Mammoplasty Using Modified Superomedial Pedicle Technique in Severely Macromastia and Ptotic Breasts.

Mammoplasty is a surgery commonly used for macromastia. Many mammoplasty techniques are described, all with their specific pros and cons. However, the concern to avoid serious complications sometimes takes precedence, and the ideal result cannot be. For macromastia and severely ptotic breasts, usually the free nipple-areolar complex (NAC) mammoplasty technique is implemented. The results, however, may only be completely satisfactory regarding cosmetics. Loss of NAC, poor appearance, flabbiness, flattening, and ptosis are among the disadvantages of this technique. This study aimed to present the results of mammoplasty employing the superomedial pedicle technique without interrupting a macromastia central base with a pedicle length of 8 to 18 cm. According to the literature, many plastic surgeons recommend the free NAC rather than the pedicle technique because of the high complication rates in mammoplasties planned for highly ptotic breasts and macromastia. On the other hand, many free NAC techniques and their modifications with pedicle mammoplasty are described. The general conviction is that a standard method, protocol, or technique good for all patients does not exist. Our results are more acceptable both cosmetically and physiologically. Therefore, the superomedial pedicle technique can be modified to achieve ideal results where free NAC mammoplasty is considered for severe macromastia and ptotic patients. This combined method contributes to the viability of NAC by increasing blood supply to breast tissue and providing an ideal breast appearance.

Bilateral accessory axillary breast tissue in a premenarchal female.

A 9-year-old premenarchal female presented to pediatric dermatology with a 6-month history of periodically tender, bilateral and symmetric axillary masses. Magnetic resonance imaging and subsequent surgical excision confirmed the diagnosis of bilateral accessory axillary breast tissue. Accessory axillary breast tissue is a rare condition seen most in pubertal, pregnant and breastfeeding women. However, it can arise in pre-adolescent patients and should be added to the differential diagnosis of an axillary mass.

Two-Stage Surgical Management of Accessory Breast Tissue With Pedicled Breast Tissue: A Case Report of Asymmetry Correction.

ABSTRACT: Accessory breast tissue is a relatively common variant of ectopic breast tissue. It defines a tissue that can be seen in conjunction with a nipple, areola, and underlying glandular tissues and can develop in addition to the normal breast tissue. While swelling may be accompanied by symptoms such as pain that worsens with the menstrual period, lactation, and limitation of shoulder joint movements, aesthetic concerns also constitute an important part of the surgical needs of patients. An 18-year-old patient without any known comorbidities attended because of a developmental disorder in her left breast that has existed since birth and an accessory breast tissue containing the nipple and areola in the upper-outer quadrant of the left breast. The surgical aim was to excise the patient's accessory breast tissue and ensure symmetry, and a two-stage surgical intervention was planned. In the first stage, the accessory breast tissue in the upper-outer quadrant of the breast was transposed preserving the 2nd and 3rd Internal Mammary Artery-based perforators by passing it through a subcutaneous tunnel and folding it in its ideal place. At second stage, the reduction mammoplasty surgery was performed on the right breast to ensure symmetry with the left breast, and resection was performed on the nipple in the middle lower quadrant of the left breast. At the end, acceptable symmetry and patient satisfaction were achieved.

Vertical Scar Reduction Mammaplasty Using the Superomedial-Based Pedicle Technique in Gigantomastia.

BACKGROUND: Breast reduction surgery has witnessed significant advancements in recent years; however, it continues to pose challenges for both surgeons and patients when dealing with cases involving excessive breast volume and severe breast ptosis. This study aimed to assess the aesthetic outcomes and the impact on the quality of life, as measured by the BREAST-Q questionnaire, in patients with gigantomastia and severe breast ptosis who underwent reduction mammaplasty using the superomedial-based pedicle technique. METHODS: We present a retrospective series comprising 84 patients who underwent reduction mammoplasty utilizing the superomedial pedicle technique. The surgical resections exceeded 1 kg per breast, with a mean resection weight of 1506.58 g (right breast) and 1500.32 g (left breast). The preoperative mean suprasternal notch to nipple distance measured 40.50 cm (right breast) and 40.38 cm (left breast). Postoperatively, the patients were followed up for a minimum of 6 months. Both preoperative and postoperative BREAST-Q surveys were administered to the participants, and scores were analyzed using descriptive statistics. RESULTS: Complications were observed in 3 patients (3.57%), characterized by partial loss of the areola, which resolved spontaneously over time. Additionally, 2 cases of hematoma and 2 instances of minor delayed wound healing were reported. All patients expressed satisfaction with their aesthetic outcomes, as they achieved a natural breast shape and minimal scarring, along with symptomatic relief. CONCLUSIONS: The superomedial pedicle reduction mammaplasty technique has demonstrated its ability to produce satisfactory aesthetic outcomes and long-term benefits in patients with excessively large breasts. Careful patient selection and postoperative management are vital for achieving optimal results. Further investigations involving larger sample sizes and longer follow-up periods are warranted to validate our findings. LEVEL OF EVIDENCE: IV.

Mental Health Trends in Patients With Symptomatic Macromastia After Reduction Mammoplasty.

BACKGROUND: Symptomatic macromastia can significantly affect both physical and mental health. Although previous studies suggested that breast reduction (BR) improves quality of life and mental health conditions, they were limited to smaller sample sizes and largely based on survey feedback. This study aims to further assess the impact of BR on mental health outcomes, specifically looking at prescribing patterns for common antidepressants. METHODS: A national insurance-based database was utilized for data collection. Patients with a diagnosis of macromastia (ICD-10 N62) between the years 2010 and 2021 that either underwent bilateral BR (CPT 19318) or did not undergo BR were included in the study. Demographics and medical comorbidities were compared. Among those who underwent BR, preoperative and postoperative rates of mental health diagnoses and antidepressant use were compared. Logistic regression analysis was performed to determine variables associated with surgery. RESULTS: Patients with a history of macromastia with a history of BR were compared with those with a history of macromastia without BR. A significantly higher percentage of patients in the BR group reported a history of depression (48.5%), obesity (55.7%), and selective serotonin reuptake inhibitor (SSRI)/serotonin-norepinephrine reuptake inhibitor (SNRI) use (55.3%) when compared with that of the no-reduction group (46.3%, 50.8%, and 52.6%). Patients with history of depression and obesity were more likely to undergo BR (odds ratio of 1.11 and 1.31). Patients who underwent BR had significantly reduced rates of mental health outcomes including depression (38.6% to 27.4%), anxiety (4.3% to 3.1%), and SSRI or SNRI prescriptions (46.3% to 29.5%) postoperatively. CONCLUSIONS: Patients who underwent BR for symptomatic macromastia showed significantly reduced rates of depression, anxiety, and most importantly, rates of SSRI/SNRI prescriptions postoperatively when compared to those who did not undergo BR for symptomatic macromastia.

Breast ultrasound: An opportunity to detect unsuspected pleural and pulmonary abnormalities.

PURPOSE: While scanning women for breast US, is possible to observe changes in the appearance of the pleural line or in the most superficial portion of the lung. The objective of this single-center, prospective study was to determine the prevalence of a variety of pleural and pulmonary US findings during routine breast US. METHODS: In this study, there were 200 women undergoing standard breast US examination. The presence of pleural and pulmonary abnormalities in these cases was recorded. Two off-site reviewers confirmed the presence of pleura and lung changes. RESULTS: There was no abnormal finding in 168 out of 200 cases (84%) while there were one or more abnormal findings in 32 cases (16%). Pleural effusion was observed in 0.5% of cases, thickening of the pleural line 5% of cases, irregularity of the pleural line in 6% of cases, increased number of vertical artifacts in 9% of cases, subpleural nodulations in 2% of cases, and lung consolidation in 0.5%. CONCLUSION: Pleural and lung changes are not uncommon during breast US. Operators performing breast US examinations should be aware of the possibility to identify unsuspected pleuro-pulmonary abnormalities.

Comparative Analysis of Lower Island Flap Transposition (LIFT) in Wise-Pattern Mastopexy: Does It Improve Upper Pole Fullness and Breast Harmony?

BACKGROUND: Utilization of autologous parenchymal flaps aims to attain enduringly favourable outcomes and uphold volume in the upper breast pole after mastopexy procedures. The objective of this study was to juxtapose and scrutinize postoperative upper pole fullness, upper/lower pole ratios, occurrences of bottoming-out deformity, and complication rates between two patient cohorts: those who underwent the wise-pattern superior pedicle mastopexy with the LIFT technique and those who underwent the conventional wise-pattern superior pedicle mastopexy. MATERIALS AND METHODS: All the patients in this study were appropriately categorized as primary patients, signifying their lack of any prior breast surgery history. These individuals presented with grades II and III breast ptosis on both breasts, ranging from moderate to severe deformities per the Regnault classification. Importantly, all patients uniformly expressed their desire to achieve a firmer breast appearance without recourse to using breast implants. The patients' ages and preoperative breast measurements were recorded for analysis. Measurements, including the distance from the NAC to the inframammary fold and from the sternal notch to the NAC, were systematically measured both before the surgery and at the 1-year postoperative mark. RESULTS: The upper and lower pole ratios, defined by Mallucci and Branford, were found to be 45.22% ± 2.20% and 54.88% ± 2.20%, respectively, within the LIFT group. In 13 instances, a lower pole distance exceeding 55% indicated a potential bottoming-out deformity (value lower than 45%/55% ratio or 0.818). Conversely, within the control group, the upper and lower pole ratios were determined as 43.22% ± 2.80% and 56.88% ± 2.80%, respectively. These findings demonstrated statistical significance. Notably, in 39 cases within the superior pedicle wise-pattern mastopexy group, a lower pole distance surpassing 55% (value lower than 45%/55% ratio or 0.818) suggested a leaning towards a bottoming-out deformity (p: 0.003). A postoperative period of at least 12 months was essential to discern the emergence of upper pole fullness and the potential development of bottoming-out deformities. Among the cases within the LIFT group, 93% exhibited successful attainment of upper pole fullness, while in the control group, this outcome was achieved in 82% of cases (p>0.05). CONCLUSION: Implementing the LIFT technique alongside the wise-pattern superior pedicle mastopexy decreases the occurrence of bottoming-out deformity after 1 year. Although there is no statistically significant difference, the LIFT flap technique has contributed to some extent to upper pole fullness. LEVEL OF EVIDENCE V: 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 .

Investigation of the Relationship of Functional Improvement and Body Mass Index in Breast Reduction Patients.

INTRODUCTION: Due to macromastia, center of gravity changes and neck, shoulder, back pain become prominent. Macromastia and obesity separately cause pain and an increase in curves of vertebra. The aim of this study is to compare the functional benefits of reduction mammoplasty between obese and non-obese patients. MATERIALS AND METHODS: Data of this retrospective study were collected from archives and include preoperative/postoperative thoracic Cobb angles, preoperative/postoperative VAS scores, BMI and resected breast tissue weight of patients who underwent reduction mammaplasty operations between August 2017 and April 2019 in Plastic, Reconstructive and Aesthetic Surgery Department. RESULTS: This study shows that reduction mammoplasty enables significant decrease both in thoracic kyphosis angles and in neck, shoulder and back VAS scores. However, no significant difference was found in preoperative/postoperative values and mean amount of changes of thoracic kyphosis angles between obese and non-obese patients. Decreases in neck, shoulder and back VAS scores were not found statistically significant between two groups. The breast resection amount was not related to correction of kyphosis, but it enabled only a significant decrease in neck VAS scores. CONCLUSION: Functional improvement was not related to body mass index in reduction mammoplasty patients. Functional benefits were observed similarly in both obese and non-obese patients. A precise threshold value for body weight, body mass index and amount of breast tissue could not be defined as an indication for functional reduction mammoplasty. LEVEL OF EVIDENCE IV: 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 .

Liposuction-Only Breast Reduction: A Systematic Review of Outcomes.

INTRODUCTION: Over the past few decades, there have been multiple reports of liposuction assisted breast reduction. This technique appeals to patients due to the limited scars and complication profile, compared to traditional reduction mammaplasty techniques. We aimed to systematically review the literature, to elucidate the outcomes and safety of liposuction-only breast reduction. METHODS: A systematic review was performed using the Ovid (Medline/PubMed) database, in accordance with the PRISMA checklist. RESULTS: In total 7 articles were included within this systematic review. A total of 652 patients were included. Liposuction-only breast reduction appears to lead to improvements in subjective outcome measures, patient satisfaction, and objective outcomes such as moderate breast volume reduction and reduction in breast ptosis. Overall, the procedure had a low complication profile. Liposuction did not preclude further surgery. No evidence of malignancy or difficulty in future breast cancer screening was noted. CONCLUSION: Macromastia leads to a considerable health burden, especially in health-related costs. From the current evidence base, liposuction-only breast reduction appears to be a safe and effective procedure, especially in patients requiring a mild-moderate breast volume reduction and mild ptosis correction. More research is required, with standardised subjective and objective outcome measures, and longer follow-up periods to confirm the effectiveness and safety of this technique. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

From Tip of Brush to Tip of Knife: The Relationship Between Post-mastectomy Breast Reconstruction and the Classical Arts.

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 photographs of breast reconstruction patients seen at the clinic of the senior author (S.O.P.) to demonstrate that achievement of perfect breast cosmesis is challenging in both breast reconstruction and 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, photographs of breast reconstruction patients were reviewed and paired with selected artworks exhibiting cosmetically similar breasts. A total of 8 pieces of selected historic art were found to have at least 1 matching patient photograph, with 9 correlative patient photographs 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 exhibited 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 emphasized that the arts frequently celebrate that which is considered beautiful, although to the trained eye of a plastic surgeon that which is considered beautiful is often classified as dysmorphic or asymmetric.

Defining the Ideal Reduction Mammaplasty: A Crowdsourcing Study.

BACKGROUND: Reduction mammaplasty relieves macromastia symptoms while improving breast aesthetics, although the ideal breast aesthetically has been shown to differ culturally in previous crowdsourcing studies. Better understanding these differences can aid in setting postoperative expectations. OBJECTIVES: The aim of this study was to characterize the ideal reduction mammaplasty according to demographics such as gender, ethnicity, socioeconomic status, and education. METHODS: A crowdsourcing platform was utilized to collect 10,169 deidentified responses. Users completed 1 of 3 surveys, either a preoperative, postoperative, or preoperative and postoperative paired survey. The preoperative and postoperative surveys addressed 10 breast measurements, including upper breast slope, projection proportion, nipple position, breast width, and breast fullness. The paired preoperative and postoperative survey assessed the nipple-areola complex (NAC), chest fit, symmetry improvement, and scarring. RESULTS: Preoperative images were rated more aesthetic than postoperative images. This was consistent across all demographics evaluated. Females, African Americans, Asians, participants ages 55+, and participants with no high school degree or a graduate degree found the most improvement in breast symmetry (P = .001, P = .002, P = .027, P < .001, P = .01). Male and Hispanic participants were most likely to see no change in symmetry (P = .008, P = .04), and South Asian participants found breasts less symmetric postoperatively (P < .001). There were significant demographic differences in aesthetic ratings of the NAC, scarring, and breast fit. CONCLUSIONS: Perceived breast aesthetics after reduction mammaplasty vary significantly across demographics, including gender, ethnicity, age, socioeconomic status, and educational achievement. Surgeons should consider demographics when planning each patient's reduction mammaplasty.

Shaken adult syndrome due to ocean wave: an autopsy case.

Severe intracranial trauma during torture or assault is reportedly caused by shaken adult syndrome. However, intracranial traumas caused by natural forces, excluding human factors and collision impact, are extremely rare. We report an autopsy case of shaken adult syndrome caused by ocean wave forces. A man in his 40s without any medical history was washed away by a wave during recreational fishing. He was found approximately 500 m away from the fishing point drifting on the ocean in a state of cardiopulmonary arrest and was confirmed dead, with no response to cardiopulmonary resuscitation, 3 h after the accident. The autopsy revealed no mechanical trauma to the entire body surface, including the head. Both lungs were inflated, and pleural effusion was observed. The brain was swollen and congested, and subarachnoid hemorrhage was observed in the interhemispheric fissure and the convexity of the parietal occipital lobe. Macroscopic and microscopic hemorrhage spots were found in the brain, and the results of the blood alcohol test and urinary toxicological screening were negative. The cause of death was determined as drowning. This case demonstrates a rare but notable mechanism of injury observed in immersed bodies.

Breast Reduction with Implants or Augmentation Reduction: Patient-Reported Outcomes from a Single-Centre Retrospective Cohort Analysis.

Background and Objectives: The correction of breast hypertrophy and ptosis with implant placement has always posed a challenge for plastic surgeons. Various methods have been devised, yielding conflicting results. The purpose of this study is to describe our surgical technique of breast reduction with silicone implants, present the safety profile of the procedure, and report patient-reported outcomes. Materials and Methods: A retrospective review was performed on our case series of cosmetic breast surgery performed by the senior author between October 2020 and November 2023. Only patients who had over 300 g of breast tissue removed were included. The surgery and demographic characteristics were recorded. Patients were asked to complete a questionnaire about satisfaction with their breasts pre-operatively and after the surgery. Results: Over 745 cases were performed, and 25 were included in the analysis. In total, 78.3% of the patients presented with a Grade 3 ptosis. The mean implant size was 352.39 cc (range 300-455 cc). The breast tissue removed ranged from 312 to 657 g. The mean follow-up was 14.17 months. Only one case required revision surgery after developing capsular contracture and a waterfall deformity. Patients reported a statistically significant improvement across all domains of the questionnaire (p < 0.001). Conclusions: Breast reduction plus implants is a safe and effective alternative for patients with large ptotic breasts who wish to attain a full upper pole. It carries a similar risk profile to augmentation mastopexy and maintains its functional benefits in alleviating back, neck, and shoulder pain.

The Surgical Treatment of Tuberous Breast Deformity: A Review Article.

ABSTRACT: Tuberous breast is a common congenital deformity that might present as unilateral or bilateral breast base constriction, asymmetry, areolar herniation, hypoplasia, ptosis, and skin deficiency. Patients might present with one or more of the mentioned features, rendering a consensus about the optimal surgical technique to correct this deformity nonexistent. In our review article, we present the most common classifications of a tuberous breast, in addition to several surgical approaches that attempt to treat this deformity.

Definitions of Abnormal Breast Size and Asymmetry: A Cohort Study of 400 Women.

BACKGROUND: Macromastia, micromastia and breast asymmetry have an impact on health and quality of life. However, there is scarce information addressing breast size and asymmetry frequency distribution in reference populations. OBJECTIVE: The current study aims to identify factors that influence breast size and symmetry and classifies abnormal breast sizes and breast asymmetries in an adult German population. METHODS: Breast base dimensions, breast volume, symmetry, and other breast anthropometric parameters of 400 German female patients were determined in a retrospective review of the MRI archives at our institution. Professional medical MRI-segmentation software was used for volume measurement. RESULTS: A total of 400 Patients were retrospectively enrolled. The patients had a mean age of 50 ± 12 years (min: 24; max: 82), mean BMI of 25.0 ± 5.0 (min: 14.7, max: 45.6), and a mean total breast volume of 976 ml (right: 973 ml, min: 64, max: 4777; left: 979 ml, min: 55, max: 4670). The strongest correlation of breast volume was observed with BMI (r = 0.834, p < 0.001), followed by breast base width (r = 0.799, p < 0.001). Smaller breasts have higher breast volume asymmetry ratios (r = - 0.124, p < 0.014). For a BMI between 18.5 and 24.9 kg/m2, micromastia is defined by breast volumes below 250 ml (5th percentile) and macromastia by volumes above 1250 ml (95th percentile). Abnormal breast volume asymmetry (< 5th and > 95th percentile) is equivalent to an absolute difference of approximately 25% relative to the smallest side (bidirectional asymmetry ratio 5th percentile - 19%; 95th percentile 26%). CONCLUSION: This study provides normative data of German women, as well as selected size-for-BMI percentiles and asymmetry ratio percentiles. The normative data may help to establish transparent and objective coverage criteria for health insurances. LEVEL OF EVIDENCE IV: 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 .

A Systematic Review of Outcomes and Complications of Tuberous Breast Surgery.

BACKGROUND: Tuberous breast is a complex congenital breast anomaly that can be challenging to correct surgically. OBJECTIVES: The authors conducted a systematic review with pooled analysis of data, with the aim of determining the effectiveness and complications related to operative management of the deformity. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were adopted in performing this systematic review. A simplified classification system for tuberous breast deformity was developed to accurately compare data and guide analysis. RESULTS: The review identified 38 studies, reporting a total of 897 patients undergoing tuberous breast surgery. The mean age of patients was 24 years (range 13-53 years). Mean follow-up was 39 months. A combination of tissue rearrangement and implant augmentation was the most common technique (73% of patients) followed by fat transfer alone (9%). Breast implants were employed in 83% of patients. The mean implanted volume per breast was 263 cc. Fat grafting was performed in 13% of patients and mean volume of fat grafted per breast was 185 cc. An overall complication rate of 20% was reported. Subjective assessment of patient satisfaction was 99%, and the mean score on BREAST-Q for satisfaction with clinical outcome was 86.7. Future studies should focus on robust study designs including randomized and cohort studies, use of patient-reported outcome measures, and long-term follow-up. CONCLUSIONS: The surgical techniques to correct tuberous breast deformity are safe, effective, and have a high satisfaction rate. Fat transfer has the capacity to provide promising results in treating tuberous breast deformity.

Large-Volume Fat Grafting to the Breast With External Expansion Assist.

BACKGROUND: Large-volume autologous fat transfer (AFT) to the breast with external expansion has emerged as an alternative to alloplastic augmentation or reconstruction in appropriate patients. OBJECTIVES: Report the authors' technique for this procedure and experience with 49 consecutive patients of a single surgeon's practice from 2013 to 2021. METHODS: The authors performed a retrospective analysis of consecutive patients undergoing fat grafting to the breast with preexpansion. Patients were included if they had a clinical problem amenable to correction with large-volume fat injection and adequate donor sites, and were willing to undergo preexpansion. Data was collected through chart review and deidentified. Demographics, diagnosis, radiation status, volume grafted, complications, and adjunct procedures were recorded. RESULTS: Forty-nine patients underwent external expansion with AFT by a single surgeon. Twenty-three patients (47%) had hypoplastic indications, including tuberous breast deformity (n = 9) and Poland syndrome (n = 1). Seventeen patients (35%) had indications for secondary breast revision of previously placed implants. Nine patients (18%) utilized the procedure for primary oncologic breast reconstruction. A total of 71 procedures were performed, with an average of 1.45 procedures per patient. The average volume of fat grafted per breast was 372 mL for hypoplasia, 240 mL for secondary breast revision, and 429 mL for oncologic reconstruction. Concurrent procedures included implant exchange, implant removal, mastopexy, and breast reduction. Follow-up ranged from 1 to 84 (average = 20) months. CONCLUSIONS: The authors' experience shows promising results with external expansion and large-volume fat grafting to the breast.

Neuroendocrine pathways and breast cancer progression: a pooled analysis of somatic mutations and gene expression from two large breast cancer cohorts.

BACKGROUND: Experimental studies indicate that neuroendocrine pathways might play a role in progression of breast cancer. We aim to test the hypothesis that somatic mutations in the genes of neuroendocrine pathways influence breast cancer prognosis, through dysregulated gene expression in tumor tissue. METHODS: We conducted an extreme case-control study including 208 breast cancer patients with poor invasive disease-free survival (iDFS) and 208 patients with favorable iDFS who were individually matched on molecular subtype from the Breast Cancer Cohort at West China Hospital (WCH; N = 192) and The Cancer Genome Atlas (TCGA; N = 224). Whole exome sequencing and RNA sequencing of tumor and paired normal breast tissues were performed. Adrenergic, glucocorticoid, dopaminergic, serotonergic, and cholinergic pathways were assessed for differences in mutation burden and gene expression in relation to breast cancer iDFS using the logistic regression and global test, respectively. RESULTS: In the pooled analysis, presence of any somatic mutation (odds ratio = 1.66, 95% CI: 1.07-2.58) of the glucocorticoid pathway was associated with poor iDFS and a two-fold increase of tumor mutation burden was associated with 17% elevated odds (95% CI: 2-35%), after adjustment for cohort membership, age, menopausal status, molecular subtype, and tumor stage. Differential expression of genes in the glucocorticoid pathway in tumor tissue (P = 0.028), but not normal tissue (P = 0.701), was associated with poor iDFS. Somatic mutation of the adrenergic and cholinergic pathways was significantly associated with iDFS in WCH, but not in TCGA. CONCLUSION: Glucocorticoid pathway may play a role in breast cancer prognosis through differential mutations and expression. Further characterization of its functional role may open new avenues for the development of novel therapeutic targets for breast cancer.

Cerebral hemorrhage caused by shaking adult syndrome? Evidence from biomechanical analysis using 3D motion capture and finite element models.

The present study combined three-dimensional (3D) motion capture with finite element simulation to reconstruct a real shaking adult syndrome (SAS) case and further explore the injury biomechanics of SAS. The frequency at which an adult male can shake the head of another person, head-shaking amplitude, and displacement curves was captured by the VICON 3D motion capture system. The captured shaking frequency and shaking curve were loaded on the total human model for safety (THUMS) head to simulate the biomechanical response of brain injury when a head was shaken in anterior-posterior, left-right, and left anterior-right posterior directions at frequencies of 4 Hz (Hz), 5 Hz, 6 Hz, and 7 Hz. The biomechanical response of the head on impact in the anterior, posterior, left, left anterior, and right posterior directions at the equivalent velocity of 6 Hz shaking was simulated. The violent shaking frequency of the adult male was 3.2-6.8 Hz; head shaking at these frequencies could result in serious cerebral injuries. SAS-related injuries have obvious directionality, and sagittal shaking can easily cause brain injuries. There was no significant difference between the brain injuries caused by shaking in the simulated frequency range (4-7 Hz). Impact and shaking at an equivalent velocity could cause brain injuries, though SAS more commonly occurred due to the cumulative deformation of brain tissue. Biomechanical studies of SAS should play a positive role in improving the accuracy of forensic identification and reducing this form of abuse and torture in detention or places of imprisonment.

Improvement of Unilateral Breast Hypoplasia With Oral Spironolactone in a Patient With Becker Nevus Syndrome.

Becker nevus (BN) is a benign cutaneous smooth muscle hamartoma that presents with a hyperpigmented patch or plaque with or without hypertrichosis.1 BN may be associated with ipsilateral breast hypoplasia or other musculoskeletal abnormalities, an association which has been termed Becker nevus syndrome (BNS).