Cadaveric Study of Breast Measurements during Augmentation with Implants

Forte, Antonio J.; Barbosa, Marco Polo; Persing, John A.; Alonso, Nivaldo; Berlin, Nicholas L.; Broer, Niclas; Narayan, Deepak; Kwei, Stephanie

doi:10.1097/prs.0000000000001060

Cited by 13 publications

(5 citation statements)

References 26 publications

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“…However, this study provided no insight into long-term outcomes observed in real patients, and the skin flaps have in preserving implant position. 10 Dorfman et al investigated geometric changes in breast projection and nipple positioning following NSM and subpectoral reconstruction with round or anatomical implants. 7 Although this study demonstrated that shaped implants had less nipple deviation from the point of maximal breast projection relative to round implants, it remains limited by the mean follow-up of 202 days and dynamic contribution of the pectoralis contraction.…”

Section: Discussionmentioning

confidence: 99%

“Direct-to-Implant, Prepectroal Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Years of Follow-Up”

Safran

Abi‐Rafeh

Viezel-Mathieu

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Prepectoral breast reconstruction has recently experienced a resurgence in popularity. However, in direct-to-implant (DTI) reconstruction, there is no opportunity for capsular modifications before final implant insertion. Implant pocket and breast shape are thus maintained, initially, solely by the mastectomy skin flaps, and eventually, by attachments of the periprosthetic capsule. The present study aims to quantify changes in breast geometric measurements over time following DTI prepectoral breast reconstruction. Methods: A retrospective chart review was performed for patients who underwent bilateral prepectoral DTI reconstruction performed by a single surgeon from June of 2016 to January of 2018. Patients followed for more than 2 years were included. Yearly standardized frontal photographs were analyzed, and nipple-to-midline, sternal notch–to–nipple, and midclavicle–to–lower pole measurements were obtained. Patient demographics, operative details, and complications were documented. Results: A total of 72 breasts (38 women) undergoing direct-to-implant, prepectoral breast reconstruction were included in the final analysis. Acellular dermal matrix was used in 56 breasts only (78.9%) for anterior coverage. The average change in nipple-to-midline distance after 2 years decreased by 0.41 cm (range, −2.00 to 2.97 cm), sternal notch–to–nipple distance decreased by 0.62 cm (range, −4.98 to 5.4 cm), and midclavicle–to–lower pole distance decreased 0.10 cm superiorly (range, −6.07 to 3.6 cm). In breasts that underwent postmastectomy radiation therapy, the average changes were −0.08, −0.43, and −0.56 cm, respectively. No patient in this cohort had severe malposition requiring further surgery. Conclusions: The present study provides insight into geometric breast measurements following prepectoral breast reconstruction at 2-year follow-up. The minimal breast shape changes observed demonstrate the feasibility of prepectoral DTI reconstruction with or without the use of acellular dermal matrix. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Section: Discussionmentioning

confidence: 99%

“Direct-to-Implant, Prepectroal Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Years of Follow-Up”

Safran

Abi‐Rafeh

Viezel-Mathieu

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Several different systems have been applied to measuring breast morphometry to describe both the unoperated and operated breast and the differences between the two. These include simple tape measure-based systems, [11][12][13][14] measurements taken from standardized photographic images, 1,[15][16][17] and measurements taken from threedimensional scanning systems. [18][19][20][21][22] Although it has been suggested that tape measurements lead to considerable interobserver and intraobserver error, this is not the experience of the author.…”

Section: Discussionmentioning

confidence: 99%

An Analysis of Ptosis following Subfascial Breast Augmentation: Calculations That Explain Dogma

Brown¹

2021

Plastic &Amp; Reconstructive Surgery

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Background: Implant placement can improve ptosis due to the position of the nipple, inframammary crease, and base of the breast acting together. The interrelationship between these was quantified via changes in morphometry following subfascial augmentation, and explains the circumstances under which dogma holds true. Methods: One hundred seventy-five patients underwent a series of static measurements before and 3 months after subfascial breast augmentation. Ptosis in the nipple and base of the breast was calculated before and after surgery. Results: All measurements except that of the the lateral sternal margin increased after surgery. All grades of ptosis reduced following surgery. There was lowering of the base in grade 1 patients, but not for other grades. Increased base ptosis correlated with reduced lateral sternal margin (1.9 cm compared with 2.9 cm; left, H5 = 24.7, p < 0.01; right, H5 = 24.5, p < 0.01). Implant volume did not correlate with change in ptosis at the nipple or base. Reduced ptosis was associated with implants that are a narrow match of implant to breast (0.52 to 0.95) (left, H5 = 28.3, p < 0.01; right, H5 = 24.9, p < 0.01). Decreasing ptosis correlated with lower lateral sternal margin compared to breasts that increased ptosis. Change in ptosis following surgery does not correlate with having children. Conclusions: Subfascial placement has varying effects on ptosis. Non-ptotic or mildly ptotic breasts appear to improve due to a disproportionate descent of the inframammary crease relative to the nipple and base. Patients with little breast tissue are more susceptible to an increase in "bottoming out," particularly if broad implants are used. A ratio matching implant to the base width has predictive value on outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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“…Although discussions on the aesthetic outcomes and distinguishability of implant shapes in cis women have been long and ongoing, a recent anthropometric study showed that round and anatomically shaped implants influence breast morphology differently [7,17,24,26]. A cadaver study showed that anatomically shaped implants were more adept at creating a longer IMF-N, and to a lesser extent, lengthening the SN-N too [14]. Importantly, these outcomes reflected the morphology directly after implant placement and do not reflect long-term outcomes that tissue quality and implant texture might have on eventual breast shape and position.…”

Section: Discussionmentioning

confidence: 99%

An anthropometric evaluation of the augmented breast: differences between cis-and transgender women and possible clinical implications

Timmermans

Mokken

Scheffers³

et al. 2021

Eur J Plast Surg

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Background The morphometric results after breast augmentations are generally understood to be clinically different between trans(gender) and cis(gender) women. The objective of this study was to establish these morphometric differences between the augmented breasts of trans and cis women and their implications for preoperative planning and expectation management of trans women. Methods A single-center, observational cross-sectional study was conducted. Three-dimensional images (VECTRA) of the chest were taken and used to measure preset morphometric parameters. Subsequently, several proportional morphometric outcome variables were calculated. We compared body, breast, and nipple dimensions and their interdependence between trans and cis women. The main outcome sets were (1) the relative dimensions of the chest, (2) the position of the breasts relative to the chest, (3) and the position of the nipple relative to the breast and nipple size. Results A total of 22 transgender and 22 cisgender women were included. The results showed that the breasts of the trans women were positioned more cranial. Furthermore, the nipple-areola complexes (NAC) were significantly smaller and positioned relatively more latero-cranial on the breasts. Conclusions Morphological characteristics of augmented breasts differ significantly between trans and cis women. The results of this study identified distinct differences between the augmented breasts of trans and cis women. Because of the apparent differences in results, surgical considerations, expectation management, and shared decision-making should play an even more pronounced role in breast augmentations in trans women. Level of evidence: Level III, risk/prognostic study.

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Cadaveric Study of Breast Measurements during Augmentation with Implants

Cited by 13 publications

References 26 publications

“Direct-to-Implant, Prepectroal Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Years of Follow-Up”

“Direct-to-Implant, Prepectroal Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Years of Follow-Up”

An Analysis of Ptosis following Subfascial Breast Augmentation: Calculations That Explain Dogma

An anthropometric evaluation of the augmented breast: differences between cis-and transgender women and possible clinical implications

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