Breast Symmetry Research Articles

Dermoglandular advancement-rotation flap for conservative treatment of breast cancer - description of technique, objective and subjective assessments.

to describe and evaluate the dermoglandular advancement-rotation flap with no contralateral surgery as a technique for the conservative treatment of breast cancer when skin or a large proportion of gland requires resection. 14 patients with breast tumors with a mean size of 4.2cm and need for skin resection. The resection area is included within an isosceles triangle, with its apex located on the areola, which is the pivot for rotation of a dermoglandular flap released through a lateral extension along that triangle base. Symmetry before and after radiotherapy was objectively assessed by authors using the BCCT.core software, as well as subjectively by three experts and patients themselves using the Harvard scale. Experts considered the breast symmetry results to be excellent/good for 85.7% of patients in the early post-operative period and 78.6% in the late post-operative period. Excellent/good ratings provided by BCCT.core software amounted to 78.6% of cases in the early post-operative period and 92.9% in the late post-operative period. Symmetry was rated as excellent/good by 100% of patients. Dermoglandular advancement-rotation flap technique with no contralateral surgery provides good symmetry when a large proportion of skin or gland requires resection on breast conservative cancer treatment.

Identification of Key Breast Features Using a Neural Network: Applications of Machine Learning in the Clinical Setting of Plastic Surgery.

In plastic surgery, evaluation of breast symmetry is an important aspect of clinical practice. Computer programs have been developed for this purpose, but most of them require operator input. Artificial intelligence has been introduced into many aspects of medicine. In plastic surgery, automated neural networks for breast evaluation could improve quality of care. In this work, the authors evaluate the identification of breast features with an ad hoc trained neural network. An ad hoc convolutional neural network was developed on the YOLOV3 platform to detect key features of the breast that are commonly used in plastic surgery for symmetry evaluation. The program was trained with 200 frontal photographs of patients who underwent breast surgery and was tested on 47 frontal images of patients who underwent breast reconstruction after breast cancer surgery. The program was able to detect key features in 97.74% of cases (boundaries of the breast in 94 of 94 cases, the nipple-areola complex in 94 of 94 cases, and the suprasternal notch in 41 of 47 cases). Mean time of detection was 0.52 seconds. The ad hoc neural network was successful in localizing key breast features, with a total detection rate of 97.74%. Neural networks and machine learning have the potential to improve the evaluation of breast symmetry in plastic surgery by automated and quick detection of features used by surgeons in practice. More studies and development are needed to further knowledge in this area.

Evaluation of Vectra Xt 3D Surface Imaging Technology in Measuring Breast Symmetry and Breast Volume

Journal of the American College of Surgeons 236(5):p S9, May 2023. | DOI: 10.1097/01.XCS.0000932304.51365.42

How Useful Is the SSN–Nipple Distance? An Analytical Questionnaire Survey on Anthropometric Measurements for the Aesthetically Ideal Positioning of the Nipple–Areolar Complex

Several studies have attempted to identify the optimal anthropometric measurement for the aesthetically ideal positioning of the nipple-areolar complex. However, no standardised solutions and measurements for planning surgical procedures have been reached. The aim of this study is to identify the optimal anthropometric measurement between the suprasternal notch (SSN)-nipple distance and mid-clavicle (MC)-nipple distance for the aesthetic position of the nipple-areola complex (NAC) on the breast. A detailed online survey was sent to 300 board-certified plastic surgeons and residents of plastic surgery departments of hospitals in German, Austrian, and Swiss. A similar survey was also provided to 100 patients who had planned or had already undergone breast surgery. All participants were asked to rank the attractiveness of a series of women's breasts in images with different NAC position measurements. The images showed breasts from two different measurements and distances: all the breasts had equal dimensions and proportions and the same areola size. Complete datasets were obtained from 203 of the 300 board-certified plastic surgeons and residents of plastic surgery departments in German-speaking countries (recall 68%) and from 100 patients. The majority of doctors and patients find a symmetrical breast with a mirrored position of the nipple-areola complex more attractive than a non-symmetrical breast. In cases with minor measurement differences, such as 0.5 cm (SSN vs. MC), there is no relevant difference in the breast symmetry. However, at larger distances, the MC-to-nipple distance is superior for achieving aesthetically appealing symmetry compared with the SSN-to-nipple distance. Using the MC-to-nipple distance seems to be superior for correct nipple positioning than the SSN-to-nipple distance and is a valuable preoperative measurement option for breast symmetry with correct nipple height. Further studies on this topic involving a more general population should be conducted to confirm the improvements in perception with the preoperative measurements using the anatomical landmarks.

Lateral thoracic adipofascial flaps in the reconstruction of defects after breast-conserving surgery in breasts with ptosis, mild ptosis or without ptosis

ObjectiveTo study the feasibility, safety, and effectiveness of lateral thoracic adipofascial flaps in reconstructing the defects following breast-conserving surgery (BCS) in breasts with either no ptosis or mild ptosis. Methods37 female patients who underwent BCS and lateral thoracic adipofascial flap breast reconstruction between June 2020 and July 2022 were analysed. Surgery-related complications, intraoperative positive margin, local recurrence, and cosmetic outcome were assessed. ResultsThree local complications occurred in patients, all of which were cured by conservative treatment. Additionally, four patients had intraoperative positive margins. After a median follow-up period of 17.5 months, none of the patients showed local recurrence. All patients achieved a satisfactory breast shape. Further, patients without ptosis achieved good volume and symmetry. However, the breast symmetry was not satisfactory for patients with ptosis. ConclusionIt is reliable and effective to use the lateral thoracic adipofascial flaps to reconstruct the defects after BCS when the breast is not ptotic and the lesions are located in the lateral and central quadrants.

Abstract P4-05-06: SURGICAL OUTCOMES FOR RECONSTRUCTION AFTER DELAYED CONTRALATERAL PROPHYLACTIC MASTECTOMY

Abstract Background: Challenges for breast reconstruction (BR) after delayed CPM relate to previous ipsilateral reconstructive procedures, adjuvant therapies and co-morbidities. The same type of BR for both sides may be impossible and use of an abdominal flap-based reconstruction for the therapeutic side precludes a similar technique for the contralateral side; an implant-based reconstruction may be difficult to size match with autologous tissue reconstruction. Alternative sites for tissue harvest are the latissimus dorsi and gluteal artery perforator flaps but these can be associated with significant donor site morbidity and poorer breast symmetry. Types of reconstruction and complications were evaluated in the context of BR and delayed CPM. Methods: A retrospective analysis examined breast cancer patients undergoing CPM either as an immediate or delayed procedure with or without breast reconstruction (BR) between January 2009 and December 2019. Clinical information was extracted from a prospectively maintained database with collection of data on demographics, timing and type of surgery, previous adjuvant treatments and complications. Patients undergoing delayed CPM were categorized into 4 groups based on BR or no BR and its timing in relation to both CPM and therapeutic mastectomy. Complications were listed according to the Clavien-Dindo system (scale of 1 – 5) with major adverse events being wound infection requiring intravenous antibiotics or drainage and explantation. Despite small numbers, complications were compared for therapeutic and prophylactic mastectomy together with the type and timing of reconstruction. Results: A total of 39 CPM patients were analyzed with 12 (31%) undergoing immediate BR at the time of cognate mastectomy, 22 (56%) choosing bilateral BR simultaneously with delayed CPM, 3(8%) opted for bilateral delayed BR following delayed CPM whilst 2 (5%) had no reconstruction. The mean patient age was 52 years (24–73) and the average interval between initial and delayed mastectomy was 2.67 years (0–22). The majority of reconstructions (28/39) were implant-based (72%) rather than exclusively autologous reconstruction and most patients had a similar type of BR for contralateral and ipsilateral sides. More than half of patients received neoadjuvant therapy and 85% had post-mastectomy radiotherapy prior to CPM. Major complications occurred in 8 patients (67%) with unilateral BR compared with 5 patients (23%) with bilateral immediate BR and 3 patients (100%) undergoing bilateral delayed BR. Small numbers and confounding factors preclude any robust statistical analysis but no statistically significant differences between the immediate and delayed BR groups were found on Fisher’s exact test. Complication rates appeared higher when immediate BR was performed after delayed CPM compared with therapeutic mastectomy. Conclusion: Potential complications and limitations of BR in the context of delayed CPM should be discussed with patients and used to inform decision-making processes for timing of CPM and associated reconstruction. There are no clear differences in rates of complications depending on laterality, type or timing of reconstruction. This study provides reassurance that reconstruction can be successfully performed either at the same time as delayed CPM (with or without BR on therapeutic side) or as a delayed procedure. Citation Format: Chien Lin Soh, Samantha Muktar, Charles M Malata, John R Benson. SURGICAL OUTCOMES FOR RECONSTRUCTION AFTER DELAYED CONTRALATERAL PROPHYLACTIC MASTECTOMY. [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 P4-05-06.

Breast asymmetry classification and diagnostics

Breast asymmetry is a polyetiological condition, which may be caused by congenital characteristics, developmental abnormalities, hormonal changes, traumas or surgery. The estimation of breast symmetry should be performed by the plastic surgeon while planning the augmentation or reduction mammoplasty as well as reconstructive surgery. Breast asymmetry is a widespread condition, according to some reports, it can be found in more than half of women. Anthropometric methods, as well as radiology methods, are used to diagnose and estimate breast asymmetry. There are many classification systems of breast asymmetry. The first ones were based on breast appearance or etiology of asymmetry, while modern classifications combine morphologic and etiologic principles. Today there is no conventional diagnostic protocol for breast asymmetry, where it would be listed, which breast parameters should be measured during breast asymmetry estimation. The first attempts were made in the middle of the XX century. Works of Penn, Smith and Westreich are considered to be basic in this field. Generally, relationships between major breast soft-tissue reference points (nipple, areola, submammary fold, lateral border) and bone structures (breastbone, jugular notch, clavicle) are estimated.Mathematic formulas for counting breast volume depending on its linear measurements were developed as well. Nowadays the importance of skeleto-muscular system state (the presence of scoliosis or rib cage deformation) estimation is emphasized, while these conditions can also cause breast asymmetry.

The Study of the Correlation between the Surgeon and the Patient Perspective in the Outcome Analysis of Patients Undergoing Liposuction and Excision for Gynaecomastia

Background: Most patients with gynaecomastia seek surgical treatment because it causes embarrassment as well as anxiety for them. Hence, apart from cosmesis, mental satisfaction also plays an important role in the surgical treatment of gynaecomastia. This study was aimed at evaluating the outcome of gynaecomastia treated by liposuction and excision. Materials Methods: A retrospective analysis of patients who underwent liposuction and excision for gynaecomastia was done. Cosmetic results were assessed at least 6 months after the surgery and included factors like breast size, breast symmetry, the shape of the Nipple areolar Complex (NAC), symmetry of NAC and quality and visibility of scars. For each of these factors, a score from 1 to 10 was given by the patient as well as the surgeon. Results: Out of 58 patients included in this study, the overall mean patient score and surgeon score were 42.53 and 42.74, respectively. Grade I patients were having the best final aesthetic result (score = 44.28) and Grade III patients were having the least score (37.66) There was a good correlation between patients’ scores and surgeons’ scores on the symmetry of breasts, size of the breast and shape of the nipple-areolar complex. The mean value for overall satisfaction was 9.15. The overall complication rate was 17.2%. Conclusions: Gynaecomastia patients treated with liposuction and excision were having very good results in terms of aesthetic outcomes. There was a good correlation between patients’ perspectives and surgeons’ perspectives on the symmetry of breasts, size of breasts and shape of the nipple-areolar complexes. They also had good overall satisfaction and confidence levels.

Exploring natural breast symmetry in the female plastic surgical patient population.

Breast symmetry remains a challenging quality to measure. The question arises of how much baseline breast symmetry exists in the female plastic surgical patient population. Several linear dimensional assessments were collected based on a retrospective analysis of objective data of women with natural breasts, who presented for an initial consultation in a plastic surgical clinic and were measured with the 3D Vectra Camera by the company Canfield Scientific Inc., U.S.A. The first 100 cases were extracted from the large database in alphabetical order. The nipple positions were examined, including the following linear dimensions: distances from the jugulum to the nipple, from the nipple to the inframammary fold, and from the nipple to midline. Furthermore, the under-breast widths were obtained. The objective three-dimensional imaging method determined that all patients had some degree of asymmetry. The linear distances from the jugulum and midline to the nipple revealed that the measurements were larger on the left side. However, the nipple to the inframammary fold measurements were roughly the same. In the sample of plastic surgical patients, the average distance between the jugulum and nipple was around 20 cm, the distance between the nipple and inframammary fold was around 6.5 cm, the distance between the nipple and midline was around 10 cm, and the under-breast width was around 13 cm. On average, the jugulum-nipple distance on the right side was 19.9±2.3 cm and 20.1±2.4 cm on the left side. The distance between the nipple and the inframammary fold was 6.4±1.1 cm, revealing a similar distribution on both sides. The mean distance from the nipple to the midline was much larger on the left side of the body at 10.0±1.2 cm than on the right side at 9.4±1.3 cm. The under-breast width on the right side was slightly larger than the left side, with measurements of 13.4±1.8 cm versus 13.2±1.7 cm. Breast dimensions can be described comprehensively by an objective three-dimensional imaging process, which can detect asymmetry in all patients. The differences related to the nipple position were larger on the left side than the right regarding the distances from the jugulum and particularly the midline to the nipple, which seems to be of special importance, but not from the nipple to the inframammary fold. The linear measurements for the distances from the jugulum and the midline to the nipple are essential to accurate symmetry assessments and form an aesthetic triangle of the breast, which is a new term and the key to a simplified shape analysis.

Commentary on: Objective Analysis of Breast Symmetry in Female Patients Undergoing Breast Reconstruction After Total Mastectomy.

Commentary on: Objective Analysis of Breast Symmetry in Female Patients Undergoing Breast Reconstruction After Total Mastectomy.

Objective Analysis of Breast Symmetry in Female Patients Undergoing Breast Reconstruction After Total Mastectomy.

Satisfaction with the breast aesthetic outcome is an expectation of breast reconstruction surgery, which is an integral part of cancer treatment for many patients. We evaluated postreconstruction breast symmetry in 82 female patients using distance and volume measurements. Clinical factors, such as reconstruction type (implant-based and autologous reconstruction), laterality, timing of reconstruction (immediate, delayed, and sequential), radiation therapy (RT), and demographic factors (age, BMI, race, and ethnicity), were evaluated as predictors of postoperative symmetry. Matched preoperative and postoperative measurements for a subset of 46 patients were used to assess correlation between preoperative and postoperative symmetry. We used standardized differences between the left and right breasts for the sternal notch to lowest visible point distance and breast volume as metrics for breast, positional symmetry, and volume symmetry, respectively. We performed statistical tests to compare symmetry between subgroups of patients based on reconstruction type, laterality, timing, RT, and demographics. Overall, reconstruction type, reconstruction timing, and RT were observed to be factors significantly associated with postoperative symmetry, with implant reconstructions and immediate reconstruction procedures, and no RT showing better postoperative breast volume symmetry. Subgroup analyses, for both reconstruction type and laterality, showed superior volume symmetry for the bilateral implant reconstructions. No correlation was observed between preoperative and postoperative breast symmetry. Demographic factors were not significant predictors of postreconstruction symmetry. This comprehensive analysis examines multiple clinical factors in a single study and will help both patients and surgeons make informed decisions about reconstruction options at their disposal.

Association of Treatment Arm with Quantitative Cosmetic Outcome in a Randomized Trial Comparing Whole Breast Irradiation Dosing Schedules

<h3>Purpose/Objective(s)</h3> We have previously validated that two measures of breast symmetry derived from an anteroposterior photograph, termed M1 and M2, correlate with patient- and physician-reported cosmetic outcome and offer an opportunity to quantitate breast cosmesis without relying on subjective human assessment. Within the context of a prospective randomized trial comparing two dosing schedules for whole breast irradiation (WBI) (50 Gy/25fx+10-14 Gy/5-7fx boost [CF-WBI] versus 42.56 Gy/16fx+10-12.5 Gy/4-5fx boost [HF-WBI]), we evaluated the impact of treatment arm on M1 and M2 through five years follow up. <h3>Materials/Methods</h3> 2D AP photographs framed from the mid-neck to umbilicus were obtained at baseline, 6 months, and yearly through 5 years on a prospective randomized trial of 287 patients with early breast cancer who were randomly assigned to CF-WBI+boost or HF-WBI+boost. For each photograph, we marked the coordinates of each nipple and inframammary fold and used these values to calculate M1 and M2 as per prior methods (PMID 28333010). M1 and M2 range from 0 to 1 with higher values indicating better nipple symmetry (M1) or vertical breast symmetry (M2). Multivariable logistic regression longitudinal models were created with M1 and M2 as outcomes, dichotomized at the median, to evaluate associations of treatment arm with M1 and M2 adjusting for relevant clinical, demographic, and treatment variables. <h3>Results</h3> A total of 287 patients were enrolled on this trial (n=149 allocated to CF-WBI; n=138 to HF-WBI) with median follow up 48 months. Median age was 60 years with 11% Black and 13% Hispanic and 44% obese. A total of 1600 photographs were acquired and marked to calculate M1 and M2. At five-years follow up, M1 was 0.92 for CF-WBI and 0.91 for HF-WBI (P=0.55) and M2 was 0.63 for CF-WBI and 0.66 for HF-WBI (P=0.40). In multivariable longitudinal analysis, treatment arm was not correlated with either M1 (OR 0.76; P=0.16) or M2 (OR 1.19; P=0.39). In contrast, obesity was associated with worse M1 (OR 0.50; P=0.003) and worse M2 (OR 0.58; P=0.03) and age≥70 years was associated with worse M2 (OR 0.39; P=0.02). <h3>Conclusion</h3> This is one of the first randomized trials to use an objective, quantitative approach to measure breast cosmesis and compare outcomes by treatment arm. We found that cosmesis as assessed via M1 and M2 was similar by treatment arm, providing high quality evidence supporting cosmetic equivalence of CF-WBI and HF-WBI. Future breast cancer radiation trials could adopt this approach to compare different radiation regimens.

Association of Dosimetric Parameters and Boost Volume with Quantitative Cosmetic Outcomes in a Randomized Trial of Conventionally Fractionated vs. Hypofractionated Whole Breast Irradiation

<h3>Purpose/Objective(s)</h3> Whole breast irradiation (WBI) is the most common treatment in radiation oncology, yet there is a relative paucity of evidence delineating the relationship between dosimetric parameters and long-term outcomes. We conducted a prospective randomized trial with longitudinal follow up to compare two different WBI dosing schedules and sought to evaluate the association of dosimetric parameters and boost volume with long term cosmetic outcomes using novel, previously validated, quantitative metrics of breast cosmesis derived from 2-dimensional photographs. <h3>Materials/Methods</h3> A prospective randomized trial of patients with early breast cancer who were randomly assigned to conventionally fractionated or hypofractionated WBI plus boost was conducted from 2011-14. Anteroposterior photographs from the low-neck to umbilicus were obtained at baseline, 6 months, and yearly through 5 years. Fiducial points marking each nipple and inframammary fold were delineated on each photograph and used to calculate a measure of nipple symmetry (M1) and breast vertical symmetry (M2), as previously described (PMID 28333010). These values range from 0 to 1 with values closer to 1 indicating better symmetry. Multivariable logistic regression longitudinal models with M1 and M2 as outcomes, dichotomized at the median, evaluated associations of dosimetric parameters and boost volume with M1 and M2 adjusting for relevant clinical, demographic and treatment variables. Candidate dosimetric variables included volume of tissue encompassed by the 90% isodose line (PTV), tumor bed volume, volume encompassed by the 105% isodose line, maximum point dose in the breast (Dmax), central axis separation, percent dose delivered with 18 MV photons, boost energy, boost position, boost modality, and cross-sectional area of the boost field. <h3>Results</h3> Of the 287 patients included in this trial, 149 patients received CF-WBI and 138 received HF-WBI, with median follow up 48 months. Median age was 60 years. Median PTV was 1340cc (IQR 904-1760), median tumor bed volume was 23cc (IQR 13-43), and median boost field size was 64cm² (IQR 54-80). 50% of patients had a Dmax of ≥107% of the prescription dose. A total of 1600 photographs were annotated to calculate M1 and M2. In multivariable analysis, highest quartile of PTV (OR 0.40, P=0.002) and boost field size (OR 0.50, P=0.02) were associated with worse M1 outcome compared to the lowest quartile. Highest quartile of tumor bed volume was associated with worse M2 compared to the lowest quartile (OR 0.52, P=0.03). <h3>Conclusion</h3> Utilizing previously validated quantitative measures of cosmetic outcome derived from 2D photographs, we found that boost fields with cross-sectional area <54 cm² and PTV <1760cc were associated with better nipple symmetry, and tumor bed volume >43cc was associated with worse vertical breast symmetry. Understanding how dosimetric parameters and boost volume affect long-term cosmetic outcomes can facilitate optimization of breast radiation treatment plans.

Improving symmetry of nipple–areola complex (NAC) position in reduction mammoplasty using laser level projection

Symmetrical height of the nipple-areola complex (NAC) is a key factor in the perception of breast symmetry. For preoperative markings, we mainly rely on conventional anthropometric measurements of distances in correlation to anatomical landmarks. In this study, we evaluated whether the use of a class 2 laser projection water level would lead to better symmetry of nipple height in reduction mammoplasty procedures when used for preoperative planning. We analysed 100 patients undergoing reduction mammoplasty with a supero-medial pedicle and wise-pattern skin resection. We compared the bilateral differences in nipple height of the last 50 reduction mammoplasty procedures before using the laser projection water level (group A; no laser) with the first 50 reduction mammoplasties after implementation of this device (group B; laser). The follow-up period was 12 months. A total of 48 patients were included in group A and 44 patients in group B. Patient demographics, mean resection weight and complications did not differ statistically significantly. Nipple height differences were significantly lower in group B (laser), measuring 0.22±0.20cm (0-0.9; n=44), than those in group A (no laser; p < 0.001), measuring 0.61±0.28cm (0.2-1.2; n=49). Using laser level projection helped improve nipple height symmetry in reduction mammoplasty. We consider a difference of more than 1 cm in nipple height to be unacceptable in aesthetic reduction mammoplasty. This simple tool facilitates preoperative markings, and we find it to be safe, quick to install and very helpful in daily practice.

Evaluation of Vectra® XT 3D Surface Imaging Technology in Measuring Breast Symmetry and Breast Volume.

Breast symmetry is an essential component of breast cosmesis. The Harvard Cosmesis scale is the most widely adopted method of breast symmetry assessment. However, this scale lacks reproducibility and reliability, limiting its application in clinical practice. The VECTRA® XT 3D (VECTRA®) is a novel breast surface imaging system that, when combined with breast contour measuring software (Mirror®), aims to produce a more accurate and reproducible measurement of breast contour to aid operative planning in breast surgery. This study aims to compare the reliability and reproducibility of subjective (Harvard Cosmesis scale) with objective (VECTRA®) symmetry assessment on the same cohort of patients. Patients at a tertiary institution had 2D and 3D photographs of their breasts. Seven assessors scored the 2D photographs using the Harvard Cosmesis scale. Two independent assessors used Mirror® software to objectively calculate breast symmetry by analysing 3D images of the breasts. Intra-observer agreement ranged from none to moderate (kappa - 0.005-0.7) amongst the assessors using the Harvard Cosmesis scale. Inter-observer agreement was weak (kappa 0.078-0.454) amongst Harvard scores compared to VECTRA® measurements. Kappa values ranged 0.537-0.674 for intra-observer agreement (p < 0.001) with Root Mean Square (RMS) scores. RMS had a moderate correlation with the Harvard Cosmesis scale (rs = 0.613). Furthermore, absolute volume difference between breasts had poor correlation with RMS (R2 = 0.133). VECTRA® and Mirror® software have potential in clinical practice as objectifying breast symmetry, but in the current form, it is not an ideal test. 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.

An original method of analysis of the breast contour curve with 3-dimensional imaging: Case series.

Introduction:Postoperative assessment of breast reconstruction results has become increasingly important. In this paper, a unique analysis method with 3-dimensional surface images of patients who were treated with immediate breast reconstruction is presented.Patient concerns:Five Japanese women were suspected of having breast cancer and visited our hospital for treatment.Diagnosis:Breast cancer was diagnosed by biopsy, mammography, ultrasonography, computed tomography, and magnetic resonance imaging.Interventions:Five patients underwent nipple/skin-sparing mastectomy, concomitant sentinel lymph node biopsy, and immediate breast reconstruction in our hospital. Three cases were reconstructed by extended latissimus dorsi flaps, one was reconstructed by a pedicled transverse rectus abdominis myocutaneous flap, and one was reconstructed by a deep inferior epigastric artery perforator flap. Three-dimensional photographs were taken 1 year postoperatively. The similarity of the breast contours between the reconstructed breast and the nonaffected opposite breast obtained from 3-dimensional images was analyzed. The calculated value is called the breast contour score.Outcomes:No recurrence was observed during the follow-up period in any cases. All cases could be analyzed by breast contour score to evaluate the breast shapes.Conclusion:The scores become a relative value that ranges from 0 (completely different) to 100 (completely the same). By expressing the score as a relative value, the breast contour score could help us understand the degree of breast symmetry more intuitively.

Unilateral immediate deep inferior epigastric artery perforator flap breast reconstruction following skin sparing mastectomy: A comparative study on revision surgeries to improve breast symmetry.

The number of revision surgeries to improve breast asymmetry after deep inferior epigastric perforator (DIEP) flap breast reconstruction is still high worldwide with impact on both patients and healthcare systems. These procedures include fat grafting, contralateral breast symmetrization, scar revision, flap repositioning and remodeling. A previously published DIEP flap insetting algorithm has proven to be effective in selecting patient-tailored strategies to achieve excellent aesthetic outcomes. This study investigated whether this insetting algorithm was effective in reducing revision surgeries in patients undergoing SSM and immediate DIEP flap breast reconstruction to achieve the goal of a one-stage reconstruction. This retrospective case-control study included 60 patients (group A) treated without the DIEP flap standardized insetting algorithm and 60 patients (group B) treated with the standardized insetting algorithm, which considers among its variables the type of breast to be reconstructed, abdominal tissue thickness, rotation due to harvesting side. Demographic data, operative data, complications and number of revision surgeries were recorded. One hundred and twenty primary and 106 revision surgeries were performed. Groups were homogenous for age (p=.32), body mass index (p=.77), flap weight (p=.7), operative time (p=.87) and early complications (p=.78). When excluding isolated nipple reconstruction from the revision surgeries, one-stage reconstruction was successfully performed in 26 patients in group A (43.3%) and 39 patients (65.0%) in group B, with a statistically significant difference between the groups (p=.003). The introduction of a standardized insetting algorithm for immediate unilateral DIEP flap breast reconstruction can be effective in reducing the number of revision surgeries for breast asymmetry, making a one-stage reconstruction an achievable and reliable target.

Symmetry following unilateral two-stage prosthetic breast reconstruction: Is there an optimal time for managing the contralateral breast?

Achieving breast symmetry following unilateral mastectomy remains a challenge. Contralateral procedures are usually necessary to achieve breast symmetry. Controversy exists regarding whether these symmetry procedures should be performed at the time of the initial reconstruction or on a delayed basis. The study included 105 patients who had unilateral mastectomy, of which 55 had a simultaneous (immediate) contralateral symmetry procedure and 50 had a delayed contralateral symmetry procedure. Outcomes were compared and assessed for each cohort based on demographics, complications, and patient satisfaction. The delayed cohort required more procedures (3.4vs. 1.8, p < 0.0001) but shorter overall hospitalization length (2.8vs. 4.1 days, p < 0.0001). The two cohorts experienced a similar rate of revision (38.3% vs. 49.3%, p=0.17) The delayed cohort required a contralateral balancing procedure after completion of reconstruction more often than the immediate cohort (p=0.021). Overall reconstruction-specific complication rates were similar in both cohorts. The 36-Item Short-Form Health Survey (SF-36), a validated questionnaire for quality-of-life assessment, was administered 3 months after surgery and demonstrated that both cohorts reported similar outcomes when comparing their satisfaction with treatment. The results of this study demonstrate that immediate contralateral symmetry operations can be performed safely without increased morbidity. A new algorithm is presented.

Prepectoral breast reconstruction with complete anterior implant coverage using a single, large, square-shaped acellular dermal matrix

BackgroundSeveral studies have discussed various methods of prepectoral direct-to-implant (DTI) breast reconstruction using an acellular dermal matrix (ADM) prosthesis to achieve full coverage. However, methods for anterior coverage have rarely been reported. In this study, prepectoral DTI breast reconstruction with complete anterior implant coverage was performed using a square piece of ADM. This study aimed to introduce our prepectoral DTI technique and determine its functional and cosmetic outcomes as well as compare them with those of existing subpectoral DTI techniques.MethodsThis prospective comparative study focused on 29 patients (35 breasts) and 34 patients (35 breasts) who underwent breast reconstruction via subpectoral implant insertion (control group) and anterior coverage prepectoral implant insertion (anterior coverage group), respectively. Postoperative complications were noted, and breast symmetry was evaluated using the Vectra H2 three-dimensional scanner. The modified Kyungpook National University Hospital Breast-Q (KNUH Breast-Q) scale was used to assess the patient’s subjective satisfaction with the reconstruction and postoperative quality of life.ResultsNo remarkable differences in terms of complications (seroma, skin necrosis, nipple–areola complex necrosis, hematoma, capsular contracture, and infection) were noted in both groups. Compared with controls, considerably better results were observed among those in the anterior coverage group in terms of the mean drain removal period. Furthermore, those in the anterior coverage group showed greater symmetry on three-dimensional scans than the controls; however, this was not statistically significant. Subjective satisfaction and postoperative quality of life measured using the KNUH Breast-Q scale were not significantly different between both groups.ConclusionsConsidering its stability, faster recovery time, and cosmetic benefit, prepectoral breast reconstruction with anterior implant coverage using a single, large ADM is a good choice to perform breast reconstruction with implant insertion in patients who have undergone mastectomy.Level of evidence: II.

Adolescent fibroadenoma diagnosis via ultrasound and mammography

Fibroadenomas are quite common benign lesions in the adolescent age group, but it is a cause of concern for the individual and the family. These may remain asymptomatic or may present with pain. Aesthetic distortion of the breast symmetry may lead to psychosocial morbidity in adolescent females. The diagnosis is initially made by ultrasound. Magnetic Resonance Imaging is done in some cases where the underlying pathology is doubtful. A 13-year-old female patient presented to the Radiology department with the complaint of pain in the left breast for the past 10-13 days. The patient had no family history of breast cancer and drug intake. Her unilateral mammography (owing to age) and ultrasound of the breast was performed. After examination and ultrasound Surgical removal of this tumor was decided and the patient was referred to the surgery department for excision. Proper diagnosis and treatment at an early stage are necessary as it can lead to the progression of mass and can be turned into cancer.