Background: The anthropomometry of the “ideal” breast is well described, but changes that occur with enlarged breasts are not. The aim of this study was to assess the prevalence of nipple asymmetry in the horizontal plane and changes in the inframammary fold (IMF) in patients presenting with macromastia (defined as excessive development of the mammary glands by Merriam-Webster dictionary). Methods: One hundred patients (200 breasts) presenting to the Plastic Surgery Clinic for bilateral breast reduction were enrolled in this study. Patients’ characteristics captured for this study included age, body mass index (BMI), and breast anthropometric measurements, such as suprasternal notch to nipple, nipple to IMF, IMF projected to cubital fossa, midhumeral point, and nipple measurement from meridian. Basic univariate statistical analyses were performed to evaluate the impact of nipple asymmetry. Results: The average age was 37 years (SD 12 years), and the median BMI was 33 (IQR 28–37). More patients presented with nipple asymmetry, of whom 45% were classified as lateral to the meridian, 19% were classified as medial to the meridian, and 36% were classified as central to the meridian. Patients with lateral asymmetry and medial asymmetry had a significantly higher BMI (median BMI 35) compared with patients with central positioning (median BMI 30). Increasing breast size was positively associated with nipple asymmetry, whereas BMI ( R = −0.30, P = 0.003) and macromastia correlated negatively with IMF position ( R = −0.38, P = 0.0001). Conclusion: In macromastia, nipple displacement from the breast meridian, especially lateral displacement, is common and is aggravated by an increase in BMI. The IMF also descends, and this is also more common in patients with a raised BMI. These changes have clinical implications.
Volume 147, Number 5 • Viewpoints 919e vascular endothelium, and an apoptotic effect of rapidly growing immature cells inducing DNA degradation.This study reports on the use of intralesional bleomycin injection for the treatment of six children with Klippel-Trenaunay syndrome presenting with localized varicosities and complaining of pain in a unilateral lower extremity, presenting to a tertiary referral hospital during a 10-year period. All the children had pretreatment and posttreatment magnetic resonance imaging studies of the affected limbs performed. All were female, and the average age was 6.6 years (range, 4.5 to 9 years). Intralesional bleomycin was injected under general anaesthesia in an ambulatory setting at a dose of 0.5 mg/kg as described previously. 3 In all cases, the lower leg was the site of the injection for an average of four sessions, but two children required seven treatments. The injections were performed approximately every 6 weeks, or until resolution occurred. Five patients had at least 3 years of follow-up, and one was lost to follow-up after 6 months. Radiologic improvement was seen in five patients. Five patients had a marked clinical response of the varicosity (size reduction, and softer, improved contour), and it appeared that the child complained of less pain. There were no adverse reactions to treatment.Previous experience with intralesional bleomycin injections in low-flow vascular malformations demonstrated complete response, or a response with a size reduction of greater than 75 percent in approximately two-thirds of cases. 3 This study 3 showed that usually multiple treatments were necessary to achieve complete or partial resolution of low-flow vascular anomalies. Furthermore, intralesional bleomycin in high doses can cause pulmonary fibrosis and hypertension 4 ; however, with serial injections, side effects are self-limiting. Hyperpigmentation may occur after superficial injections.Management of patients with Klippel-Trenaunay syndrome can be challenging and requires a multifaceted approach. Limited studies have also reported on sclerotherapy for Klippel-Trenaunay syndrome. 5 Intralesional bleomycin injection could be considered as a method of treatment for children with Klippel-Trenaunay syndrome presenting with localized varicosities with or without accompanying pain to assist in the management of symptoms, but often requires multiple injections.
fold histology among investigators. We also wish to highlight some issues.Caveat 1: The inframammary fold is a variable structure that may be poorly formed in severe hypoplasia (type F0 and F1 breasts, 26 percent in their study). When the inframammary fold is better developed, it is essentially a subcutaneous structure occurring between the superficial fascia and the skin, but it also has a deeper component, emanating from deeper structures (i.e., deep fascia or periosteum), that is more tenuous. Raising the arm stretches the poorly formed subcutaneous structure and effaces it in F0 and F1 breasts. In contrast, in patients presenting with macromastia, 2 the fold was always present (F3).Caveat 2: The inframammary fold is mainly a subcutaneous structure, similar to the nasolabial fold or buttock crease. If a new fold is created, the whole length of the original inframammary fold must be destroyed from medial to lateral or it will persist, especially in the F3 breast. If a new fold is formed, it should ideally be recreated from the medial aspect of the breast to its lateral aspect, not just along the suture line.Caveat 3: A double-bubble deformity 3 occurs when a prosthesis is placed below the original inframammary fold, unless the original fold is totally destroyed, which becomes more difficult as the inframammary fold definition increases. The deformity occurs irrespective of the plane in which the prosthesis is inserted. It will be more obvious clinically in F3 breasts if the neo-inframammary fold is designed lower than the original fold, as shown in their study. It is the subcutaneous part of the inframammary fold that persists. If the prosthesis is bigger than the vertical breast foot plate, this will create a double bubble, except when there is a poorly defined fold (type F0 and F1).Caveat 4: There is a ratio of suprasternal notch to nipple::nipple-inframammary fold of usually 21:7 in the "ideal" breast. 4 Nipple position is slightly changed by augmentation; it is usually elevated by approximately 1 cm. In contrast, the nipple-to-inframammary fold distance lengthens with augmentation, even if the original inframammary fold is retained. Hence, by insertion of a "large" prosthesis combined with lowering the inframammary fold (2 cm or more), that "golden ratio" is distorted, which may lead to the "headlight" breast, where the nipple sits in the middle of the breast and the suprasternal notch-to-nipple distance is similar to the nipple-to-inframammary fold.Caveat 5: The inframammary fold will descend with time due to the weight of the prosthesis 5 and aging. Fixation of the incision/fold is critical to minimize this outcome. The inframammary incision is usually about 5 cm long, but the inframammary fold runs from the medial aspect of the breast to the anterior axillary line. These inframammary fold sutures, acting together with the integrity and strength of the rest of the inframammary fold, provides support to the prosthesis. The inframammary fold is more tenuous between the deep fascia/muscle and the superfici...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.