Direct neurotization of free nipple grafts with cadaveric nerve grafts following mastectomy for gender affirming surgery.

BACKGROUND: Free nipple grafting makes sensory recovery challenging. Permanent decreased sensation to touch and temperature in skin-grafted skin is common. Direct neurotization of the nipple-areolar complex (NAC) graft has been described. However, quantitative data regarding degree of nipple reinnervation possible is unknown. This study aims to quantify and qualify sensation recovery following nerve coaptation to reinnervate the NAC. METHODS: Patients undergoing mastectomy for gender dysphoria from 2020 to 2022 were offered nerve allograft to restore nipple sensation. A lateral intercostal nerve was selected and coapted to allograft which was embedded beneath the nipple graft. Semmes Weinstein testing was used to assess nipple sensation. Assessments were made at visits <1 year and >1 year from surgery. Filaments used represented normal sensation, minor diminished sensation, diminished sensation, loss of protective sensation, and deep pressure sensation only. RESULTS: A total of 115 patients elected for direct neurotization. Semmes Weinstein testing was limited to 46 patients representing 46 encounters and 92 nipples in the <1 year group and 24 encounters and 48 nipples in the >1 year group. Of the 92 nipples in the <1 year group, 17 (18.5%) noted return of normal sensation and 37 (40.2%) noted minor diminished or diminished sensation, indicating nerve reinnervation. There were 38 (41%) nipples with loss of protective sensation or deep sensation only. There were 48 nipples included in the >1 year group. Of the 48 nipples, 4 (8.3%) noted normal sensation and 30 (62.5%) noted minor diminished or diminished sensation, indicating nerve reinnervation. For the remaining 14 nipples, 14 (29%) noted loss of protective sensation or deep sensation only. CONCLUSION: Sensory outcomes in NAC grafts used for reconstruction in patients undergoing double incision mastectomy remain poor. Sensation restoration beyond that expected from full thickness skin grafts can be achieved in the majority of patients with nerve allograft via direct neurotization.

Long-term breast and nipple sensation after nipple-sparing mastectomy with implant reconstruction: Relevance to physical, psychosocial, and sexual well-being.

BACKGROUND: The effect of postoperative sensation on quality-of-life (QoL) following nipple-sparing mastectomy (NSM) with implant-based reconstruction is not well described. We evaluated the impact of breast and nipple sensation on patient QoL by using BREAST-Q. METHODS: Patients undergoing NSM with implant reconstruction from 2008 to 2020 were mailed a survey to characterize their postoperative breast and nipple sensation. BREAST-Q metrics were compared between totally numb patients and those with sensation. RESULTS: A total of 349 patients were included. Overall, 131 (38%) responded; response rates regarding breast and nipple sensation were 36% (N = 124/349) and 34% (N = 117/349). Median time from surgery to survey completion was 6 years. The majority had bilateral procedures (101, 77%), including direct-to-implant (99, 76%) and tissue expander (32, 24%) reconstruction. Regarding breast sensation, the majority of patients reported their reconstructed breasts as totally numb (47, 38%) or much less sensation than before surgery (59, 48%). Regarding nipple sensation, the majority of patients reported their nipples were totally numb (67, 57%) or had much less sensation than before surgery (37, 32%). Total numbness of reconstructed breasts resulted in a significantly lower chest physical well-being (mean score: 73.5 vs. 81.2, respectively, P = 0.048). Total numbness of postoperative nipple(s) resulted in significantly lower chest physical (mean score: 74.8 vs. 85.2, respectively, P = 0.007), psychosocial (mean score 77.4 vs. 84.4, respectively, P = 0.041), and sexual well-being (mean score: 55.7 vs. 68.3, respectively, P = 0.002). CONCLUSIONS: Long-term breast and nipple sensation are significantly diminished after NSM with implant reconstruction. Patients with preserved sensation experience better physical, psychosocial, and sexual well-being.

Galactorrhea After Nipple-Sparing Mastectomy: Case Report, Review of the Literature, and Algorithmic Approach to Management.

ABSTRACT: Nipple discharge is a rare but possible occurrence after nipple-sparing mastectomy (NSM). This study presents the first case of galactorrhea in a female patient after NSM. Although milky discharge due to physiologic lactation related to pregnancy is more common, galactorrhea is still possible and should be worked up appropriately to ensure that all breast tissue has been removed and that there are no other more worrisome causes.

Risk factors for lactation mastitis in China: A systematic review and meta-analysis.

BACKGROUND: Lactation mastitis (LM) affects approximately 3% to 33% of postpartum women and the risk factors of LM have been extensively studied. However, some results in the literature reports are still not conclusive due to the complexity of LM etiology and variation in the populations. To provide nationally representative evidence of the well-accepted risk factors for LM in China, this study was aimed to systematically summary the risk factors for LM among Chinese women and to determine the effect size of individual risk factor. MATERIAL AND METHODS: Six major Chinses and English electronic literature databases (PubMed, Web of Science, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Wan fang Database and China Science Technology Journal Database) were searched from their inception to December 5st, 2020. Two authors extracted data and assessed the quality of included trials, independently. The strength of the association was summarized using the odds ratio (OR) with 95% confidence intervals (CI). The population attributable risk (PAR) percent was calculated for significant risk factors. RESULTS: Fourteen studies involving 8032 participants were included. A total of 18 potential risk factors were eventually evaluated. Significant risk factors for LM included improper milking method (OR 6.79, 95%CI 3.45-13.34; PAR 59.14%), repeated milk stasis (OR 6.23, 95%CI 4.17-9.30; PAR 49.75%), the first six months postpartum (OR 5.11, 95%CI 2.66-9.82; PAR 65.93%), postpartum rest time less than 3 months (OR 4.71, 95%CI 3.92-5.65; PAR 56.95%), abnormal nipple or crater nipple (OR 3.94, 95%CI 2.34-6.63; PAR 42.05%), breast trauma (OR 3.07, 95%CI 2.17-4.33; PAR 15.98%), improper breastfeeding posture (OR 2.47, 95%CI 2.09-2.92; PAR 26.52%), postpartum prone sleeping position (OR 2.46, 95%CI 1.58-3.84; PAR 17.42%), little or no nipple cleaning (OR 2.05, 95%CI 1.58-2.65; PAR 24.73%), primipara (OR 1.73, 95%CI 1.25-2.41; PAR 32.62%), low education level (OR 1.63, 95%CI 1.09-2.43; PAR 23.29%), cesarean section (OR 1.51, 95%CI 1.26-1.81; PAR 18.61%), breast massage experience of non-medical staff (OR 1.51, 95%CI 1.25-1.82; PAR 15.31%) and postpartum mood disorders (OR 1.47, 95%CI 1.06-2.02; PAR 21.27%). CONCLUSIONS: This review specified several important risk factors for LM in China. In particular, the incidence of LM can be reduced by controlling some of the modifiable risk factors such as improper breastfeeding posture, improper milking method, repeated milk stasis, nipple cleaning, breast massage experience of non-medical staff and postpartum sleeping posture.

Topical Alpha-1 Adrenergic Receptor Agonist Applied to the Nipple/Areola Complex Improves Female Orgasmic Function.

Background: The impact of nipple sensation and its relationship to sexual function have often been neglected in medical literature. However, several recent studies report the importance of the nipple/areola complex (NAC) in sexual arousal and overall function. The nipple is composed of smooth muscle that can be erected via adrenergic nerves. In two complementary studies, we demonstrate that stimulation of the alpha-1 adrenergic receptor in the NAC with topical adrenergic agents can initiate erection of the nipple, increase NAC sensitivity, and improve sexual function. Materials and Methods: Thirteen breast surgery patients with nipple sensitivity loss were recruited to an unblinded study of topical phenylephrine hydrochloride. Sensitivity to pressure was measured before and after the application of the intervention to the NAC. In a second pilot study, 35 women completed a double-blinded placebo-controlled trial of a novel formulation, RJ101, containing a norepinephrine releasing agent. The intervention or placebo was applied to the NAC 30 minutes before sexual activity over the 4-week trial period. The arousal, lubrication, and orgasm domains of the female sexual function index (FSFI) were used to measure sexual function. Results: The application of phenylephrine hydrochloride was shown to increase nipple sensitivity to pressure by an average of 20% in our cohort of 13 breast augmentation patients. In addition, it was shown that intermittent application of the alpha-1 agonist for 8 weeks increased basal NAC sensitivity. In the follow-up pilot study, we demonstrate that stimulation of the NAC with RJ101 produced statistically significant increases versus placebo in the lubrication and orgasm domains of the FSFI, p = 0.0226 and p = 0.0269, respectively. Conclusion: For the first time, we demonstrate that the application of a topical alpha-1 adrenergic receptor agonist or a norepinephrine-releasing agent increases the sensitivity of the NAC and subsequently significantly improves sexual function.

Nipple-Sparing Mastectomy Long-Term Outcomes: Early and Late Complications.

Background and Objectives: The surgical choice treatment of the breast cancer mostly depends on the stage of the disease. In the last years, breast cancer surgery has moved from being destructive to being more respectful of the anatomical and physiological integrity of the gland. The aim of the breast surgery should be finalized to obtain the best aesthetic and functional results, respecting the principles of oncologic radicality. The present study is a retrospective analysis aimed to evaluate the long-term outcomes of a conservative technique like the nipple-sparing mastectomy. Materials and Methods: We observed 894 patients with a median age of 47.5 years old, underwent nipple-sparing mastectomy between 2002-2017. The data acquired include population and tumor characteristics, patient reconstructive outcomes, including locoregional, regional, and distant metastases; other variables, among nipple-areola complex necrosis and infection were collected. Results: The complications detected were considered as "early" within 1 month later the nipple-sparing mastectomy or "late" after this time. The overall complications rate (early and late) and the overall survival and the relapses detected by this study were comparable with those reported in the literature. In order to identify factors that correlate with complications, either early or later, it has been processed an evaluation of the univariate analysis showing adjuvant chemotherapy as the only predictive factor for late complications, while we encountered no predictors for early complications. Conclusions: The present study adds to the data already present in literature, demonstrating that the nipple-sparing mastectomy is a safe procedure, providing good oncological and aesthetic results in patients carefully selected.

Novel topical formulation applied to the nipple-areola complex improves female orgasm.

BACKGROUND: The nipple-areola complex (NAC) is an often overlooked but important erogenous zone in the female sexual response and sexual functional repertoire. Research suggests that nipple stimulation is significant to female sexual satisfaction in as many as 80% of women. Previously, we have reported that stimulation of the arrector pili muscle in the NAC increases nipple sensitivity and has a positive impact on female sexual function. AIMS: To study the effect of RJ-101 on female orgasm. METHODS: A randomized double-blinded placebo-controlled study of RJ101, a novel topical formulation that stimulates the arrector pili muscle of the NAC, in 59 women. Each subject completed a survey composed of Likert scale questions in order to identify changes in orgasm after topical application of RJ101 or placebo. RESULTS: We demonstrated a positive increase in the perceived intensity of orgasm and orgasmic satisfaction/pleasure in women using RJ101 vs those in the placebo group. After 4 weeks of treatment, 76% of the women in the RJ101 arm reported a positive improvement in satisfaction with orgasm versus 47% in the placebo cohort. The mean change in score for overall satisfaction with orgasm in the RJ101 group was statistically significant (P = .007) compared to placebo. CONCLUSION: The application of RJ101 to the NAC 30 minutes prior to sexual activity can improve orgasmic strength, pleasure, and satisfaction.

A prospective comparison of breast sensibility after reduction mammoplasty: Superior versus superomedial pedicle.

BACKGROUND: Breast sensitivity is a significant issue in preoperative consultation prior to reduction mammoplasty. Although a range of techniques is used, recovery of sensation is usually evaluated using the inferior pedicle. Our objective was to evaluate and compare the change in breast sensitivity using the superomedial versus the superior pedicle. METHODS: We performed a non-randomized, monocentric, prospective study. Thirty-six patients were examined by a single evaluator with von Frey monofilaments on the day prior to the surgery, at 3-6 months, and at 1 year postoperatively. The breast skin, areola, and nipple sensitivity were tested. The breasts were classified into two groups depending on whether the superior pedicle (S) or the superomedial pedicle (SM) technique was used. RESULTS: The differences between the two groups indicate that the SM group had better sensitivity at 4.5 and 12 months postoperatively. The thresholds for the size filaments that could be felt at the first follow-up on the skin, the areola, and the nipple for the S group vs. the SM group were 2.55 vs. 2.41 (p = 0.41), 4.57 vs. 4.45 (p = 0.28), and 4.17 vs. 3.81 (p = 0.04) size units, respectively. At 1 year postoperatively, the respective values were 2.62 vs. 2.52 (p = 0.49), 4.28 vs. 4.05 (p = 0.04), and 3.63 vs. 3.38 (p = 0.10). CONCLUSION: The nerve fibers appear to be better preserved in the superomedial pedicle than in the superior pedicle. However, these differences were not clinically relevant. The choice of the technique should be made on the basis of the size and the shape of the breast, the patient morphology, and the operator's preference rather than being on the basis of the recovery of sensitivity.

Thermal physiology of the lactating nipple influences the removal of human milk.

The nipple has a critical role in successful breastfeeding. Nipple trauma or pain may negatively impact breastfeeding duration which has significant public health implications. The aim of this study was to examine changes in nipple temperature during breastfeeding and pumping within participants. Thirty lactating women participated in two pumping (electric breast pump) and one breastfeeding session. Nipple temperature of both breasts was monitored for two minutes before and after each session with the non-pumped/non-suckled nipple temperature recorded throughout each session. The mean increase in nipple temperature after milk removal by the infant was 1.0 ± 1.6 °C (range -3.2-3.2) and after expression was 1.8 ± 1.4 °C (range -0.9-6.1). Nipple temperature pre expression was significantly lower than post expression (Pre 32.6 ± 1.6, Post 34.3 ± 1.3, p < 0.001) with no difference between the two pumping sessions. For every 1 °C rise in temperature an additional 10 mL of milk was removed on average. The breastfed nipple temperature was significantly lower pre feed than post feed (Pre 32.4 ± 1.6, Post 33.2 ± 1.2 p = 0.01) with a significant but smaller change in nipple temperaturecompared to pumping (Breastfeed 1.0 ± 1.6, Pumping 1.7 ± 1.4, p = 0.03). Nipple temperature increases during pumping and breastfeeding suggesting the breasts have a similar physiological response to different stimuli. Further, the increased temperature potentially plays a role in effective milk removal.

Sensation-Sparing Correction of Inverted Nipples Using the 'Drawbridge' Flap Approach.

INTRODUCTION: An inverted nipple can cause significant functional and psychologic disturbance to women. The holy grail of any surgical technique to correct this is to restore adequate nipple projection and at the same time, try to preserve lactation and nipple sensation. We describe our experience using an inferior dermal nipple-areolar interposition flap to correct the inverted nipple alongside with selective release of the lactiferous ducts of the nipple. MATERIALS AND METHODS: We have employed this technique successfully in 97 cases of inverted nipples in 60 patients with follow-up periods of up to 2 years. Twenty-three of them had unilateral inversion, and 37 of them had bilateral nipple inversion. RESULTS: The appearance of the nipple was good to excellent. Seventy to 80% of the initial postoperative nipple projection at the end of 1 year was maintained. Postoperative complications included stitch abscess in one patient (n = 1) and an epidermal cyst in another (n = 1). Nipple sensation was preserved in 100% of cases. There was no recurrence of inversion in any of the nipples. DISCUSSION: By identifying the root cause of inverted nipples in each individual case, and selectively targeting them, we minimize surgical morbidity with a simple technique that avoids any form of traction or compression of the nipple and minimizes the risk of altered nipple sensation. 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 .

Management of fetal growth restriction using the contraction stress test: a case-control study.

Purpose: Fetal growth restriction (FGR) is a concerning health issue. However, studies on FGR management are limited due to its rarity. We aimed to evaluate the efficacy of the contraction stress test (CST) for FGR management. Materials and methods: A case-control retrospective study design. Our institute innovated CST in FGR management in 2017. We included women in their 33rd-40th week of pregnancy with a diagnosis of FGR and retrospectively divided them into groups: the CST group (FGR management with CST) and no CST group (FGR management without CST) before and after CST development. Neonatal outcome, pH, and pO2 of umbilical artery (UA) were compared between the two groups. Results: No significant differences in the rate of birth weight, Apgar score <7 (5 minutes), neonatal death, hospitalization to newborn childhood intensive care unit (NICU), and UA pH were found between groups. Average UA pH was 7.29 ± 0.05 and 7.29 ± 0.04 in the CST and no CST groups, respectively (p = .864). Average UA pO2 values were 21.1 ± 8.6 and 15.7 ± 5.0 mmHg in the CST and no CST groups, respectively (p = .016), showing significant differences. Conclusions: Neonatal outcomes and UA pH were slightly different between the groups managed with and without CST. However, UA pO2 values significantly differed between the groups. For FGR management, the use of a CST may allow for early intervention before fetal acidemia and acidosis. For establishing the effects of a CST for FGR management, analysis including several cases and investigation of long-term outcomes of newborn infants is necessary.

Lactation Assessment Tools: A Qualitative Analysis of Registered Nurses' Perceptions of Tool Limitations and Suggested Improvements.

Background Several lactation assessment tools are available for in-hospital assessment of breastfeeding dyads, and their components vary widely. To date, no research has evaluated the perceptions of registered nurses (RNs) regarding the limitations and future improvements of these tools. Research Aim The aim was to describe RNs' perceptions of the limitations of currently used lactation assessment tools and how these tools could be enhanced. Methods Focus groups ( n = 7) were conducted with RNs ( N = 28) whose current responsibilities included in-hospital breastfeeding assessment. Recruitment occurred from April through July 2015 at regional and international lactation conferences. Focus groups were audiotaped and transcribed verbatim. Two lactation researchers analyzed the transcripts to identify emerging themes and subthemes. Results RNs identified three key limitations of the tools included being too subjective and time-consuming, difficulty in assessing audible swallows, and missing the big picture (e.g., overemphasizing numbers, being a snapshot in time). Suggested improvements focused on maternal characteristics (evolving breasts and nipples, holding it together, "got milk?," risk factors, embracing the role), infant characteristics (day of life, latch/suck/swallow, baby's "driving the bus," risk factors for supplemental feeding), their interaction (two to tango, positioning, better qualitative descriptors), and tool organization (formatting and multiple versions). Conclusions RNs suggested novel components for consideration when developing future lactation assessment scales, including removing audible swallowing, adding mother/infant interactions, infant output, and expressible colostrum, and developing criteria specific to infant age. Future research should translate these suggestions into evidence-based indicators and evaluate the resulting proposed tools for reliability and validity.

Defining the Role of Free Flaps in Partial Breast Reconstruction.

BACKGROUND: Free flaps have a well-established role in breast reconstruction after mastectomy; however, their role in partial breast reconstruction remains poorly defined. We reviewed our experience with partial breast reconstruction to better understand indications for free tissue transfer. METHODS: A retrospective review was performed of all patients undergoing partial breast reconstruction at our center between February 2009 and October 2015. We evaluated the characteristics of patients who underwent volume displacement procedures versus volume replacement procedures and free versus pedicled flap reconstruction. RESULTS: There were 78 partial breast reconstructions, with 52 reductions/tissue rearrangements (displacement group) and 26 flaps (replacement group). Bra cup size and body mass index (BMI) were significantly smaller in the replacement group. Fifteen pedicled and 11 free flaps were performed. Most pedicled flaps (80.0%) were used for lateral or upper pole defects. Most free flaps (72.7%) were used for medial and inferior defects or when there was inadequate donor tissue for a pedicled flap. Complications included hematoma, cellulitis, and one aborted pedicled flap. CONCLUSION: Free and pedicled flaps are useful for partial breast reconstruction, particularly in breast cancer patients with small breasts undergoing breast-conserving treatment (BCT). Flap selection depends on defect size, location, and donor tissue availability. Medial defects are difficult to reconstruct using pedicled flaps due to arc of rotation and intervening breast tissue. Free tissue transfer can overcome these obstacles. Confirming negative margins before flap reconstruction ensures harvest of adequate volume and avoids later re-operation. Judicious use of free flaps for oncoplastic reconstruction expands the possibility for breast conservation.

Melanin of the nipple areola complex.

Biological pigments or biochromes are ubiquitous in animals, plants, and simpler organisms such as fungi and bacteria. They serve a wide spectrum of functions from photosynthesis, camouflage, mimicry, photo protection from the environment to attracting mates. The human female nipple areola complex (NAC) is a highly-pigmented area. Currently, the prevailing theory as to the evolution of the pigmented human NAC is based on infant recognition of breast feeding latching zone; however, due to the protruding shape of the nipple and surrounding breast, the authors of this letter believe that the evolutionary advantage of the pigmented NAC has a direct physiological function, namely the initiation of involution at the end of the infant lactation period.

Developmental changes in feeding behaviors of infant chimpanzees at Mahale, Tanzania: Implications for nutritional independence long before cessation of nipple contact.

OBJECTIVES: Weaning of chimpanzees is considered to occur at 4-5-years-old with complete cessation of nipple contact and timing of reconception calculated by inter-birth interval minus gestation length. This is also the basis of "early weaning" in humans (i.e., approximately 2.5-years-old). However, recent studies of the survival of orphans and the first molar (M1) eruption in wild chimpanzees have predicted that infants move toward nutritional independence at 3-years-old. Therefore, this study aimed to investigate ontogeny of feeding behavior at around 3-years-old in wild infant chimpanzees. MATERIALS AND METHODS: I studied 19 infants aged 1-60 months in the M group in Mahale Mountains National Park, Tanzania. The total observation time was 518 h, 25 min. RESULTS: At around 3-years-old, infant chimpanzees spent more total feeding time, and time feeding on leaves, and food physically difficult to process without food transfer from other individuals. These results suggest that infant chimpanzees significantly reduced their dependence on milk for nutrition at around 3-years-old, that is, before cessation of nipple contact. DISCUSSION: This study suggests that M1 eruption in wild Eastern Chimpanzees is an index of the period when infants move toward nutritional independence with a key dietary transition. This is the first study to provide behavioral evidence of the large temporal gap between nutritional independence of infants and reconception of mothers in great apes, and clarify the unique feature of human life history whereby mothers can reconceive before an infant reaches nutritional independence.

Characterization of an Acellular Scaffold for a Tissue Engineering Approach to the Nipple-Areolar Complex Reconstruction.

A significant number of patients undergo mastectomies and breast reconstructions every year using many surgical-based techniques to reconstruct the nipple-areolar complex (NAC). Described herein is a tissue engineering approach that may permit a human NAC onlay graft during breast reconstruction procedures. By applying decellularization, which is the removal of cellular components from tissue, to an intact whole donor NAC, the extracellular matrix (ECM) structure of the NAC is preserved. This creates a biologically derived scaffold for cells to repopulate and regenerate the NAC. A detergent-based decellularization method was used to derive whole NAC scaffolds from nonhuman primate rhesus macaque NAC tissue. Using both histological and quantitative analyses for the native and decellularized tissues, the derived ECM graft was assessed. The bioactivity of the scaffold was evaluated following cell culture with bone marrow-derived mesenchymal stem cells (BMSCs). The data presented here demonstrate that scaffolds are devoid of cells and retain ECM integrity and a high degree of bioactivity. The content of collagen and glycosaminoglycans were not significantly altered by the decellularization process, whereas the elastin content was significantly decreased. The proliferation and apoptosis of seeded BMSCs were found to be approximately 65 and <1.5%, respectively. This study characterizes the successful decellularization of NAC tissue as compared to native NACs based on structural protein composition, lubricating protein retention, the maintenance of adhesion molecules, and bioactivity when reseeded with cells. These histological and quantitative analyses provide the foundation for a novel approach to NAC reconstruction.

Breast Durometer (Mammometer): A Novel Device for Measuring Soft-Tissue Firmness and Its Application in Cosmetic Breast Surgery.

The measurement of soft-tissue firmness has many potential applications in medical practice. This study reports a user-friendly, novel device that is capable of measuring changes in soft-tissue firmness in a reproducible manner. The study reports the development of the equipment and how it has been applied to breast implant surgery. The device was tested for both intra- and inter-observer variability on an in vitro model, using a breast implant. Once reproducibility was confirmed, breast firmness was measured on a series of patients who underwent sub-fascial breast augmentation (n = 50) to examine how it varied post-operatively. Firmness in the upper half of the breast increased to a maximum level two weeks post-surgery (0.44-0.61 Pa), reducing to pre-operative levels by 6 weeks (0.37-0.54 Pa). There was no further significant change at 12 weeks. Firmness in the nipple areolar complex (NAC) and at the lower outer quadrant (LOQ) followed a similar pattern, but remained firmer at 12 weeks. We interpret these patterns as implying that measurements taken at the upper half of the breast are indicative of post-operative oedema, whereas those at the NAC and LOQ represent changes in firmness produced by the breast implant composite. We consider the potential for this novel device in the measurement of soft-tissue firmness in aesthetic breast surgery and would encourage other researchers to explore novel applications. 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 .