Breast asymmetry pattern in women with idiopathic scoliosis.

Breast asymmetry is frequent in women with idiopathic scoliosis. To understand the pattern of breast asymmetry in these women a clinical study was performed in which 54 female patients with idiopathic scoliosis were evaluated. The information recorded for each patient included: age, weight, height, scoliosis type, Cobb angle, breast measurements, and presence of rib cage asymmetry. Breast volume was calculated using anatomic measurements (anthropomorphic method). The mean age of the group was 25 +/- 7 years. A right convex thoracic curve occurred in 85%, with a mean Cobb angle of 32 +/- 15 degrees. Our study indicated that women with idiopathic scoliosis consistently presented breast asymmetry that followed a predictable pattern. The breast on the side of the convex thoracic scoliosis curve is always smaller in volume (mean difference 59 +/- 39 mi). The affected side also presents a smaller areola, a higher position of the nipple (mean difference 2.2 +/- 1.3 cm) and a higher position of the inframammary fold (mean difference 2.1 +/- 1.4 cm) when compared to the opposite breast. Though the asymmetry is predictable, the degree to which the patient presents these changes does not correlate with the severity of the scoliosis (Cobb angle). We believe that the severity of the asymmetry is a result of the difference between the hypoplastic breast and the normal breasts. In women with very large opposite breasts the asymmetry appears to be worse.

Rising medical liability cost and patient access to care in Puerto Rico: public survey.

OBJECTIVE: The high cost of medical liability increases healthcare expenditure and decreases healthcare services. To understand the public perception of medical liability issues in Puerto Rico, a survey was made with the assistance of Gaither International. METHODS: Five hundred interviews were made in a representative sample of all six US Census demographic regions in Puerto Rico. Respondents were selected randomly by age, gender, socioeconomic level and region of residence. All had visited an Emergency Room in the past two years, either for their medical needs or those of a family member. This study requested information on general demographics, use of emergency medical services, insurance coverage, access to medical care, and perception of the medical liability issues. All results had a margin of error of +/- 4.4 with a 95% confidence level. RESULTS: When rating areas of concern in healthcare, "cost of health insurance and services" was greatest, followed by "difficulty finding a specialist". One-third of respondents experienced difficulty or failed to obtain a specialist, orthopedic surgeons topping the list. When asked who benefits most from lawsuits, 63% of the public believed that lawyers benefit most, while only 33% believed that the patient (plaintiff) benefits most. In the interviews, 84% of respondents supported establishing government limits on professional liability awards as part of the effort to reduce healthcare cost. CONCLUSION: The public appears to be aware of how medical liability raises the cost and limits access to healthcare.

Breastfeeding after augmentation mammaplasty with saline implants.

It has been reported that breastfeeding problems occur in women who have breast implants. The breastfeeding success of women who had augmentation with saline implants and subsequently had a live birth (n = 107) was compared with that of women of similar age who had hypoplastic breasts and had children before their consultation (n = 105). A self-administered 11-item questionnaire was used to collect data on demographics and breastfeeding success. The information requested included age, weight, height, whether breastfeeding was attempted, if it was successful, and the need to supplement. Additional information requested from the study group included position of breast scar, implant volume, and whether loss of nipple sensation had occurred after the surgery (as judged by the patient). The groups were not significantly different in age (22 +/- 7 vs. 23 +/- 5). There was, however, a significant difference (P < 0.05) in the breastfeeding success and need to supplement feedings. Successful breastfeeding occurred in 88% of the control and 63% of the study group. A need to supplement breastfeeding occurred in 27% of the control group but increased to 46% in the study group. No significant difference (P > 0.05) was found in the breastfeeding experience between periareolar and inframammary approaches. Loss of nipple sensation after augmentation mammaplasty was reported by 2% of both the periareolar and inframammary subgroups. The success rate of breastfeeding decreases approximately 25% and the need to supplement breastfeeding increases 19% in young women with hypoplastic breasts after augmentation mammaplasty, irrespective of whether a periareolar or inframammary approach is used.

Lactational performance after breast reduction with different pedicles.

BACKGROUND: Uncertainty still exists as to whether one type of pedicle is superior to another in preserving the breastfeeding potential of young women who need breast reduction surgery. METHODS: The lactational performance of women who had breast reduction surgery with different pedicle types was compared with that of women of child-bearing age with macromastia but no prior breast surgery. Of those who had reduction mammaplasty, 48 had superior, 59 had medial, and 57 had inferior full-thickness dermoglandular pedicles. A total of 151 women with macromastia but without prior breast surgery comprised the control group. All women completed a questionnaire on breastfeeding success. Successful breastfeeding was defined as breastfeeding for 2 weeks or more. The women were also classified as having breastfed exclusively or with supplementation. RESULTS: Of the women in the control group who attempted to breastfeed, 62 percent were successful. Breastfeeding success rates for patients who had breast reduction surgery were 62 percent for superior pedicle, 65 percent for medial pedicle, and 64 percent for inferior pedicle. No significant difference (p > 0.05) was found between groups. Thirty-four percent of the control group supplemented breastfeeding and no significant difference was found between the control group and the patients who had breast reduction surgery with superior (38 percent), medial (38 percent), and inferior (35 percent) pedicles. Loss of nipple sensation was 2 percent for all pedicle types. CONCLUSION: The lactational performance of women who had breast reduction surgery using superior, medial, or inferior full-thickness pedicles was not significantly different from that of women with macromastia but no breast surgery.

Effect of pregnancy and breast-feeding on vertical mammaplasty.

BACKGROUND: A retrospective study was performed to evaluate the effect of pregnancy and breast-feeding on the breasts of women who had undergone vertical reduction mammaplasty. METHODS: The study group consisted of 57 women who had pregnancies after their vertical reduction mammaplasty. Of this group, 24 breast-fed. The control group consisted of 103 women who had vertical mammaplasty but no subsequent pregnancies. An evaluation form was completed that included the age, body mass index, amount of tissue removed per breast, pregnancies after the mammaplasty, history of breast-feeding, and breast measurements. All patients had breast measurements routinely performed postoperatively at 2 weeks and again at 2 years. The following measurements were obtained: mid-clavicle to nipple, and inframammary fold to inferior areola. RESULTS: No significant difference was found between the control and the study group regarding age (27 +/- 12 versus 29 +/- 10), body mass index (26 +/- 5 versus 27 +/- 4), and grams of tissue excised per breast (610 +/- 201 versus 598 +/- 279). The breast measurement from the mid-clavicle to nipple was not significantly altered by pregnancy with or without breast-feeding (p > 0.05). The distance between the inframammary fold and the inferior margin of the areola was significantly (p < 0.05) increased by pregnancy both with breast-feeding (4.1 +/- 2.3 cm) and without (3.5 +/- 2.6 cm) when compared with the control group (1.2 +/- 1.5 cm). CONCLUSION: The vertical mammaplasty has less tendency for pseudoptosis (bottoming out), but the alterations of breast volume brought about by pregnancy and breast-feeding may affect the final outcome of even this good reduction mammaplasty method.

Breast-feeding after vertical mammaplasty with medial pedicle.

A retrospective study was performed in which the breast-feeding success of women of childbearing age (15 to 40 years) with macromastia but no prior breast surgery was compared with that of women of similar age who had undergone medial pedicle/vertical pattern reduction mammaplasty. All women completed a self-administered questionnaire that provided information on their breast-feeding success. The control group consisted of 149 women with macromastia (mean age, 27 years) who had been evaluated for possible breast reduction surgery and who had children before their consultation. The study group consisted of 58 women (mean age, 29 years) who had children after their vertical mammaplasty. The mean weight of breast tissue removed was 610 g per breast. None of the patients had absent nipple sensation. A period of 2 weeks or more was chosen as the defining duration of a successful breast-feeding attempt. Those individuals judged able to breast-feed were further classified on the basis of having breast-fed exclusively or with supplementation. The results demonstrated that, of the women who attempted to breast-feed, 61 percent in the control group and 65 percent in the study group were successful, with no significant difference between the groups (p > 0.05). The breakdown of the successful groups indicated that 36 percent in the control group and 38 percent in the study group supplemented their breast-feeding with formula. The groups were not significantly different (p > 0.05). In conclusion, this study found no significant difference in the rate of breast-feeding success between women who had medial pedicle/vertical pattern reduction mammaplasty and women who had no prior breast surgery.

Vertical versus Wise pattern breast reduction: patient satisfaction, revision rates, and complications.

A prospective, randomized study was designed to compare the outcome of inferior pedicle/Wise pattern reduction (group I) with medial pedicle/vertical pattern reduction (group II) in moderate resections averaging 500 g per breast. There were 105 women in group I and 103 women in group II. All surgical procedures were performed by the same plastic surgeon. Patient information recorded included age, body mass index, type of surgery, weight of specimen, need for surgical revision, and complications. Six months postoperatively the patients were asked to complete a questionnaire, which rated their satisfaction with the surgical outcome. The questionnaire used a 10-point response format ranging from very disappointed (score of 1) to very pleased (score of 10). The results demonstrated that there was no significant difference between the groups in age (31 +/- 12 versus 29 +/- 13 years), body mass index (26 +/- 4 versus 27 +/- 5), and amount of tissue excised (553 +/- 203 g versus 548 +/- 205 g). Group I required no surgical revisions, but in group II revisions for dog-ears were required in 11 percent. The rate of other complications was similar in both groups. Patients' evaluations of breast size, shape, symmetry, nipple sensation, symptom relief, ease of brassiere/clothing fitting, and overall satisfaction were not significantly different. The vertical mammaplasty was ranked significantly (p < 0.05) higher by patients in regard to scars (6 +/- 2 versus 3 +/- 3) and overall aesthetic results (8 +/- 1 versus 6 +/- 3). In the management of moderate macromastia, this study indicates that patients who have a vertical reduction are less disappointed with the scars but require a significantly higher rate of surgical revisions compared with patients who have a Wise pattern reduction.

Macromastia: how much of it is fat?

A total of 25 patients who underwent bilateral breast reduction were included in this study. Each patient's age, weight, height, and amount of breast tissue removed from each breast were recorded. The body mass index was calculated for each patient. On the day of the operation, tissue samples (two each) were taken from the central, lateral, and preaxillary areas of the breast. One of the samples was weighed, placed in a closed glass container, and heated for 10 minutes in a microwave oven at full power. The liquid fat was separated from the solid residue, and the percentage of fat was calculated. The other sample from each area was examined grossly, and representative sections, corresponding to the distribution of fat and connective tissue, were submitted for evaluation. In these samples, the percentage of fat, gland, and connective tissue was estimated using low-magnification light microscopy. In this group of patients (who had an average age of 34 years and who were significantly overweight as determined by a mean body mass index of 28), it was found (using the microwave method) that there was a mean fat percentage of 61 percent in the central breast area, 74 percent in the lateral breast area, and 73 percent in the preaxillary area. Upon microscopic examination, the pathologist reported that fat accounted for 64 percent of the central breast area, 92 percent of the lateral breast area, and 94 percent of the preaxillary area. On average, the central breast area in macromastia patients had only seven percent gland and 29 percent connective tissue. The lateral and preaxillary areas of the breast had one to three percent gland and five percent connective tissue. The two methods had a significant (p < 0.05) positive correlation in the central breast area, but in the lateral and preaxillary regions, the correlation was poor. In the microscopic examination, there was a tendency to overestimate the amount of fat. Both methods of evaluation used in the study concur that the enlarged breast of macromastia consists primarily of fat and that the glandular element is rather small.