = 0.14) or electron boost (42% vs 56%, p = 0.13). Conclusion There was no significant difference in CT cavity size between wire localization and magnetic seed localization, suggesting that the choice between these surgical techniques does not impede RT boost delivery. Citation Format: Michael Dykstra, Jessica Thompson, Jessica Aldous, Shannon Jiang, Tasha Hughes, James Hayman, Aleksandar Dragovic, Jennifer Shah, Alfred Chang, Corey W. Speers, Michael Sabel, Lesly Dossett, Matthew Schipper, Reshma Jagsi. Effect of Wire vs Magnetic Seed Localization on Lumpectomy Cavity Size [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-05.

Abstract P2-15-04: Surgical outcomes of ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction

Abstract Purpose: Since 2015, mastectomy with immediate implant-based reconstruction at our institution is an ambulatory “day surgery” procedure. Ambulatory criteria for surgery including ASA level, BMI and major comorbidities were used to screen patients. We aim to evaluate surgical outcomes for women who undergo ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction. Our primary objective was to determine the impact of mastectomy type (nipple- or skin-sparing mastectomy) and device location (subpectoral versus prepectoral plane) on complication rates. Methods: We performed a retrospective cohort study of women receiving immediate alloplastic reconstruction following mastectomy for either breast cancer or risk reduction at Women’s College Hospital in Toronto, Ontario, Canada between 2015 and 2021. We collected demographic data on age, ethnicity, smoking status, and menopausal status. Clinical data collected included breast size, ptosis, surgical indications, laterality, location and type of implant, type of mesh used, and overall complication rate. We used a multivariable logistic regression model to determine the impact of mastectomy type and implant location on complication rates, with age, smoking status, breast size, ptosis, surgical indication, and use of mesh as covariates. Statistical analysis was performed using SAS® OnDemand for Academics and P values &amp;lt; 0.05 were considered statistically significant. Results: 284 women underwent mastectomy with immediate alloplastic reconstruction for risk reduction (130, 45.8%) and breast cancer (154, 54.2%). 134 (47%) underwent skin-sparing mastectomy (SSM) and 149 (53%) underwent nipple-sparing mastectomy (NSM). Demographic and clinical data are presented in Table 1. There was an overall complication rate of 19.4%; women having NSM had a higher crude complication rate compared with SSM (25.5% vs 12.6%, P = 0.006). In our multivariable logistic regression model, there was no interaction between mastectomy type and device location on complication rate (P = 0.5). There was also no difference in complication rates associated with SSM compared with NSM (OR 2.9, 95% CI 0.95 – 9.0, P = .06) or implant location (P = 0.1). Younger age (OR 0.93/year increase in age, 95% CI 0.89-0.98, P = 0.005) and having surgery for breast cancer (OR 3.4, 95% CI 1.1 – 10.2, P = 0.03) were associated with an increased likelihood of complications. Conclusion: In women undergoing ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction, there was no impact of mastectomy type (SSM vs NSM) or implant location (subpectoral vs prepectoral) on complication rates. Non-modifiable factors such as age and having surgery for breast cancer predicted having a complication. Our data suggest that with appropriate patient selection, there is no difference in surgical outcomes between mastectomy types and implant location in the ambulatory surgery setting. Table 1.1 Total Cohort Demographic and Clinical Data Table 1.2 Total Cohort Demographic and Clinical Data Citation Format: Simran Sandhu, Tulin D. Cil, Jaime M. Escallon, Mitchell Brown, John Semple, David Lim. Surgical outcomes of ambulatory mastectomy with immediate alloplastic reconstruction for breast cancer or risk reduction. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-15-04.