Self-reported breast size, exercise habits and BREAST-Q data - an international cross-sectional study of community runners.

Women with larger breasts tend not to participate in high-intensity exercise and exercise less frequently. This study investigates how breast size impacts exercise habits and how breast reduction surgery changes women's participation in recreational exercise. Recruitment was generated via parkrun Limited (Richmond, UK), an organization offering weekly community-based runs. Female parkrun members aged over 18 years with no history of breast cancer were invited to complete a survey, including questions about their exercise habits, breast size, any breast alteration surgery, and BREAST-Q questionnaires. A total of 1987 women completed the survey, including 56 women who had undergone breast reduction. Results demonstrate that women with bigger breasts believe that reducing their breast size would improve their exercise performance and participation and that their breast size significantly impacts their type of exercise. Women who had undergone breast reduction reported increased overall frequency, enjoyment, and willingness to exercise in a group. Additionally, women that have undergone breast reduction report higher BREAST-Q scores than their non-surgical counterparts. This study supports the existing literature that breast size can impact exercise habits and demonstrates that women who have undergone breast reduction participate in healthier lifestyle practices. We suggest that if breast size impacts women's participation in sport and fitness, health practitioners and policymakers should advocate for better access to reduction mammoplasty in the publicly funded health sector.

Long-term outcomes of breast reduction surgery: A prospective cohort study.

BACKGROUND: Breast reduction surgery has been shown to be the most effective treatment for symptomatic breast hypertrophy in women. However, existing studies have been limited to a relatively short-term follow-up. This study aimed to assess the long-term outcomes following breast reduction surgery. METHODS: This is a prospective cohort study of women aged 18 years and above who underwent breast reduction surgery over a 12-year period. Participants completed a series of patient-reported outcome measures, including the Short Form-36 (SF-36), BREAST-Q reduction module, Multidimensional Body-Self Relations Questionnaire (MBSRQ), and study-specific questions preoperatively, 12 months postoperatively, and at a long-term follow-up of up to 12 years postoperatively. RESULTS: Long-term outcome data were obtained from 103 participants. The median follow-up time following surgery was 6.0 years, range 3-12 years. The mean SF-36 scores remained stable and significantly higher than baseline over time, with no significant differences found in all eight subscales or summary scales. BREAST-Q scores remained significantly higher than baseline in all four scales. MBSRQ scores for appearance evaluation, health evaluation, and body areas satisfaction score remained significantly higher than scores reported preoperatively; in contrast, scores for appearance and health orientation and self-classified weight were significantly lower. Compared with normative data, long-term outcome scores remained stable and at levels equivalent or beyond population norms. CONCLUSIONS: This study demonstrated that patients continue to report a high level of satisfaction and improved health-related quality of life in the longer term following breast reduction surgery.

A comparison of reconstructive outcomes following rotation flap approach (RoFA) versus standard mastectomy: a randomized controlled trial.

BACKGROUND: The rotation flap approach (RoFA) mastectomy is a skin-sparing technique that actively imports skin to the centre of the skin envelope and therefore aids in achieving natural ptosis to the reconstructed breast. The objective of this study was to compare clinical outcomes, aesthetics, patient satisfaction and health-related quality of life between the ROFA mastectomy and standard mastectomy approach. METHODS: This study is a prospective randomised controlled trial of participants undergoing mastectomy using either the RoFA technique or standard technique with breast reconstruction. The BREAST-Q was administered pre-operatively and at 3-, 6-, 9- and 12-months following mastectomy. A panel assessment of clinical photographs was conducted to score aesthetics and outcomes of reconstruction. RESULTS: A total of 100 participants were enrolled in the study; of these, 51 underwent RoFA incision, 47 underwent standard incision and 2 were lost to follow up. There were no statistically significant differences in BREAST-Q scores or panellist assessment between the mastectomy groups following breast reconstruction. The post-operative incidence of mastectomy skin flap tip necrosis was high in the RoFA incision group, with rates of other complications such as seroma being similar. CONCLUSION: The RoFA skin-sparing mastectomy incision showed no significant difference in results across patient-reported outcomes or aesthetics when compared to the standard approach, however, did rate higher for skin flap tip necrosis.

Normative data for the BREAST-Q Reconstruction module in an Australian population and comparison with US norms and breast reconstruction patient outcomes.

BACKGROUND: Normative data for interpreting the BREAST-Q reconstruction module are currently limited to the US population. This study aimed to generate normative BREAST-Q data from women in the Australian general population and compare it to US norms. Secondary aims were to compare normative scores to those of women undergoing breast reconstruction post-mastectomy. METHODS: Women aged 18 years and older without a history of breast cancer or breast surgery were recruited according to the Australian Census-derived population distribution. Participants completed the pre-operative BREAST-Q Reconstruction module and provided socio-demographic information. A comparison was made to a breast reconstruction patient cohort and published US norms. RESULTS: BREAST-Q data were obtained from 500 women. Mean BREAST-Q scores were as follows: Satisfaction with Breasts (Aus. 50.4 ± 15.2, US 57.8 ± 18.4), Psychosocial Well-being (Aus. 55.4 ± 15.8, US 70.7 ± 17.6), Physical Well-being Chest (Aus. 78.5 ± 14.8, US 92.6 ± 10.7), Physical Well-being Abdomen (Aus. 76.1 ± 19.6, US 78.1 ± 20.3) and Sexual Well-being (Aus. 41.5 ± 20.6, US 56.5 ± 8.2). Australian women with a higher BMI or chronic health condition reported lower scores for four of the five BREAST-Q scales. Lower scores were reported by younger women for Psychosocial Well-being and Sexual Well-being. Mean BREAST-Q scores for the Australian population were significantly lower than US norms in four of the five scales. When compared to normative data, breast reconstruction patients had significantly higher BREAST-Q scores post-operatively in all scales except for Physical Well-being Chest. CONCLUSION: This study derived only the second set of normative scores for the BREAST-Q reconstruction module reported globally and found that significant differences exist between populations.

Cost-utility analysis of breast reduction surgery for women with symptomatic breast hypertrophy.

OBJECTIVE: To assess the cost-effectiveness of breast reduction surgery for women with symptomatic breast hypertrophy in Australia. DESIGN: Cost-utility analysis of data from a prospective cohort study. SETTING, PARTICIPANTS: Adult women with symptomatic breast hypertrophy assessed for bilateral breast reduction at the Flinders Medical Centre, a public tertiary hospital in Adelaide, April 2007 - February 2018. The control group included women with breast hypertrophy who had not undergone surgery. MAIN OUTCOME MEASURES: Health care costs (for the surgical admission and other related hospital costs within 12 months of surgery) and SF-6D utility scores (measure of health-related quality of life) were used to calculate incremental costs per quality-adjusted life-year (QALY) gained over 12 months, extrapolated to a 10-year time horizon. RESULTS: Of 251 women who underwent breast reduction, 209 completed the baseline and at least one post-operation assessment (83%; intervention group); 124 of 350 invited women waiting for breast reduction surgery completed the baseline and 12-month assessments (35%; control group). In the intervention group, the mean SF-6D utility score increased from 0.313 (SD, 0.263) at baseline to 0.626 (SD, 0.277) at 12 months; in the control group, it declined from 0.296 (SD, 0.267) to 0.270 (SD, 0.257). The mean QALY gain was consequently greater for the intervention group (adjusted difference, 1.519; 95% CI, 1.362-1.675). The mean hospital cost per patient was $11 857 (SD, $4322), and the incremental cost-effectiveness ratio (ICER) for the intervention was $7808 per QALY gained. The probability of breast reduction surgery being cost-effective was 100% at a willingness-to-pay threshold of $50 000 per QALY and 88% at $28 033 per QALY. CONCLUSIONS: Breast reduction surgery for women with symptomatic breast hypertrophy is cost-effective and should be available to women through the Australian public healthcare system.

The anatomical distribution of non-melanoma skin cancer: a retrospective cohort study of 22 303 Australian cases.

BACKGROUND: Non-melanoma skin cancers (NMSC) are the most common skin cancers worldwide with research establishing that ultraviolet (UV) radiation influences occurrence. However, recent studies about NMSC tumour frequencies suggested high NMSC predilections in low UV-exposed skin regions. METHODS: The 'Human Surface Anatomy Labeling System' was used to define 100 skin regions to map NMSC locations excised at Flinders Medical Centre (FMC) between 1 January 2012 and 31 December 2017. Data were retrieved from the FMC histopathology database. A customised phrase algorithm was used to run a systematic word search on the dataset to quantify NMSC locations. RESULTS: A total of 22 303 NMSC excisions were identified; 80% were head and neck excisions. Scalp, periocular and nasal regions showed a significantly greater predilection for basal cell carcinomas (BCC). Squamous cell carcinomas (SCC) had significantly more excisions in lip, neck and scalp regions. Regarding gender-related variations, more males had BCC excisions in ear regions and more females had nasal, lip, and ankle excisions. In SCC excisions, more males had scalp excisions and more females had leg and lip excisions. Considering age-related variation, significantly higher proportions of BCC were found with forehead excisions compared to scalp, neck and lower limb regions for SCC, all being highest for 60-79-year age groups. CONCLUSION: The relationship between NMSC type and anatomical distribution may be partially explained by gender and age affecting NMSC predilections particularly in the head and neck. However, other skin regions could not be explained solely by these factors.

Outcomes of Breast Reduction Surgery Using the BREAST-Q: A Prospective Study and Comparison with Normative Data.

BACKGROUND: This study aimed to assess breast-related satisfaction and well-being in women with breast hypertrophy before and after breast reduction surgery, and to compare these scores with Australian general population norms, using the BREAST-Q Reduction module. METHODS: A prospective cohort study was conducted between March of 2010 and February of 2016. Participants self-completed the BREAST-Q preoperatively and 12 months postoperatively. Normative BREAST-Q data were generated from women aged 18 years and older for comparison. Statistical analysis was performed and values of p < 0.05 were considered significant. RESULTS: The BREAST-Q was completed by 132 participants preoperatively and 12 months postoperatively. Statistically significant improvements were found following surgery in Satisfaction with Breasts, Psychosocial Well-being, Sexual Well-being, and Physical Well-being. In comparison with normative data, patients with breast hypertrophy had significantly lower scores preoperatively, with scores significantly increasing postoperatively to levels representative of the general population. Satisfaction with outcome was not significantly different between patients who were eligible by traditional insurance requirements (Schnur sliding scale/500-g minimum rule) and those who were not. The presence of surgical complications did not affect change in BREAST-Q scores or postoperative satisfaction with outcome. Differences were observed in mean BREAST-Q scores when comparing generated Australian norms to published U.S. norms. CONCLUSIONS: Breast reduction surgery significantly improves the satisfaction and quality of life in women with breast hypertrophy to a level that is at least equivalent to that of the normative population. Surgery is of benefit to all women, including those who do not meet traditional insurance requirements. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Cytochrome P450 CYP3A in marsupials: cloning and characterisation of the second identified CYP3A subfamily member, isoform 3A78 from koala (Phascolarctos cinereus).

Cytochromes P450 (CYPs) are critically important in the oxidative metabolism of a diverse array of xenobiotics and endogenous substrates. Previously, we cloned and characterised the CYP2C, CYP4A, and CYP4B gene subfamilies from marsupials and demonstrated important species-differences in both activity and tissue expression of these CYP enzymes. Recently, we isolated the Eastern grey kangaroo CYP3A70. Here we have cloned and characterised the second identified member of marsupial CYP3A gene subfamily, CYP3A78 from the koala (Phascolarctos cinereus). In addition, we have examined the gender-differences in microsomal erythromycin N-demethylation activity (a CYP3A marker) and CYP3A protein expression across test marsupial species. Significant differences in hepatic erythromycin N-demethylation activity were observed between male and female koalas, with the activity detected in female koalas being 2.5-fold higher compared to that in male koalas (p<0.01). No gender-differences were observed in tammar wallaby or Eastern grey kangaroo. Immunoblot analysis utilising anti-human CYP3A4 antibody detected immunoreactive proteins in liver microsomes from all test male and female marsupials including the koala, tammar wallaby, and Eastern grey kangaroo, with no gender-differences detected across test marsupials. A 1610 bp koala hepatic CYP3A complete cDNA, designated CYP3A78, was cloned by reverse transcription-polymerase chain reaction approaches. It displays 64% nucleotide and 57% amino acid sequence identity to the Eastern grey kangaroo CYP3A70. The CYP3A78 cDNA encodes a protein of 515 amino acids, shares approximately 68% nucleotide and 56% amino acid sequence identity to human CYP3A4, and displays high sequence similarity to other published mammalian CYP3As from human, monkey, cow, pig, dog, rat, rabbit, mouse, hamster, and guinea pig. Collectively, this study provides primary molecular data regarding koala hepatic CYP3A78 gene and enables further functional analyses of CYP3A enzymes in marsupials. Given the significant role that CYP3A enzymes play in the metabolism of both endogenous and exogenous compounds, the clone provides an important step in elucidating the metabolic capacity of marsupials.

Intrauterine growth restriction delays surfactant protein maturation in the sheep fetus.

Pulmonary surfactant is synthesized by type II alveolar epithelial cells to regulate the surface tension at the air-liquid interface of the air-breathing lung. Developmental maturation of the surfactant system is controlled by many factors including oxygen, glucose, catecholamines, and cortisol. The intrauterine growth-restricted (IUGR) fetus is hypoxemic and hypoglycemic, with elevated plasma catecholamine and cortisol concentrations. The impact of IUGR on surfactant maturation is unclear. Here we investigate the expression of surfactant protein (SP) A, B, and C in lung tissue of fetal sheep at 133 and 141 days of gestation (term 150 +/- 3 days) from control and carunclectomized Merino ewes. Placentally restricted (PR) fetuses had a body weight <2 SD from the mean of control fetuses and a mean gestational Pa(O(2)) <17 mmHg. PR fetuses had reduced absolute, but not relative, lung weight, decreased plasma glucose concentration, and increased plasma cortisol concentration. Lung SP-A, -B, and -C protein and mRNA expression was reduced in PR compared with control fetuses at both ages. SP-B and -C but not SP-A mRNA expression and SP-A but not SP-B or -C protein expression increased with gestational age. Mean gestational Pa(O(2)) was positively correlated with SP-A, -B, and -C protein and SP-B and -C mRNA expression in the younger cohort. SP-A and -B gene expression was inversely related to plasma cortisol concentration. Placental restriction, leading to chronic hypoxemia and hypercortisolemia in the carunclectomy model, results in significant inhibition of surfactant maturation. These data suggest that IUGR fetuses are at significant risk of lung complications, especially if born prematurely.