Aspectos Morfológicos de la Mama. Una Revisión de la Literatura / Morphological Aspects of the Breast. A Literature Review

La glándula mamaria tiene su origen embriológico, posteriormente se diferencia histológica y anatómicamente; a lo largo del tiempo se han ido descubriendo nuevos hallazgos, además de nueva terminología. El objetivo de este trabajo consistió en describir la actualización en los aspectos morfológicos de la glándula mamaria. Se realizó una búsqueda de artículos en diferentes fuentes primarias y secundarias de la literatura científica como: Pubmed, Embase, WOS, Scopus, Scielo obteniendo 623 publicaciones, seleccionado 53 para su revisión y 17 incluidos. La mama se ha ido actualizando en los aspectos morfológicos; Los conductos se ubican cercanos a la areola y al pezón donde desembocan directamente, las ramificaciones de los conductos se ubican cercanos a la areola; los pezones tienen entre 15 y 20 lóbulos, de los cuales sólo 5-9 son verdaderos orificios del conducto mamario, no existen senos lactíferos por lo que la leche desemboca directamente en el pezón, en cuanto a la inervación de la mama son inervados por las ramas cutáneas anterior y lateral de los nervios intercostales. La evidencia existente demuestra la necesidad de realizar estudios permanentes en el ámbito de la morfología, como fue descrito en este artículo de revisión sobre la mama. En diferentes aspectos, tales como términos, funciones y estructuras. Está información es importante para, la formación de pregrado, post grado, y su utilización en la clínica, identificación de patologías, clínicas de lactancia, entre otros.

SUMMARY: The mammary gland has its embryological origin, later it differentiates histologically and anatomically; over time new findings have been discovered, as well as new terminology. The aim of this work was to describe the update on the morphological aspects of the mammary gland. A search for articles was carried out in different primary and secondary sources of scientific literature such as: Pubmed, Embase, WOS, Scopus, Scielo, obtaining 623 publications, 53 selected for review and 17 included. The breast has been updated in morphological aspects; the ducts are located close to the areola and the nipple where they open directly, the branches of the ducts are located close to the areola; the nipples have between 15 and 20 lobes, of which only 5- 9 are true mammary duct orifices, there are no lactiferous sinuses, so the milk flows directly into the nipple, in terms of innervation of the breast they are innervated by the anterior and lateral cutaneous branches of the intercostal nerves. The existing evidence demonstrates the need for permanent studies in the field of morphology, as described in this review article on the breast. In different aspects, such as terms, functions and structures. This information is important for undergraduate and postgraduate training, and its use in the clinic, identification of pathologies, lactation clinics, among others.

[Embryology and anatomy of the thorax and breast]. / Embryologie et anatomie du thorax et du sein.

Embryology and anatomy of the chest wall and breast will be developed in this chapter. The walls of the thorax will be described; the anatomical notions of thoracic deformities will be detailed. The anatomy of the mammary gland will be developed around the understanding of the means of fixity and vascularization. The anatomical descriptions come from the writings of ancient anatomists, notably Testut and Latarjet, as well as the iconographies taken from their various works.

Women with larger breasts are less satisfied with their breasts: Implications for quality of life and physical activity participation.

INTRODUCTION: Although low breast satisfaction has been associated with a range of potential negative health implications, little is known about key factors that influence breast satisfaction across the lifespan. This study aimed to determine the impacts of age, body mass and breast size on breast satisfaction and how breast satisfaction impacts psychosocial and sexual well-being-related quality of life outcomes and physical activity behaviours. METHODS: Three hundred and forty-five women (age range: 18.1-83.7 years) had their body mass (kg), standing height (cm) and breast volume (ml) measured. A 13-item questionnaire comprising the Breast-Q and Active Australia Survey was used to assess breast satisfaction, quality of life outcomes and participation in physical activity. RESULTS: Breast satisfaction was influenced by breast size, such that women with larger breasts were less satisfied with their breasts compared to their counterparts with smaller breasts. Greater breast satisfaction was associated with improved psychosocial and sexual well-being-related measures of quality of life, and time spent participating in physical activity. CONCLUSION: Interventions to improve breast satisfaction among women across the breast size spectrum should be encouraged in public health initiatives to better engage and encourage positive health behaviours and reduce potential adverse health implications.

Experimental characterisation and modelling of breast Cooper's ligaments.

The aim of this study was to characterise the mechanical behaviour of Cooper's ligaments. Such ligaments are collagenous breast tissue that create a three-dimensional structure over the entire breast volume. Ten ligaments were extracted from a human cadaver, from which 28 samples were cut and used to perform uniaxial tensile tests. Histological analysis showed that the main direction of the fibres visible to the naked eye corresponds to the orientation of the fibres on a microscopic scale. The specimens were cut according to this orientation, which allowed the sample to be stretched in the main fibre direction. From these experimental stretch/stress curves, an original anisotropic hyperelastic constitutive law is proposed to model the behaviour of Cooper's ligaments and the material parameter validity is discussed.

Breast Anthropometry: Values and Application in Breast Surgery for Vietnamese Women.

OBJECTIVES: Breast surgery requires a high aesthetic outcome and should be individualized according to anthropometric breast and body characteristics. This study aimed to measure the anthropometric parameters and volume of Vietnamese female breasts and their application in breast surgery. SUBJECTS AND METHODS: A cross-sectional descriptive study enrolled 240 women treated at Vietnam National Cancer Hospital aged 18 to 78 years old. The measurements were obtained with the patient sitting upright in the anatomic position based on key landmarks and breast volume was also assessed. Differences in breast anthropometric measurements and breast volume were compared between groups of age, BMI, and the number of children. The correlation between breast volume calculated by anthropometric method and surgical specimen volume was evaluated to determine the accuracy of this method. RESULTS: The mean values of the right and left breast volumes are less statistically different. Mean breast volume of the right breast and left breast were 396.1±182.3ml and 399.4±182.2ml, respectively. The proportion of breast ptosis increased with age (p=0.027), Body mass index (p<0.0001), and the number of children (p=0.004). The most important factor affecting the size and shape of the breast was body mass index (BMI). Mastectomy specimen volume and breast volume calculated by the anthropometric method are highly correlated with r=0.966. CONCLUSIONS: The results of this study should be applied in clinical practice in breast surgery for Vietnamese women.
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Investigating Women's Health Behavior and Impact of Health Exercise on Low Back Pain Caused by Breast Size.

Objectives: The breast size causes back pain in women of every age. Back pain is critical for women with increasing age as they gradually lose energy to carry large breasts. Medical advancement in surgery has introduced treatment for large breast sizes. Natural remedies are difficult to take for women to reduce their breast size. This objective of this cross-sectional research was to investigate the impact of health exercise on low back pain in women caused by increased breast size with moderating influence of health literacy and access to doctors. Methods: The primary data was randomly collected from women in gyms and parks focusing on factors that can account for improving the health of women by reducing their back pain. Results: Furthermore, the study contributes a significant model in the body of knowledge related to the health behavior of women concerning their low back pain. Conclusion: Following significant findings, the study has deliberated the theoretical implication that enriched the literature and practical implications to improve the health behavior of women and reduce the chances of low back pain caused by breast size. Finally, this research highlighted some future directions based on research limitations.

Anatomy of the Breast Fascial System: A Systematic Review of the Literature.

BACKGROUND: Understanding the anatomy of the fascial and ligamentous structures of the breast is important in both aesthetic and reconstructive breast surgery. Several structures have been identified that play a significant role in the aesthetic qualities and support of the breast warranting consideration in the context of breast reconstruction. METHODS: The authors performed a systematic review of anatomical, clinical, histologic, and radiologic studies that have described, characterized, and named these structures. The authors have summarized and critically appraised prior research to clarify and define the key fascial structures of the breast, their anatomical function, and their clinical significance in aesthetic and reconstructive breast surgery. RESULTS: Through their review, six distinct breast fascial structures were encountered consistently in the literature. The authors have organized them into intraglandular and extraglandular structures and have reviewed their significance in the context of reconstructive breast surgery. CONCLUSIONS: The primary fascial structures of the breast are important anatomical landmarks with numerous clinical applications. Cooper ligaments divide the breast parenchyma. The superficial and deep layers of the superficial fascia encase the breast in a "pocket," condensing into one thickened layer of fascia along the peripheral breast footprint. The inframammary fold supports and defines the inferior pole. The horizontal septum is a reliable neurovascular landmark. The vertical septum is a newly discovered fascial structure. There are certainly clinical implications that have yet to be described because of the relatively limited and disputed information on the fascia of the female breast and, ultimately, more research is warranted.

Understanding Preoperative Breast Satisfaction among Patients Undergoing Mastectomy and Immediate Reconstruction: BREAST-Q Insights.

BACKGROUND: This study aims to present normative values for satisfaction with breasts among preoperative breast reconstruction patients as assessed using the BREAST-Q instrument and to delineate factors associated with preoperative breast satisfaction. METHODS: A retrospective analysis of prospectively collected data was performed examining women undergoing postmastectomy breast reconstruction at a tertiary care center who preoperatively completed the BREAST-Q from 2010 to 2017. Because breast satisfaction scores were nonnormally distributed, scores were categorized into quartiles for analysis. Patient- and treatment-level variables were tested in a multivariable ordinal logistic regression model as predictors of breast satisfaction. Preoperative satisfaction was also tested for association with choice of reconstructive modality. RESULTS: Among 1306 postmastectomy reconstruction patients included in the study, mean preoperative Satisfaction with Breasts score was 61.8 ± 21.5 and the median score was 58.0 (interquartile range, 48 to 70). Factors associated with significantly lower preoperative satisfaction included history of psychiatric diagnosis, preoperative radiotherapy, marital status (married), and higher body mass index. Factors associated with significantly higher scores were malignancy (localized tumor), medium bra size (B to C cup), and self-identification as black. Preoperative breast satisfaction was lower among patients who elected autologous reconstruction than among those with implant reconstruction (p < 0.001). CONCLUSIONS: Preoperative breast satisfaction is influenced by multiple factors. Understanding these factors may improve preoperative counseling and expectation management for patients who undergo postmastectomy breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

A Novel Classification of the Inframammary Fold for Use in Primary Breast Augmentation.

BACKGROUND: Previous aesthetic breast surgery algorithms have not addressed the importance of evaluating the native inframammary fold before primary breast augmentation. In the authors' experience, assessment of native inframammary fold anatomy significantly impacts surgical planning and technique. Failure to adequately evaluate and manage the inframammary fold leads to many of the common problems of the lower pole, including double-bubble deformity. METHODS: The authors assessed the inframammary fold preoperatively in 2192 consecutive patients undergoing primary breast augmentation between June of 2014 and December of 2018. A novel classification of inframammary fold morphology was devised based on review of standardized preoperative photographs. Outcome assessment was performed postoperatively at 3-month intervals. RESULTS: The authors identified four clear inframammary fold subtypes based on their clinical appearance, ranging from the nonexistent type F0 to the well-formed and fixed type F3. The key outcome measure examined was the presence of double-bubble deformity postoperatively. There were three total cases of double-bubble deformity identified in our cohort (<1 percent of patients). All cases of double-bubble deformity occurred in patients with a type 3 fold. CONCLUSIONS: The inframammary fold defines the inferior boundary of the lower pole of the breast and is a critical landmark to the aesthetic breast surgeon. The authors describe a unique and simple inframammary fold classification system that assists in selection of the appropriate approach to the inframammary fold in addition to implant dimensional planning. The authors have found that this system-in particular, the identification of the type F3 inframammary fold-has minimized the risk of inframammary fold-associated complications in over 2000 cases. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

25 Years of Research in Human Lactation: From Discovery to Translation.

Researchers have recently called for human lactation research to be conceptualized as a biological framework where maternal and infant factors impacting human milk, in terms of composition, volume and energy content are studied along with relationships to infant growth, development and health. This approach allows for the development of evidence-based interventions that are more likely to support breastfeeding and lactation in pursuit of global breastfeeding goals. Here we summarize the seminal findings of our research programme using a biological systems approach traversing breast anatomy, milk secretion, physiology of milk removal with respect to breastfeeding and expression, milk composition and infant intake, and infant gastric emptying, culminating in the exploration of relationships with infant growth, development of body composition, and health. This approach has allowed the translation of the findings with respect to education, and clinical practice. It also sets a foundation for improved study design for future investigations in human lactation.

Subfascial versus Subglandular Breast Augmentation: A Randomized Prospective Evaluation Considering a 5-Year Follow-Up.

BACKGROUND: Subfascial breast augmentation is becoming popular because of a better understanding of breast anatomy. However, because the subglandular approach is also another popular method, it is critical to assess the influence of the superficial fascia of the pectoralis major muscle on the subfascial and subglandular pockets to determine if one method is superior to another. This study investigated whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. METHODS: Twenty patients were recruited, and each was randomly sorted to the subfascial and/or subglandular pocket per breast. Both patients and surgeons were blinded. Differences were evaluated through five independent surgeons and by magnetic resonance imaging scans. Subsequently, 1-year and 5-year follow-ups were conducted. RESULTS: The results of the 5-year follow-up considering the aesthetics of the breast contour were significantly different between groups, with more good and excellent evaluations in the subfascial group. Regarding breast shape, there were also statistical differences, also with more good and excellent evaluations in the subfascial group. For breast consistency, subglandular had 84.20 percent of patients classified into Baker I and II, whereas subfascial had 100 percent. Magnetic resonance imaging scans showed a smaller implant base in the subglandular pockets, which was a significant result. There were no significant differences in implant projection. Comparison of the number of folds revealed significant differences between groups, with more folds in the subglandular group. CONCLUSION: Statistical differences between methods were found regarding breast shape and contour, capsular contracture, implant base, and the number of folds, showing that subfascial breast augmentation is superior to subglandular breast augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

An Analysis of Ptosis following Subfascial Breast Augmentation: Calculations That Explain Dogma.

BACKGROUND: Implant placement can improve ptosis due to the position of the nipple, inframammary crease, and base of the breast acting together. The interrelationship between these was quantified via changes in morphometry following subfascial augmentation, and explains the circumstances under which dogma holds true. METHODS: One hundred seventy-five patients underwent a series of static measurements before and 3 months after subfascial breast augmentation. Ptosis in the nipple and base of the breast was calculated before and after surgery. RESULTS: All measurements except that of the the lateral sternal margin increased after surgery. All grades of ptosis reduced following surgery. There was lowering of the base in grade 1 patients, but not for other grades. Increased base ptosis correlated with reduced lateral sternal margin (1.9 cm compared with 2.9 cm; left, H5 = 24.7, p < 0.01; right, H5 = 24.5, p < 0.01). Implant volume did not correlate with change in ptosis at the nipple or base. Reduced ptosis was associated with implants that are a narrow match of implant to breast (0.52 to 0.95) (left, H5 = 28.3, p < 0.01; right, H5 = 24.9, p < 0.01). Decreasing ptosis correlated with lower lateral sternal margin compared to breasts that increased ptosis. Change in ptosis following surgery does not correlate with having children. CONCLUSIONS: Subfascial placement has varying effects on ptosis. Non-ptotic or mildly ptotic breasts appear to improve due to a disproportionate descent of the inframammary crease relative to the nipple and base. Patients with little breast tissue are more susceptible to an increase in "bottoming out," particularly if broad implants are used. A ratio matching implant to the base width has predictive value on outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Comparing Outcomes of Wise-Pattern, Two-Stage Breast Reduction-Reconstruction with and without Acellular Dermal Matrix.

BACKGROUND: Aesthetic results in breast reconstruction for ptotic/obese breasts may be improved when using Wise-pattern closures compared with nipple-sparing mastectomies. In two-stage reconstruction, acellular dermal matrix is commonly used to support the prosthesis. This study tests the efficacy of an alternate technique that uses deepithelialized excess breast skin in lieu of acellular dermal matrix. To better understand whether acellular dermal matrix is necessary, the authors compared postoperative outcomes from reduction-reconstructions that used matrix to those that did not. METHODS: The authors retrospectively reviewed the outcomes of patients who underwent staged breast reconstruction following Wise-pattern closures between September of 2016 and October of 2019. Two cohorts were created based on whether acellular dermal matrix was used. Charts were reviewed for incidence of postoperative complications. RESULTS: A total of 164 breasts were reconstructed in 85 female patients. The acellular dermal matrix cohort consisted of 68 breasts, whereas the non-acellular dermal matrix cohort included 96 breasts. After the first stage, the incidence of one or more complications was similar between cohorts (acellular dermal matrix, 32.4 percent; nonmatrix, 35.4 percent; p = 0.684). Minor infection rates were significantly higher in reconstructions using acellular dermal matrix (16.2 percent versus 6.3 percent; p = 0.040). After the second stage, the complication incidence was also similar between cohorts (acellular dermal matrix, 16.2 percent; nonmatrix, 13.5 percent; p = 0.638). Final follow-up time was 445.2 days. CONCLUSIONS: Overall complication rates following both stages of reconstruction were similar with and without acellular dermal matrix. When acellular dermal matrix was used, minor infection rates were higher following expander placement. In patients desiring a reduction-reconstruction, the authors find the deepithelialized dermal flap provides ample prosthesis support, without the need for acellular dermal matrix. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Understanding the Evidence and Improving Outcomes with Implant-Based Prepectoral Breast Reconstruction.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of prepectoral breast reconstruction. 2. Have knowledge of primary immediate and delayed prepectoral breast reconstruction techniques and secondary procedures required. 3. Describe data on outcomes of prepectoral breast reconstruction. SUMMARY: Once considered to have an unacceptable complication profile, prepectoral breast reconstruction is increasing in popularity because of decreased surgical invasiveness and postoperative pain and the absence of animation deformity. Short-term outcomes studies comparing prepectoral breast reconstruction to partially submuscular techniques demonstrate similarly acceptable rates of postoperative complications. Aesthetic outcomes demonstrate similar rates of capsular contracture but increased rippling and implant palpability of the upper pole. Postoperative functional data are limited but overall show decreased pain and more rapid return of function but equivalent satisfaction on the BREAST-Q. Long-term aesthetic data and rates of revision are lacking.

Finesse in Mastopexy and Augmentation Mastopexy.

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe surgical techniques associated with mastopexy and mastopexy augmentation. 2. Understand the evolution of mastopexy and augmentation mastopexy. 3. Address patient goals. 4. Achieve a favorable cosmetic outcome. SUMMARY: The surgical techniques associated with mastopexy and mastopexy augmentation have continued to evolve. Traditional mastopexy techniques have included periareolar, circumvertical, and inverted-T patterns; however, adjuncts to these have included the use of various surgical mesh materials, implants, and fat grafting. This evidence-based article reviews how the techniques of mastopexy and augmentation mastopexy have evolved to best address patient goals and provide a favorable cosmetic outcome.

Investigation into the Effect of Breast Volume on Irradiation Dose Distribution in Asian Women with Breast Cancer.

Reports on irradiation dose distribution in breast cancer radiotherapy with sufficient sample size are limited in Asian patients. Elucidating dose distribution in Asian patients is particularly important as their breast volume differs compared to patients in Europe and North America. Here, we examined dose distribution in the irradiation field relative to breast volume for three irradiation methods historically used in our facility. We investigated the influence of breast volume on each irradiation method for Asian women. A total of 573 women with early-stage breast cancer were treated with breast-conserving surgery and adjuvant radiotherapy. Three methods were compared: wedge (W), field-in-field (FIF), and wedge-field-in-field (W-FIF). In patients with small breast volume, FIF decreased low- and high-dose areas within the planning target volume, and increased optimal dose area more than W. In patients with medium and large breast volumes, FIF decreased high-dose area more than W. The absolute values of correlation coefficients of breast volume to low-, optimal-, and high-dose areas and mean dose were significantly lower in FIF than in W. The correlation coefficients of V107% were 0.00 and 0.28 for FIF and W, respectively. FIF is an excellent irradiation method that is less affected by breast volume than W in Asian breast cancer patients.

Analysis of Geometric and Dosimetric Effects of Bra Application to Support Large or Pendulous Breasts During Radiotherapy Planning: A Retrospective Single-Center Study.

PURPOSE: To evaluate geometric and dosimetric effects of bra application during radiotherapy planning for breast cancer patients with large and pendulous breasts. MATERIALS AND METHODS: Twenty patients with chest sizes >38 inches between April 2019 and July 2019 underwent radiotherapy planning with and without a radiation bra (Chabner XRT®). Geometric and dosimetric parameters included the breast volume, superior-inferior (SI) distance, separation (S) as the distance of the longest diameter of the clinical target volume (CTV), conformity number (CN), and homogeneity index (HI) of CTV. The organs at risk (OARs) were defined as the lungs, heart, and liver. RESULTS: The use of the radiation bra provided mean changes of -0.51 cm for S, -1.45 cm for SI, and -61.18 cc for breast volume (all P < 0.05). Breast volume was correlated with bra-related changes in cross diameter (r = 0.641, P = 0.002) and volume (r = 0.680, P = 0.001). Significant dose reductions were observed for the lungs (mean V10: 19.58 cc, V20: 17.13 cc, Dmean: 86.24 cGy) and heart (Dmean: 170.23 cGy). No significant differences were observed for CN (0.62-0.67) and HI (0.19-0.20) of the CTV. CONCLUSION: The application of a radiation bra was associated with better geometric and dosimetric planning parameters, with a smaller CTV and lower doses to the OARs (lungs and heart) in the radiotherapy field. In addition, we expect that bra use during radiotherapy would provide emotional benefits.

Assessment of breast arteries and lymph nodes by 3D MR angiography enhancement imaging: feasibility and pilot clinical results.

BACKGROUND: Conventional dynamic contrast enhanced (DCE) magnetic resonance (MR) hardly achieves a good imaging performance of arteries and lymph nodes in the breast area. Therefore, a new imaging method is needed for the assessment of breast arteries and lymph nodes. METHODS: We performed prospective research. The research included 52 patients aged from 25 to 64 between June 2019 and April 2020. The isotropic e-THRIVE sequence scanned in the coronal direction after DCE-THRIVE. Reconstructed images obtained by DCE-THRIVE and the coronal e-THRIVE were compared mainly in terms of the completeness of the lateral thoracic artery, thoracodorsal artery, and lymph nodes. We proposed a criterion for evaluating image quality. According to the criterion, images were assigned a score from 1 to 5 according to the grade from low to high. Two board-certified doctors evaluated images individually, and their average score was taken as the final result. The chi-square test was used to assess the difference. RESULTS: The coronal e-THRIVE score is 4.60, which is higher than the DCE-THRIVE score of 3.48, there are significant differences between the images obtained by two sequences (P = 1.2712e-8). According to the score of images, 44 patients (84.61%) had high-quality images on the bilateral breast. Only 3 patients' (5.77%) images were not ideal on both sides. The improved method is effective for most patients to get better images. CONCLUSIONS: The proposed coronal e-THRIVE scan can get higher quality reconstruction images than the conventional method to visualize the course of arteries and the distribution of lymph nodes in most patients, which will be helpful for the clinical follow-up treatment.

The 10-Year Experience with Volume Distribution Mastopexy: A Novel, Safe, and Efficient Method for Breast Rejuvenation.

BACKGROUND: Recurrent ptosis may occur after mastopexy procedures over time. The volume distribution mastopexy technique provides breast lifting with projection enhancement and maintains breast suspension. METHOD: Since 2010, 50 patients underwent volume distribution mastopexy procedures. The technique consists of a superior or superomedial pedicle, dissection of a Würinger-septum-based chest wall flap, suspension of the flap to the pectoralis major muscle using a prosthetic mesh, gland suture to the mesh, and fat grafting if required. A prospective study was conducted. Nipple position and length of the lower pole distance of the breast were noted. Patient satisfaction and results evaluation were reported using a Likert scale. RESULTS: A Vicryl mesh was used in the first 23 patients and a mixed polyester/Vicryl mesh was used in the following 27 patients. Wound dehiscence occurred in one patient. At an average follow-up of 3 years, nipple position remained stable in position, but lower pole distance elongation was observed in five patients (20 percent) and in one patient (3 percent) who had Vicryl mesh and mixed mesh respectively (p < 0.05). Only four breasts (4.7 percent) demonstrated significant lower pole elongation over time (>15 percent), all in the Vicryl mesh group. Worth noting, both the patients and the independent evaluators provided high ratings of the result of 4.7 and 4.6, respectively, on a Likert scale. CONCLUSIONS: The volume distribution mastopexy technique repositions the ptotic gland with a mesh to suspend the breast gland and to maintain the lifting effect. However, the synthetic mixed mesh proved to be significantly more effective in achieving this goal. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.