Breast Size Research Articles

Asinan Nanas Upaya Peningkatan Nilai Jual Nanas Madu Di Desa Tanah Tinggi

Asinan pineapple is one example of the diversity of culinary snacks in Indonesia made from fresh pineapple. Pineapple pickles, besides being rich in benefits, can also be a solution to the problem of low selling value complained about by farmers. In addition to being able to increase the selling value, the pineapple pickle business also has a great opportunity, this is supported by the sweet and sour taste which is a flavor that is much loved by people both among young people, mothers to students. As a business, the capital required to start a pineapple pickle business is also not too expensive. This is due to the abundant amount of pineapple, affordable prices, and the ingredients needed are not too many. Therefore, the pineapple pickle business, especially in the urban area of Bengkulu, is very promising, supported by the hot weather. Business activities are carried out at the residence of one of the members who resides in Vila Pematang Indah, Pematang Gubernur. The choice of this place was based on the consideration that the location is a large location that facilitates the production process. Meanwhile, Tanah Tinggi Village, Padang Jaya Sub-district, North Bengkulu is the location where raw materials are collected.1. Strength Pickled pineapple has a price that is affordable by all people. Pineapple as raw material is easy to obtain, especially in Tanah Tinggi Village, Padang Jaya District, Bengkulu Utar which is the center of pineapple plantations. 2. Weakness Cannot be consumed in excess because it causes infections in the mouth and stomach. 3. Opportunity The high consumer appetite for the combination of salty and spicy flavors found in pineapple asians 4. Threat The high cost of transportation from the raw material supplier to the production site. There are processed pickled businesses from other fruits. This pineapple fruit pickled business is good for attracting consumers because it is unique and there are still few who use pineapple as a pickled ingredient. With varying cup sizes, of course, this will increase consumer interest in choosing these products. The need for vitamins and various benefits of consuming pineapple fruit can be found through these preparations, one of which is good for the body's metabolism, but sometimes people are very lazy to consume it in its whole form because of boredom, therefore this is a processing creation with a new variant so that people do not feel bored to consume pineapple fruit.

Robust 3D breast reconstruction based on monocular images and artificial intelligence for robotic guided oncological interventions.

Breast cancer is a global public health concern. For women with suspicious breast lesions, the current diagnosis requires a biopsy, which is usually guided by ultrasound (US). However, this process is challenging due to the low quality of the US image and the complexity of dealing with the US probe and the surgical needle simultaneously, making it largely reliant on the surgeon's expertise. Some previous works employing collaborative robots emerged to improve the precision of biopsy interventions, providing an easier, safer, and more ergonomic procedure. However, for these equipment to be able to navigate around the breast autonomously, 3D breast reconstruction needs to be available. The accuracy of these systems still needs to improve, with the 3D reconstruction of the breast being one of the biggest focuses of errors. The main objective of this work is to develop a method to obtain a robust 3D reconstruction of the patient's breast, based on RGB monocular images, which later can be used to compute the robot's trajectories for the biopsy. To this end, depth estimation techniques will be developed, based on a deep learning architecture constituted by a CNN, LSTM, and MLP, to generate depth maps capable of being converted into point clouds. After merging several from multiple points of view, it is possible to generate a real-time reconstruction of the breast as a mesh. The development and validation of our method was performed using a previously described synthetic dataset. Hence, this procedure takes RGB images and the cameras' position and outputs the breasts' meshes. It has a mean error of 3.9 mm and a standard deviation of 1.2 mm. The final results attest to the ability of this methodology to predict the breast's shape and size using monocular images.Clinical Relevance- This work proposes a method based on artificial intelligence and monocular RGB images to obtain the breast's volume during robotic guided breast biopsies, improving their execution and safety.

How Camera-to-Subject Distance and Height Affect Breast Measurement and Follow-Up Assessment in Plastic Surgery.

Due to several factors that affect photograph quality, bias is inevitably present in two-dimensional (2D) breast photography. The principal variables affecting image performance at a fixed focus length are the distance between the camera and the subjects and the photography angles. This study aimed to investigate the effects of camera-to-subject distances and camera height on breast measurement parameters to understand the trend of breast deformation and provide guidance for the accurate evaluation of planar follow-up. We enlisted 16 volunteers with various breast cup sizes (A-D). Frontal and lateral photos were obtained with a steady focus of 50 mm at distances between 1.10 m and 2.20 m and at heights between 30 cm above the nipple and 30 cm below the nipple at intervals of 10 cm. Two researchers independently evaluated each volunteer's breast aesthetic parameters, including 11 linear parameters, 3 area parameters, and 3 ratio parameters, using Vernier calipers and Photoshop. The correlation coefficient of the two investigators ranged from 0.922 to 0.999. The results measured by Photoshop were 29.67 ± 5.23% greater than those of the Vernier caliper (p < 0.01). In contrast to ratio parameters, which showed no significant changes in each distance group (p = 1.00), linear parameters and area parameters significantly increased as object distance decreased (p < 0.05). The lower pole of the breast grew wider and flatter and occupied a larger proportion of the breast as height declined. Camera-to-subject distances of 1.5-1.7 m are recommended for stabilized and uniform breast photography. Varying shooting height affects breast distortion. Quantifying the relationship between photographic conditions and breast morphology enables plastic surgeons to conduct more comprehensive and accurate assessments. 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. Bullet point list: 1. The breast morphology will get more distortion with a smaller camera-to-subject distance. 2. Camera-to-subject distances of 1.5~1.7m are recommended for stabilized and uniform breast photography. 3. Height rather than distance affects the breast proportion.

The accuracy of an accelerometer-based portable navigation system for total hip arthroplasty using 3D CT measurement in the supine position: a prospective multicenter study

PurposeThis multicenter prospective study aimed to evaluate the accuracy of the cup alignment of an accelerometer-based portable navigation system (AP navigation) for a total hip arthroplasty (THA) in spine position. MethodsThis study prospectively enrolled 324 THAs using supine position in 9 hospitals. An AP navigation was used for cup fixation and the intraoperative navigation data (cup alignment, pelvic tilt, and pelvic rotation) were recorded. Computed tomography (CT) of the pelvis was performed 2 weeks post-operatively and cup alignment was measured on 3D-CT images. ResultThe accuracy (absolute difference in cup alignment between the intraoperative navigation record and postoperative 3D-CT measurements) was 3 ​± ​3° (mean ​± ​standard deviation) for cup inclination and 3 ​± ​3° for cup anteversion. The pelvis tilted anteriorly in 148 hips (46%) and posteriorly in 162 hips (50%), and did not tilt in 14 hips (4%). The pelvis rotated toward the operating side in 179 hips (55%), toward the contralateral side in 112 hips (35%), and did not rotate in 33 hips (10%). Multiple regression analysis showed that the patients’ characteristics (sex, body mass index, diagnosis, Crowe classification, laterality, intraoperative pelvic tilt, intraoperative pelvic rotation, and cup size) and the surgical factors (approach, preparation time, number of screws, and institution) did not affect the accuracy of the navigation system. ConclusionsThis is the first prospective multicenter study of this navigation system. The accuracy was not affected by patient characteristics, surgical factors, or substantial pelvic movement during cup fixation.

Self-reported breast size, exercise habits and BREAST-Q data – an international cross-sectional study of community runners

Women with larger breasts tend not to participate in high-intensity exercise and exercise less frequently. This study investigates how breast size impacts exercise habits and how breast reduction surgery changes women's participation in recreational exercise. Recruitment was generated via parkrun Limited (Richmond, UK), an organization offering weekly community-based runs. Female parkrun members aged over 18 years with no history of breast cancer were invited to complete a survey, including questions about their exercise habits, breast size, any breast alteration surgery, and BREAST-Q questionnaires. A total of 1987 women completed the survey, including 56 women who had undergone breast reduction. Results demonstrate that women with bigger breasts believe that reducing their breast size would improve their exercise performance and participation and that their breast size significantly impacts their type of exercise. Women who had undergone breast reduction reported increased overall frequency, enjoyment, and willingness to exercise in a group. Additionally, women that have undergone breast reduction report higher BREAST-Q scores than their non-surgical counterparts. This study supports the existing literature that breast size can impact exercise habits and demonstrates that women who have undergone breast reduction participate in healthier lifestyle practices. We suggest that if breast size impacts women's participation in sport and fitness, health practitioners and policymakers should advocate for better access to reduction mammoplasty in the publicly funded health sector.

Intercostal artery perforator flaps for partial breast reconstruction after breast-conserving surgery

Introduction Breast conservative surgery’s objectives include a thorough oncologic excision and a satisfactory aesthetic outcome. The greatest strategy to prevent undesirable aesthetic outcomes is to use oncoplastic procedures to do so during conservative surgery in one step. For small to medium-sized breasts (up to C or D cup size), volume replacement treatments are advised, particularly in cases of bigger tumors. This entails inserting tissue into the tumor excision defect from a nearby or distant site. Musculocutaneous flaps, fasciocutaneous flaps, and most recently ‘perforator’ skin flaps have all been used in autologous tissue restoration. Due to the intercostal artery’s strong blood supply, anterior and lateral intercostal artery perforator (LICAP) flaps are dependable tissue sources. These flaps have the benefit of being able to fill the resection cavity, preventing further deformities. The study aimed to assess the feasibility of intercostal artery perforator flaps in partial breast reconstruction following breast-conserving surgery. Materials and methods The study was carried out on 42 breast cancer patients admitted to the surgical oncology unit, at Alexandria Main University Hospital in the duration between January 2021 and December 2022. A modified lateral intercostal artery perforator flap (mLICAP) and anterior intercostal artery perforator flap (AICAP) were used depending on the tumor location within the breast. The postoperative assessment was done by another breast surgeon and by the patient. Results Modified LICAP was used in 37 patients and AICAP was used in 5 patients. 90.5% of patients were satisfied with the aesthetic outcomes (85.7 gave excellent results). 69% of patients had excellent results based on the surgeon’s assessment. Complications were encountered in 11 patients in the form of seroma, hematoma, and minimal wound dehiscence. Conclusion Modified LICAP affords excellent access to the axilla and offers an option that facilitates both a pleasing aesthetic result and obviates the need for symmetrizing contralateral surgery to maintain breast symmetry. AICAP is a good option to partially reconstruct the breast following BCS for tumors located in the lower half of the breast.

Bra Usage Duration and Breast Cancer Risk: A Case-Control Study

Introduction: Breast cancer is a disease feared by most women, with 2.3 million women worldwide being diagnosed with this disease. In 2024, Indonesia will relocate its capital to East Kalimantan Province, which currently has the second-highest (1%) prevalence of breast cancer cases in Indonesia. Objective: Given the increasing prevalence of breast cancer, it is worthwhile to scientifically examine the relationship between the duration of bra usage, age at first bra usage, bra size suitability, and types of bras used in relation to the occurrence of breast cancer. Method: The study design used was a case-control study with a 1:1 ratio of 48 respondents (24 cases and 24 controls) selected through purposive sampling. The analysis employed chi-square and odds ratio tests. Results: The study revealed that the average age of the respondents was 45.25 years. Furthermore, the variables of bra usage duration (OR=2.333), age at first bra usage, bra size suitability, and bra type (OR=0.639) showed no association with the occurrence of breast cancer (α&gt;0.05). Conclusion: This research concludes that there is no association between bra usage and the occurrence of breast cancer in women in East Kalimantan Province. Recommendation: It is suggested to reduce the duration of bra usage to less than 24 hours to minimize the risk factors for breast cancer.

A Multi-factor Analysis of Revision in Total Hip Replacement Using the Collarless-Polished-Tapered Stems with Different Cups.

Collarless-polished-tapered (CPT) stems have been widely used in total hip replacement (THR). Given that various types of cups are combined with CPT in clinical practice, however, what cup type performs the best for use with CPT is still unclear. This study aimed to investigate the effects of three types of commonly used cups with CPT on revision and survival life using multi-factor analysis. This study is a cohort study using the data between October 1998 to September 2021. The data of THR patients with ZCA All-poly Acetabular Cup, Continuum Acetabular System, and Trilogy Acetabular System with CPT were collected from several hospitals in the UK. The patients aged from 20 to 97 (n = 5981, 2345 male and 3636 female). Age, gender, body mass index, diagnosis, surgeon grade, cup material, cup size, surgical approach, survival life, complications, and Harris hip scores (HHS) were analyzed in relation to revision status. SPSS statistical software was used to analyze the relationship among various factors. The main statistical methods included chi-square with cross tables, analysis of variance (ANOVA) and survival analysis. The results in relation to HHS shows that the continuum cup has the best outcome in the postoperative period of 1 and 5 years (1 year = 90.7, 5 years = 91.3; P < 0.001); the Trilogy cup was the second (1 year = 88.4, 5 years = 87.3; P < 0.001); and the ZCA cup was the third (1 year = 84.6, 5 years = 82.4; P < 0.001). However, the Trilogy cup performed the best regarding survival life on revision while the Continuum cup was the worst. When the CPT stem is combined with different cups, the trilogy cup shows the best characteristics in terms of survival trends with revision ratios compared with the continuum and ZCA cups, and is therefore recommended by this study.

Lesion detection in digital breast tomosynthesis: human reader experiments indicate no benefit from the integration of information from multiple planes.

In digital breast tomosynthesis (DBT), radiologists need to review a stack of 20 to 80 tomosynthesis images, depending upon breast size. This causes a significant increase in reading time. However, it is currently unknown whether there is a perceptual benefit to viewing a mass in the 3D tomosynthesis volume. To answer this question, this study investigated whether adjacent lesion-containing planes provide additional information that aids lesion detection for DBT-like and breast CT-like (bCT) images. Human reader detection performance was determined for low-contrast targets shown in a single tomosynthesis image at the center of the target (2D) or shown in the entire tomosynthesis image stack (3D). Using simulations, targets embedded in simulated breast backgrounds, and images were generated using a DBT-like (50deg angular range) and a bCT-like (180deg angular range) imaging geometry. Experiments were conducted with spherical and capsule-shaped targets. Eleven readers reviewed 1600 images in two-alternative forced-choice experiments. The area under the receiver operating characteristic curve (AUC) and reading time were computed for the 2D and 3D reading modes for the DBT and bCT imaging geometries and for both target shapes. Spherical lesion detection was higher in 2D mode than in 3D, for both DBT- and bCT-like images (DBT: , , ; bCT: , , ), but equivalent for capsule-shaped signals (DBT: , , ; bCT: , , ). Average reading time was up to 134% higher for 3D viewing (). For the detection of low-contrast lesions, there is no inherent visual perception benefit to reviewing the entire DBT or bCT stack. The findings of this study could have implications for the development of 2D synthetic mammograms: a single synthesized 2D image designed to include all lesions present in the volume might allow readers to maintain detection performance at a significantly reduced reading time.

The role of 3-dimensional preoperative planning for primary total hip arthroplasty based on artificial intelligence technology to different surgeons: A retrospective cohort study.

Preoperative planning with computed tomography (CT)-based 3-dimensiona (3D) templating has been achieved precise placement of hip components. This study investigated the role of the software (3-dimensional preoperative planning for primary total hip arthroplasty [THA] based on artificial intelligence technology, artificial intelligence hip [AIHIP]) for surgeons with different experience levels in primary THA. In this retrospective cohort study, we included patients, who had undergone THA with the help of the AIHIP, and matched to patients, who had undergone THA without the help of the AIHIP, by age and the doctor who operated on them. The subjects were divided into 4 groups, senior surgeon (Chief of Surgery) with AIHIP group, senior surgeon without AIHIP group, junior surgeon (Associate Chief of Surgery) with AIHIP group and junior surgeon without AIHIP group. The general data, imaging index, clinical outcomes and accuracy of stem size prediction and cup size prediction were retrospectively documented for all patients. There was a significant difference in discrepancy in leg length (P = .010), neck-shaft angle (P = .025) and femoral offset (P = .031) between the healthy side and the affected side, operation duration (P < .001), decrease in hemoglobin (Hb) per 24 hours (P = .046), intraoperative radiation exposure frequency (P < .050) and postoperative complications (overall P = .035) among the patients in junior surgeon group. No significant differences were found between senior surgeon groups with respect to discrepancy in leg length (P = .793), neck-shaft angle (P = .088)and femoral offset (P = .946) between the healthy side and the affected side, operation duration (P = .085), decrease in Hb per 24 hours (P = .952), intraoperative radiation exposure frequency (P = .094) and postoperative complications (overall P = .378). The stem sizes of 95% were accurately estimated to be within 1 stem size, and 97% of the cup size estimates were accurate to within 1 cup size in senior surgeon group with AIHIP. A total of 87% stem sizes were accurately estimated to be within 1 stem size, and 85% cup sizes were accurate to within 1 cup size in junior surgeon group with AIHIP. In conclusion, our study suggests that an AI-based preoperative 3D planning system for THA is a valuable adjunctive tool for junior doctor and should routinely be performed preoperatively.

THE FATE OF REVISION TOTAL HIP ARTHROPLASTY FOR INSTABILITY

Instability is a common indication for revision total hip arthroplasty (THA). However, even after the initial revision, some patients continue to have recurrent dislocations. This study investigates those at risk for recurrent dislocation after revision THA for instability at a single institution.Between 2009 and 2019, 163 patients underwent revision THA for instability at a single institution. Thirty-three of these patients required re-revision THA due to recurrent dislocation. Cox proportional hazard models with death as a competing event were used to analyze risk factors, including prosthesis sizing and alignment. Paired t-tests or Wilcoxon signed rank tests were used to assess patient outcomes (Veterans RAND 12 (VR-12) physical score, VR-12 mental score, Harris Hip Score, and hip disability and osteoarthritis outcome score for joint replacement).Duration of follow-up until either re-revision or final follow-up was a mean of 45.3 ± 38.2 months. The 1-year cumulative incidence for recurrent dislocation after revision was 8.7%, which increased to 19.6% at 5 years and 32.9% at 10 years postoperatively. In the multivariable analysis, high ASA score [HR 2.71], being underweight (BMI&lt;18 kg/m2) [HR 36.26] or overweight/obese (BMI&gt;25 kg/m2) [HR 4.31], use of specialized liners [HR 5.51–10.71], lumbopelvic stiffness [HR 6.29], and postoperative abductor weakness [HR 7.20] were significant risk factors for recurrent dislocation. Increasing the cup size decreased the dislocation risk [HR 0.89]. The dual mobility construct did not affect the risk for recurrent dislocation in univariate or multivariable analyses. VR-12 physical and HHS (pain and function) scores improved postoperatively at midterm.Patients requiring revision THA for instability are at risk for recurrent dislocation. Higher ASA scores, abnormal BMI, use of special liners, lumbopelvic stiffness, and postoperative abductor weakness are significant risk factors for re-dislocation.

Low frequency 3D transmission ultrasound tomography: technical details and clinical implications

A novel 3D ultrasound tomographic (3D UT) method (called volography) that creates a speed of sound (SOS) map and a reflection modality that is co-registered are reviewed and shown to be artifact free even in the presence of high contrast and thus shown to be applicable for breast, orthopedic and pediatric clinical use cases. The 3D UT images are almost isotropic with mm resolution and the reflection image is compounded over 360 degrees to create sub-mm resolution in plane. MethodsThe physics of ultrasound scattering requires 3D modeling and the concomitant high computational cost is ameliorated with a bespoke algorithm (paraxial approximation – discussed here) and Nvidia GPUs. The resulting reconstruction times are tabulated for clinical relevance. The resulting SOS map is used to create a refraction corrected reflection image at ∼3.6 MHz center frequency. The transmission data are highly redundant, collected over 360 degrees and at 2 mm levels by true matrix receiver arrays yielding 3D data.The high resolution SOS and attenuation maps and reflection images are used in a segmentation algorithm that optimally utilizes this information to segment out glandular, ductal, connective tissue, fat and skin. These volumes are used to estimate breast density, an important correlate to cancer. ResultsMultiple SOS images of breast, knee and segmentations of breast glandular and ductal tissue are shown. Spearman rho is calculated between our volumetric breast density estimates and Volpara™ from mammograms, as 0.9332. Multiple timing results are shown and indicate the variability of the reconstruction times with breast size and type but are ∼30 minutes for average size breast. The timing results with the 3D algorithm indicate ∼60 minute reconstruction times for pediatrics with two Nvidia GPUs. Characteristic variations of the glandular and ductal volumes over time are shown. The SOS from QT images are compared with literature values.The results of a multi-reader multi-case (MRMC) study are shown that compares the 3D UT with full field digital mammography and resulted in an average increase in ROC AUC of 10%. Orthopedic (knee) 3D UT images compared with MRI indicate regions of zero signal in the MRI are clearly displayed in the QT image.Explicit representation of the acoustic field is shown, indicating its 3D nature. An image of in vivo breast with the chest muscle is shown and speed of sound agreement with literature values are tabulated. Reference is made to a recently published paper validating pediatric imaging. ConclusionsThe high Spearman rho indicates a monotonic (not necessarily linear) relation between our method and industry gold standard Volpara™ density. The acoustic field verifies the need for 3D modeling. The MRMC study, the orthopedic images, breast density study, and references, all indicate the clinical utility of the SOS and reflection images. The QT image of the knee shows its ability to monitor tissue the MRI cannot. The included references and images herein indicate the proof of concept for 3D UT as a viable and valuable clinical adjunct in pediatric and orthopedic situations in addition to the breast imaging.

Brassiere Cup Size Agreement between Patients and Plastic Surgeons: Do Surgeons and Patients Speak the Same Size Language?

Three-dimensional (3D) scans of 32 subjects were evaluated by 10 plastic surgeons estimating cup size using the American brassiere system. The surgeons were blinded to all parameters, including the 3D surface software-derived volume measures of the Vectra scan. The 3D scans of the anterior torsos were viewed. The plastic surgeons' estimations were compared with the cup sizes stated by the subjects (disclosed cup size), using simple and weighted Kappa statistics. Agreement between the estimated and disclosed brassiere sizes was only slight (0.1479 ± 0.0605) using a simple Kappa analysis. Even when a Fleiss-Cohen-weighted comparison was used, only moderate agreement (0.6231 ± 0.0589) was found. The interrater agreement intraclass correlation coefficient was 0.705. Rater accuracy varied. The percentage of time spent in cosmetic practice and gender were not significantly correlated with accuracy. Agreement between cup size disclosed by subjects and estimates by plastic surgeons was low. A miscommunication between the surgeon and patient may occur when using brassiere sizes to communicate wishes and estimates in procedures that involve changes in breast volume.

Are preoperative sexual well-being and breast satisfaction associated with the decision making in patients with early-stage breast cancer undergoing oncologic surgery?

e12573 Background: Early-stage breast cancer is treated with lumpectomy with radiation therapy or mastectomy in the absence of medical contraindications. Patients have the autonomy to pursue the surgery of their choice. However, the associations between patients’ decisions on surgery (lumpectomy vs. mastectomy) and their preoperative sexual wellbeing and breast satisfaction remain largely unknown. We investigated early-stage breast cancer patients’ preoperative sexual wellbeing and breast satisfaction who underwent lumpectomy vs. mastectomy using the validated and widely used BREAST-Q questionnaire. Secondary aim described the expectations and concerns through qualitative methods. Methods: This is a study using BREAST-Q to investigate early-stage breast cancer patients’ preoperative sexual wellbeing and breast satisfaction at a university-affiliated community hospital between October 2022 and February 2023. Structured telephone interviews with open-ended questions conducted. All patients received preoperative teaching regarding current guideline-directed treatment. Multivariate logistic regression analysis examined factors predictive of surgery and two-sample t-test for baseline characteristics. Statistical analyses were performed using Stata/IC 16.1. Results: A total of 109 patients were screened, 6 patients declined, and 22 patients were eligible for enrollment. 90.1% were White, 9.1% were Black. We identified 68.8% of patients agreed to undergo lumpectomy; 87.5% expressed that the decision was based on total trust for the multidisciplinary team, whereas 12.5% based on personal decision. 70% underwent lumpectomy and 20% mastectomy, among which two were recommended mastectomy by physicians' clinical judgement, two elected mastectomy in the hope for no cancer recurrence. Preoperative sexual wellbeing score (48.4 vs 53, p = 0.74) and breast satisfaction score (60.2 vs 69.2, p = 0.39) showed no difference in lumpectomy vs mastectomy. The multivariate logistic regression model adjusted for baseline demographics (age, race, BMI, bra size), relationship status, and socioeconomic status (education and annual personal income) indicated that no independent factors predictive of decisions. Patients reported answers to open-ended questions revealed the following most common expectations were 42.8% cancer free, 28.5% fast recovery, meanwhile concerns were 38.1% cancer recurrence, 28.6% surgical complications, 9.5% breast appearance. Conclusions: Our study shows that most patients made trust-based decisions despite available information and preoperative teaching. Patients' preoperative sexual wellbeing and breast satisfaction had no association with patients' decisions in lumpectomy vs. mastectomy. No social determinants associated with patients' decision making were identified.

Definitions of Abnormal Breast Size and Asymmetry: A Cohort Study of 400 Women.

Macromastia, micromastia and breast asymmetry have an impact on health and quality of life. However, there is scarce information addressing breast size and asymmetry frequency distribution in reference populations. The current study aims to identify factors that influence breast size and symmetry and classifies abnormal breast sizes and breast asymmetries in an adult German population. Breast base dimensions, breast volume, symmetry, and other breast anthropometric parameters of 400 German female patients were determined in a retrospective review of the MRI archives at our institution. Professional medical MRI-segmentation software was used for volume measurement. A total of 400 Patients were retrospectively enrolled. The patients had a mean age of 50 ± 12years (min: 24; max: 82), mean BMI of 25.0 ± 5.0 (min: 14.7, max: 45.6), and a mean total breast volume of 976ml (right: 973ml, min: 64, max: 4777; left: 979ml, min: 55, max: 4670). The strongest correlation of breast volume was observed with BMI (r = 0.834, p < 0.001), followed by breast base width (r = 0.799, p < 0.001). Smaller breasts have higher breast volume asymmetry ratios (r = - 0.124, p < 0.014). For a BMI between 18.5 and 24.9kg/m2, micromastia is defined by breast volumes below 250ml (5th percentile) and macromastia by volumes above 1250ml (95th percentile). Abnormal breast volume asymmetry (< 5th and > 95th percentile) is equivalent to an absolute difference of approximately 25% relative to the smallest side (bidirectional asymmetry ratio 5th percentile - 19%; 95th percentile 26%). This study provides normative data of German women, as well as selected size-for-BMI percentiles and asymmetry ratio percentiles. The normative data may help to establish transparent and objective coverage criteria for health insurances. 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 .

A novel and easily reproducible technique for determining nipple placement in chest masculinization surgery

The rate of chest masculinization surgery for gender affirming purposes is increasing in the United States. This rise in popularity can be attributed to greater awareness of the needs of the transgender population and improved insurance coverage for gender affirming care. 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 2 Cohen W.A. Shah N.R. Iwanicki M. et al. Female-to-Male Transgender Chest Contouring: A Systematic Review of Outcomes and Knowledge Gaps. Ann Plast Surg. 2019; 83: 589-593https://doi.org/10.1097/SAP.0000000000001896 Crossref PubMed Scopus (21) Google Scholar Although there is a growing body of literature detailing techniques, algorithms, and outcomes of chest contouring, relatively little attention has been paid to management of the nipple-areolar complex (NAC). 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 3 Agarwal C.A. Wall V.T. Mehta S.T. et al. Creation of an Aesthetic Male Nipple Areolar Complex in Female-to-Male Transgender Chest Reconstruction. Aesthetic Plast Surg. 2017; 41: 1305-1310https://doi.org/10.1007/s00266-017-0935-7 Crossref Scopus (24) Google Scholar , 4 Canner J.K. Harfouch O. Kodadek L.M. et al. Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States. JAMA Surg. 2018; 153: 609https://doi.org/10.1001/jamasurg.2017.6231 Crossref PubMed Scopus (162) Google Scholar In comparison to surgery for cisgender males, the neo-NAC for transgender males is formed from a NAC which tends to have a larger areola, more prominent nipple, and different anatomic location. Incorrect positioning of the NAC (most often too high and too medial) is a common pitfall in chest masculinization surgery. 1 American Society of Plastic Surgeons2019 Plastic Surgery Statistics Report. 2019; : 1-23〈http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Plastic+Surgery+Statistics+Report#1〉 Google Scholar , 5 Lane M. Ives G.C. Sluiter E.C. et al. Trends in gender-affirming surgery in insured patients in the United States. Plast Reconstr Surg - Glob Open. 2018; 6https://doi.org/10.1097/GOX.0000000000001738 Crossref Scopus (93) Google Scholar Management of the NAC in chest masculinization surgery additionally requires understanding the dynamic response of the body to the chosen techniques. This is influenced by multiple factors including the breast size, excess skin, degree of ptosis, and pre-operative positioning of the NAC.

Expanding Scope About Factors Influencing Seroma Formation After Breast Cancer Surgery.

To determine the incidence of seroma formation after breast cancer surgery, and its association with common risk factors. The correlationalstudy was conducted at the General Surgery department of Kafrelsheikh University Hospital, Egypt, from March 2020 to March 2022 and comprised patients having breast cancerstage I, II or III, as per the Tumour Node-Metastasis classification, who were scheduled to undergo modified radical mastectomy, breast conserving surgery or reconstructive surgery. Baseline, intraoperative and postoperative data was collected on a proforma. Data was analysed using SPSS 22. Of the 50 female patients with mean age 45±5.20 (range: 20-70 years), 30(60%) were in the elderly group aged >45 years, while 20(40%) were aged <45years. Overall, 12(24%) cases developed seroma; 9(30%) in the elderly group. There were 24(48%) cases of modified radical mastectomy, and 8(33.3%) had seroma. Electrocautery was used for breast dissection in 30(60%) cases, and, among them, seroma developed in 10(33.3%) patients. Age, body weight, afflicted breast side, site, and size of breast mass were not found to be significant predictors of seroma formation following breast cancer surgery.

Seroma After Breast Reconstruction With Tissue Expanders: Outcomes and Management.

Seroma is a relatively common complication after breast reconstruction with tissue expanders. The main risk in the presence of seroma is development of periprosthetic infection, which can lead to implant loss. Our goals were to identify risk factors for seroma, and to describe our protocol for managing fluid accumulation. An IRB approved breast reconstruction database was reviewed to identify patients who underwent tissue expander reconstruction. Patient characteristics, details of surgery, outcomes and treatment were recorded. Two hundred nineteen tissue expander reconstructions were performed in 138 patients. Twenty-eight reconstructions developed seroma (12.8%), and 75 were identified to have prolonged drains (34.2%). Seroma was more common in patients with lymph node surgery ( P = 0.043), delayed reconstruction ( P = 0.049), and prepectoral reconstruction ( P = 0.002). Seroma and/or prolonged drains were more commonly noted in patients with higher body mass index ( P = 0.044) and larger breast size ( P = 0.001). Aspiration was the most common intervention (85.7%), which was performed in the clinic utilizing the expander port site. There was no difference in infection or explantation rate between seroma and no-seroma patients ( P = 0.546 and 0.167), whereas patients with any fluid concern (seroma and/or prolonged drains) were more prone to developing infection and undergoing explantation ( P = 0.041 and P < 0.005). We recommend that prolonged drain placement longer than 3 weeks should be avoided, and patients should be screened for fluid accumulation after drain removal. Serial aspiration via expander port site and continuation of expansion provide a safe and effective method to manage seromas to avoid infection and expander loss.

Gestational gigantomastia: The sentinel event to systemic lupus erythematosus

Gestational gigantomastia or gravid macromastia is a rare condition presenting as incapacitating breast enlargement during pregnancy. It is physically and psychologically debilitating for the patient. Fewer than 100 cases have been published to date. The etiology of the condition is unknown, but various theories have been proposed. Here we report a case of a 27 year old woman in her second pregnancy, with an abnormal increase in the size of breasts. Her breast size increased from 34B to 52D brassiere size. Routine antenatal, hormone, and initial autoimmune investigations were within normal limits. The patient was managed conservatively with breast support and had a spontaneous resolution in the postpartum period. During follow up she was diagnosed with systemic lupus erythematosus, making the association of the two conditions a possibility. Good knowledge about this rare condition is necessary for all doctors, especially obstetricians.

Impact of Neoadjuvant Paclitaxel/Trastuzumab/Pertuzumab on Breast Tumor Downsizing for Patients with HER2+ Breast Cancer: Single-Arm Prospective Clinical Trial.

The impact of abbreviated neoadjuvant regimens for HER2+ breast cancer on rates of breast conservation therapy (BCT) is unclear. We aimed to determine BCT rates in a single-arm prospective trial of neoadjuvant paclitaxel/trastuzumab/pertuzumab (THP) in patients with stage II-III HER2+ breast cancer. BCT eligibility was prospectively recorded before and after THP. Pre- and post-treatment mammogram and breast ultrasound were required; breast MRI was encouraged. Patients with a large tumor to breast size ratio were eligible for downsizing. Multifocal/multicentric tumors, extensive calcifications, and contraindications to radiation were considered BCT contraindications. Overall, 92 patients who received neoadjuvant THP on trial were included. At presentation, 39 (42.4%) were considered eligible for BCT and 53 (57.6%) were not. BCT-eligible patients were older (median 54 years versus 47 years, respectively, p=0.006) and had smaller tumors by palpation (median 2.5 cm versus 3 cm, respectively, p=0.004). Of 53 BCT-ineligible patients, 28 were candidates for tumor downsizing, whereas 25 had contraindications to BCT. Overall, 51(55.4%) patients underwent BCT. Of the 28 patients who were candidates for downsizing, 22 (78.6%) became BCT-eligible after THP and 18/22 (81.8%) underwent BCT. In total, 44/92 (47.8%) patients experienced breast pathologic complete response (pCR, ypT0), including 11/25 (44.0%) patients with BCT contraindications at presentation. De-escalated neoadjuvant systemic therapy led to high BCT rates in this cohort. The impact of de-escalated systemic therapy on local therapy and outcomes in early stage HER2+ breast cancer warrants further investigation.