Gigantomastia is a rare but disabling condition characterised by excessive breast growth. Most definitions of gigantomastia refer to a particular weight of excess breast tissue. We speculate that in gigantomastia the weight of the breasts contributes significantly to the BMI, which has implications for healthcare rationing. This study aims to establish the contribution breast tissue makes to BMI in gigantomastia. In so doing, we propose a new definition of gigantomastia. Retrospective data was collected from the case notes of 68 females who underwent breast reduction or therapeutic mastectomy for gigantomastia. For the purposes of patient inclusion, gigantomastia is arbitrarily defined as excessive breast growth of over 1.5kg per breast. The difference between pre- and post-operative BMI is statistically significant (P<0.001). Mean pre-operative BMI is 38.7 with a mean specimen weight of 4506g. Mean contribution of specimen to body weight is 4.29%. There is no correlation between pre-operative body weight and the percentage contribution the breast resection specimen makes to body weight. Based on our data, we define gigantomastia as excess breast tissue that contributes 3% or more to the patient's total body weight, approximately one standard deviation below the mean. We suggest that the estimated excess breast tissue weight is taken into account when calculating pre-operative BMI in the gigantomastia population. The challenge of estimating excess breast weight pre-operatively may be met by 3D photography coupled with computer-assisted volumetry.
Fibularis tertius (FT) may be used during reconstructive surgery and muscle transposition with retention of function. The muscle was examined in both lower limbs of 41 cadavers. Measurements were made of muscle belly length and width, tendon length and width, and the size of the origin on the fibula. Tendon insertion, nerve and blood supplies were also examined. FT was absent in five (6.1%) lower limbs of three (7.3%) subjects. The size of its origin demonstrated inter- and intra-individual variation. FT arose from the distal fibula and on average occupied (28.4 +/- 9.1)% (mean +/- S. D.) of the total shaft length. In all cases the tendon inserted into the dorsal surface of the shafts of both the fourth and fifth metatarsals. A small nerve branch consistently arose from the deep fibular nerve near the origin of extensor digitorum longus. The nerve ran parallel to the length of this muscle, between it and extensor hallucis longus, before piercing FT. Anatomy textbooks describe FT as inserting into the fifth metatarsal only. This study, supported by data from previous reports, suggests that the "textbook" accounts of FT should be updated to record that most commonly its tendon reaches both the fourth and fifth metatarsals.
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The body mass index (BMI) is an arbitrary criterion used by third party fundholders in some countries for rationing the public funding of reduction mammaplasty and abdominoplasty surgery. Many patients have commented that the weight of their excess breast tissue or abdominal pannus contributes to an overestimation of their body mass index. This study seeks to establish the truth of this by ascertaining whether the difference between pre- and postoperative body mass indices of patients undergoing reduction mammaplasty or abdominoplasty is significant. Case notes of 30 sequential reduction mammaplasty patients and 16 abdominoplasty patients were analyzed to ascertain their preoperative weight, height, calculated BMI, and the mass of the breast reduction or abdominal resection specimen as measured in theater. This information was used to retrospectively calculate the difference the weight of the specimen would have made to their BMI. Overall, the difference between pre- and postoperative BMI is not statistically significant (reduction mammaplasty P = 0.22; abdominoplasty P = 0.62, 2-tailed t test). However, the largest contribution breast reduction and abdominoplasty resection specimens made to the BMI in our series was 1 and 2.4, respectively. We suggest that it may be appropriate to consider a minority of patients for surgery if their BMI is within 1.0 (for breast reduction) or 2 (for abdominoplasty) of any set target BMI, and highlight the specific patient subpopulations to which this is most applicable. An estimate of resection weight preoperatively may allow a "corrected" BMI to be used for determining eligibility for surgery.
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