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Image analyses of nucleus and chromosome territories. (A) The maximum intensity projection of 22 optical sections for a diploid cell. Overlay image showing the nucleus and enclosed chromosome territories for X (green), 12 (red) and 8 (yellow). (B) 3D modeling of nucleus and chromosome territories (CT) of the cell shown in (A) using SPHARM in the same color code. (C) The maximum intensity projection of 29 optical sections for a trisomy 12 nuclei. (D) 3D models of nucleus and CTs of cell shown in (C).
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Plastic surgeons aim to achieve breast symmetry during cosmetic and reconstructive breast surgery. They rely on measures of breast size, position, and projection to determine and achieve breast symmetry, but normative data on symmetry in preoperative breast reconstruction patients are scarce.
Methods:
A statistical evaluation was performed to exa...
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... However, when the excised glandular volume ranges from 20% to 50%, BCS fails to yield significant aesthetic benefits due to the sizable local defect resulting from tumor excision, posing challenges for repair (8). Additionally, BCS may not consistently deliver satisfactory aesthetic outcomes for all patients, particularly those with small-to medium-volume breasts (9)(10)(11)(12). Such breasts possess limited glandular tissue, rendering even excised tissue percentages below 20% irreparable, thus precluding BCS as a viable option. ...
... Shi et al. 10.3389/fonc.2024.1367477 ...
Inadequate tissue volume at the lower pole of the breast following tumor excision can compromise aesthetic outcomes when employing the conventional inverted-T reconstruction technique. With the aim of reducing postoperative deformities, we have refined this technique. A total of 104 patients underwent the T technique, while 32 underwent the modified T technique and 72 underwent the traditional T technique. In this study, we present the surgical outcomes of the modified T technique group and compare both surgical and oncological outcomes with those of the traditional T technique group. In the modified T technique group, the average tumor size was 23.34 mm, and the mean operation duration was 107.75 min, which was significantly shorter than that of the traditional T technique (p = 0.039). Additionally, the average blood loss was 95.93 mL, which was significantly lower than that of the traditional T technique (p = 0.011). Although complication rates did not differ significantly between the two groups (p = 0.839), the modified T technique yielded superior aesthetic outcomes compared to the traditional T technique (p = 0.019). Survival analysis indicated no significant difference in 5-year recurrence-free survival between the two groups, both before and after propensity score matching (p = 0.381 vs. p = 0.277). As part of our series of oncoplastic techniques for the lower breast quadrant, the modified inverted-T technique utilizes a cost-effective flap to address lower pole defects, mitigating deformities and restoring the breast’s natural shape.
... Это, в свою очередь, не учитывает большое количество этапов, проводимых для получения симметрии [46,47]. Во многих исследованиях отмечалось, что именно симметрия является наиболее важным фактором, влияющим на эстетический результат реконструкции МЖ и, следовательно, на психосоциальное благополучные и качество жизни пациенток в долгосрочной перспективе [30,37,48,49]. Так, в исследовании, проведенном M. von Glinski и соавт. ...
Purpose of a study: to explore the main methods of evaluating the aesthetic results of autologous breast reconstruction with a DIEP flap (deep inferior epigastric artery perforator), to identify the key factors influencing the aesthetic result of breast reconstruction.
The scientific papers in the databases PubMed, Google Scholar, SCOPUS, Science Direct, RSCI for the period from 2013 to 2023 were analyzed. The systematic review includes articles evaluating the aesthetic result of breast reconstruction with a DIEP flap. The search was carried out by keywords: “breast”, “DIEP flap”, “aesthetic result”, “symmetry of breast”.
As a result of the analysis, it was found that the evaluation of the aesthetic results of breast reconstruction is carried out using data of patient reported outcome measures, scales which is used to rate the surgeon’s perception of the aesthetic outcomes and quantitative objective measurements. The key factor influencing the aesthetic result of reconstruction is the symmetry of the breasts.
Conclusion . The most commonly used methods for assessing the aesthetic results of breast reconstruction with a DIEP flap are: self-assessment of the results of reconstruction by patients (BREAST-Q questionnaire), evaluation of the results by surgeons (professional aesthetic assessment scales), quantitative objective methods for determining the degree of symmetry. According to many studies, symmetry is a critical factor affecting the aesthetics of the breasts and, consequently, patient satisfaction with the results of reconstruction, psychosocial well-being and quality of life in the long term.
... Bilateral symmetry of the breasts was assessed using a previously reported method based on the ratio of measurements on one side to those on the other side. 23 The SN-N distances, C-N distances, nipple to IMF (N-IMF) distances, and breast widths on both sides were measured on the constructed 3D images to calculate symmetry scores (shorter distance divided by the longer distance). Wilcoxon signed-rank test was performed using Prism version 7.02 for Windows (GraphPad Software, La Jolla, Calif.) to statistically compare the symmetry scores before immediate reconstruction surgery and those after NAC reconstruction, and to evaluate the influence of this technique on the bilateral symmetry of the breasts. ...
Background
A skin paddle severely impairs the appearance of the reconstructed breast. We have established a new technique called “minimal scar autologous breast reconstruction” involving delayed nipple reconstruction using a local flap designed on the skin paddle and simultaneous resection of the residual skin paddle.
Methods
We analyzed 20 patients with unilateral breast cancer who underwent skin-sparing mastectomy followed by immediate breast reconstruction using a free flap (deep inferior epigastric perforator flap in 13 patients and profunda artery perforator flap in seven). Approximately 1 year after primary reconstruction, nipple reconstruction using an arrow flap designed on the skin paddle and resection of the residual skin paddle were performed. Several months later, medical areola tattooing was performed. Bilateral breast symmetry scores, obtained from the distances between anatomic landmarks, were compared before and after breast reconstruction.
Results
Postoperative complications such as necrosis of the reconstructed nipple were not observed after two-stage reconstruction, and all procedures including total resection of the skin paddle, nipple reconstruction, and medical tattooing were performed successfully in all cases. Aesthetic outcomes were excellent: comparison of symmetry scores showed no significant differences in any parameters between before surgery and after reconstruction of the nipple-areola complex.
Conclusions
We have established step-by-step strategies for mastectomy, autologous breast reconstruction, and then nipple reconstruction, keeping in mind that the skin paddle would later be totally resected in nipple reconstruction, and thereby achieved breast reconstruction with markedly reduced postoperative scarring compared with conventional autologous breast reconstruction.
... Breast symmetry has been demonstrated to be a critical factor that influences breast aesthetics and, consequently, long-term patient satisfaction. [5][6][7]10 Symmetry is widely used as a surgical outcome using both subjective 11,12 and objective measures (Table 1). [13][14][15][16][17][18][19] Breast symmetry is affected by several clinical factors, such as the reconstruction type, timing, and laterality of reconstruction and cancer therapeutics, such as the use of adjuvant chemotherapy and/or radiation therapy (RT). ...
... We annotated fiducial points 10,25 (Figure) on the patients' 3D images and computed breast volume 26 and the distance between the sternal notch (SN) and lowest visible point (LVP) for each breast. The distance from SN-to-LVP provides a measure of vertical positional symmetry. ...
... We utilized SN-to-LVP distance, instead of SN-to-nipple distance, to allow inclusion of patients who had not undergone nipple reconstruction or nipple tattooing. Deriving the metric from previous work on symmetry in natural breasts, 10 we calculated the standardized difference percentage (SD%, Eq. (1)) between the left and right breast using either SN-to-LVP distance (positional symmetry) or volume (volume symmetry). Lower SD% values indicate greater symmetry. ...
Background
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 post reconstruction breast symmetry in 82 female patients using distance and volume measurements.
Objectives
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.
Methods
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.
Results
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 post reconstruction symmetry.
Conclusions
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.
... This is consistent with our objective results on symmetry, as our newly developed symmetry index revealed good results for both methods (93 %). The Department of Plastic Surgery at The University of Texas MD Anderson Cancer Center, Houston, found that a substantial proportion of women (50.6 % of a non-operated cohort) exhibit a volume difference of greater than 50 ml between the right and left breasts [27]. The MDACC study provides normative data on the extent of breast asymmetry in preoperative patients that can guide us in setting realistic goals for reconstruction procedures. ...
Aims
Congenital breast asymmetry represents a particular challenge to the classic techniques of plastic surgery given the young age of patients at presentation. This study reviews and compares the long-term results of traditional breast augmentation using silicone implants and the more innovative technique of lipografting.
Methods
To achieve this, we not only captured subjective parameters such as satisfaction with outcome and symmetry, but also objective parameters including breast volume and anthropometric measurements. The objective examination was performed manually and by using the Vectra ® H2 photogrammetry scanning system.
Results
Differences between patients undergoing either implant augmentation or lipograft were revealed not to be significant with respect to patient satisfaction with surgical outcome ( p = 0.55) and symmetry ( p = 0.69). Furthermore, a breast symmetry of 93 % was reported in both groups. Likewise, no statistically significant volume difference between the left and right breasts was observed in both groups ( p < 0.41). However, lipograft patients needed on average 2.9 procedures to achieve the desired result, compared with 1.3 for implant augmentation. In contrast, patients treated with implant augmentation may require a number of implant changes during their lifetime.
Conclusion
Both methods may be considered for patients presenting with congenital breast asymmetry.
Level of Evidence III
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 .
... This is consistent with our objective results on symmetry, as our newly developed Symmetry Index showed good results for both methods (93 %). The Department of Plastic Surgery at The University of Texas MD Anderson Cancer Center, Houston found that a substantial portion of women (50.6 % of a non-operated cohort) exhibit a volume difference greater than 50 ml between right and left breast [27]. This study provides normative data on the extent of breast asymmetry in preoperative patients that can guide us in setting realistic goals for reconstruction procedures. ...
Congenital breast asymmetry represents a particular challenge to the classical techniques of plastic surgery due to a young group of patients. This study compares traditional breast augmentation using silicone implants to the more innovative lipograft technique regarding long-term results. To achieve this, we not only captured subjective parameters like satisfaction with outcome and symmetry, but also objective parameters such as breast volume and anthropometric measurements. Objective examination was performed manually and by using the Vectra® H2 photogrammetry scanning system. Patients who underwent implant augmentation and lipograft both showed no significant differences in patient´s satisfaction with surgical outcome (p = 0.55) and symmetry (p = 0.69). Furthermore, a breast symmetry of 93 % in both groups was reported. Likewise, no statistically significant volume difference between left and right breast was observed in both groups (p<0.41). However, on average, lipograft patients needed 1.3 procedures more until the desired result was achieved. In contrast, patients treated with implant-based breast augmentation usually need several implant changes during their life. In conclusion, both methods should be considered for patients with congenital breast asymmetry.
... Breast symmetry does also play an important role for satisfaction, but is not found to be a major determinant of outcome (22). Breast asymmetry is a common phenomenon and the proportions of patients in this study that obtained an acceptable symmetri of 0.5 cm or less difference in SSN:N measurement was in accordance with a normal population opting for BR (23). Absolut symmetry is not the ultimate goal and patients were informed of this prior to surgery in an attempt to manage patients' expectations. ...
Background:
The use of acellular dermal matrix (ADM) in one-stage immediate implant-based breast reconstruction (BR) may offer advantages over the two-stage expander-to-implant technique, but literature shows conflicting results. The aim of the present study was to compare these two techniques for immediate implant-based BR regarding postoperative complications, aesthetic correction procedures and aesthetic outcome.
Methods:
The study was designed as an observational cohort study with 44 participants admitted for immediate implant-based BR at Department of Plastic Surgery, Aarhus University Hospital, Denmark. 21 patients underwent BR with a one-stage direct-to-implant technique using ADM and 23 patients underwent BR with a two-stage expander-to-implant technique. Follow-up time was 2 years.
Results:
The risk of implant loss was equal between groups; one-stage group 16% and two-stage group 17% whereas the risk of implant exchange (but not loss of BR) was 13% in the one-stage group compared to 7% in the two-stage group. The risk of at least one major complication were equal between groups; 28% and 24% but the risk of at least one minor complication was significantly higher in the two-stage group (41%) compared to the one-stage group (3%). Number of aesthetic corrections were equally frequent in the two treatment groups (one-stage group 1.8, two-stage group 1.5). Patient and investigator assessed aesthetic outcome was very high in both groups as well as the degree of symmetry between breasts. No capsular contracture Baker grade 3 or 4 was observed.
Conclusions:
The present study design sets limitations for drawing wide conclusions. This study did not reveal any significant differences between the two breast reconstructive techniques besides a higher risk of minor complications in the two-stage group, that did, however, not lead to a higher risk of implant loss. With equally high satisfaction with the aesthetic result and no significant difference in number of aesthetic corrections between the two groups we suggest, that the one-stage approach using ADM may be feasible and allows the patient to achieve an implant-based BR with a minimum of surgeries and outpatient visits. The study was registered in ClinicalTrials.gov (NCT04209010).
... They found no association between tumour size and BV asymmetry. 36 Our study also broadly agrees with the findings of a previous small case-control study, which used a bespoke algorithm for estimating mammographic density percentage (%MD) asymmetry in 230 cases found clear of cancer at the time the image was taken but who were subsequently diagnosed with breast cancer and 230 matched cancer-free controls. 22,25 Increasing %MD asymmetry was positively associated with the odds of cancer at the subsequent screen (1-3 years later) after adjusting for age and subjective breast density category (BIRADS), 22,25 in line with our findings. ...
... If asymmetry is simply attributable to the presence of a tumour in the breast, then a higher correlation between tumour size and asymmetry would be expected together with a closer correspondence between tumour laterality and the breast with larger volume/ density (in our study only ~55% of unilateral screen detected tumours were located in the breast with higher DV/BV) and previous studies found no evidence that the tumour was associated with the larger BV. 20,21,36 In our study, there was some evidence of a weak positive correlation between DV asymmetry and tumour size, but overall little of the observed asymmetry in our study can simply be explained by the presence of a tumour in the larger breast. We therefore conclude that asymmetry cannot be explained by the presence of a tumour alone but may be a biomarker of increased genetic/early life susceptibility to breast cancer. ...
Objectives
To assess the associations between automated volumetric estimates of mammographic asymmetry and breast cancers detected at the same (“contemporaneous”) screen, at subsequent screens, or in-between (interval cancers).
Methods
Automated measurements from mammographic images (N = 79,731) were used to estimate absolute asymmetry in breast volume (BV) and dense volume (DV) in a large ethnically-diverse population of attendees of a UK breast screening programme. Logistic regression models were fitted to assess asymmetry associations with the odds of a breast cancer detected at contemporaneous screen (767 cases), adjusted for relevant confounders. Nested case-control investigations were designed to examine associations between asymmetry and the odds of: (a) interval cancer (numbers of cases/age-matched controls: 153/646) and (b) subsequent screen-detected cancer (345/1438), via conditional logistic regression.
Results
DV, but not BV, asymmetry was positively associated with the odds of contemporaneous breast cancer (P-for-linear-trend (Pt) = 0.018). This association was stronger for first (prevalent) screens (Pt = 0.012). Both DV and BV asymmetry were positively associated with the odds of an interval cancer diagnosis (Pt = 0.060 and 0.030, respectively). Neither BV nor DV asymmetry were associated with the odds of having a subsequent screen-detected cancer.
Conclusions
Increased DV asymmetry was associated with the risk of a breast cancer diagnosis at a contemporaneous screen or as an interval cancer. BV asymmetry was positively associated with the risk of an interval cancer diagnosis.
Advances in knowledge
The findings suggest that DV and BV asymmetry may provide additional signals for detecting contemporaneous cancers and assessing the likelihood of interval cancers in population-based screening programmes.
... Breast asymmetry affecting bra fit is another challenge that is amplified for women who undergo a mastectomy, even if followed by reconstructive surgery. While most women have some amount of breast asymmetry [2], mastectomy followed by reconstruction often results in dramatic changes in the volume and in the fundamental footprint (location on the chest wall and shape) of the breast, so that the bra can no longer properly support and protect the breasts. * mia.markey@utexas.edu; ...
Breast reconstruction is highly complex, requiring navigation of not only clinical and operative realities, but of patient expectations as well. The authors sought to identify historical art pieces that exhibit breast asymmetries and deformities for comparison with photos of breast reconstruction patients seen at the clinic of the senior author to demonstrate that achievement of perfect breast cosmesis is challenging in both breast reconstruction as well as in the classical arts. Open access libraries and Creative Commons images were reviewed to identify appropriate works of art from various time periods and geographic locations. Following artwork selection, photos of breast reconstruction patients were reviewed and paired with selected artworks exhibiting cosmetically similar breasts. A total of 9 pieces of selected historic art were found to have at least one matching patient photo, with 11 correlative patient photos ultimately chosen. Common breast asymmetries and deformities identified included ptosis, asymmetric chest wall placement, asymmetric nipple placement, and absence of the nipple. This review identified diverse artworks of varying styles spanning vast expanses of both geography and time that exhibit breast deformities and asymmetries commonly encountered in patients seeking revision of breast reconstruction. This underscores that creating the cosmetically ideal breast is difficult both in the operating room and the art studio. Importantly, the authors emphasize that the arts frequently celebrate that which is considered beautiful, though to the trained eye of a plastic surgeon, that which is considered beautiful, is often classified as dysmorphic or asymmetric.
