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BACKGROUND: The amount of tissue resection, measured in weight per breast, in breast reduction surgery has been considered a potential risk factor for complications. OBJECTIVE: We aimed to evaluate the effect of removing >1000 g versus <1000 g of breast tissue in women with macromastia. METHODS: A systematic search was performed on Pubmed, Embase, and Cochrane in March 2024 for studies that compared resection weight >1000 g versus <1000 g in reduction mammoplasty. Pooled odds ratios were computed for binary endpoints. We used R Studio for statistical analysis. RESULTS: We included 8 studies, with 1760 breasts, among which 493 (28.1%) had resection of ≥1000 g per breast. Women who had >1000 g of tissue resected per breast had lower risk of developing hypertrophic scar (OR 0.07; 95% CI 0.02-0.25; p < 0.001) and surgical site infection (OR 0.17, 95% CI 0.07-0.42, p < 0.001) than those who had <1000 g of breast resection. No statistical difference was observed among the groups for the outcomes of delayed wound healing and dehiscence, hematoma, fat or areolar necrosis, overall complications rates, and seroma. CONCLUSION: Among women who underwent reduction mammoplasty, resection of >1000 g of tissue per breast was associated with lower risk of hypertrophic scar development and surgical site infection than resection of <1000 g.

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BACKGROUND: Botulinum toxin (BTX) is globally the most common aesthetic procedure. Its usage has expanded beyond facial treatments to therapeutic areas, including managing scars and postsurgical deformities. Breast cancer survivors often face significant deformities and asymmetry during recovery. OBJECTIVES: This study systematically reviewed literature from the past 4 years on botulinum toxin applications in breast cancer survivors and presented a case report of a patient treated with Incobotulinum toxin (IncoBonTA; Xeomin, Merz Pharmaceuticals GmbH, Frankfurt, Germany) for left breast deformity postchemotherapy and radiotherapy. METHODS: Following PRISMA guidelines, a systematic search was conducted on PubMed and Scopus using keywords: "botulinum toxin," "breast cancer," and "breast asymmetry," identifying relevant literature from 2020 to 2024. Five full-text articles were included. Additionally, a 2024 case report of a patient with significant breast asymmetry postsurgery and radiotherapy was published. RESULTS: The literature review indicated botulinum toxin's primary uses in breast cancer include pain management, upper limb impairment, postsurgical scars, and capsular contracture. Although some benefits were reported, further research is needed. In the case report, the patient was treated in one session with IncoBonTA at two different dilutions based on contracture severity without complications. CONCLUSION: The review showed promising advances in using botulinum toxin for deformities secondary to oncological treatment in breast cancer patients. The therapy was administered to a 53-year-old patient, resulting in significant aesthetic improvement, especially at the nipple and areola, suggesting that it was a viable option for these patients.

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El cáncer de mama es una de las neoplasias diagnosticadas con mayor frecuencia en las mujeres a nivel mundial y representa la segunda causa de muerte en este grupo poblacional. La prevención primaria es esencial para la detección temprana del cáncer de mama con énfasis en el tamizaje anual para brindar un tratamiento oportuno, basado en un manejo multidisciplinario que incluye las áreas de cirugía, oncología, patología y nutrición. Con el objetivo de estudiar el rol anticarcinogénico de los polifenoles en el cáncer de mama no metastásico, se realizó una búsqueda bibliográfica utilizanbdo las bases de datos Medline, HINARI, ARDI y SciELO. Se seleccionaron, revisaron y analizaron artículos originales en idioma inglés y español de fuentes de tipo primaria y secundaria. Los polifenoles son compuestos provenientes de la dieta que han adquirido importancia en los últimos años por su rol anticarcinogénico en la prevención y tratamiento de cáncer de mama no metastásico. Entre ellos se encuentran la curcumina, el resveratrol, la quercetina, el galato de epigalocatequina y la luteolina. Los polifenoles poseen propiedades antiinflamatorias, antioxidantes y anticarcinogénicas. Su introducción como medida de prevención podría disminuir la incidencia del cáncer de mama y, en aquellos casos con diagnóstico confirmado, mejorar el efecto del tratamiento quimioterapéutico

Breast cancer is one of the most frequently diagnosed neoplasms in women worldwide and represents the second leading cause of death in this population group. Primary prevention is essential for the early detection of breast cancer with emphasis on annual screening to provide timely treatment, based on a multidisciplinary management that includes the areas of surgery, oncology, pathology and nutrition. To study the anticarcinogenic role of polyphenols in non-metastatic breast cancer, a literature search was performed using the Medline, HINARI, ARDI, and SciELO databases. Original articles in English and Spanish from primary and secondary sources were selected, reviewed and analyzed. Polyphenols are dietary compounds that have gained importance in recent years for their anticarcinogenic role in the prevention and treatment of non-metastatic breast cancer. They include curcumin, resveratrol, quercetin, epigallocatechin gallate and luteolin. Polyphenols possess anti-inflammatory, antioxidant and anticarcinogenic properties. Their introduction as a preventive measure could reduce the incidence of breast cancer and, in those cases with a confirmed diagnosis, improve the effect of chemotherapeutic treatment

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This case report discusses the migration of a foreign body from the breast to the mediastinum, which is rarely reported, and highlights complications associated with Okibari acupuncture. This technique involves the insertion of metal fragments into the skin. A 53-year-old woman underwent mammography showing acupuncture-related metallic fragments in the breast. Cardiac evaluation revealed the presence of metallic fragments in the right ventricle and myocardium. Despite the fragments' location in the mediastinum, the patient remained asymptomatic, leading us to take a conservative approach. This case highlights the importance of awareness of the potential complications of foreign bodies and emphasizes the need for careful monitoring.

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Quantitative ultrasound is a non-invasive image modality that numerically characterizes tissues for medical diagnosis using acoustical parameters, such as the attenuation coefficient slope. A previous study introduced the total variation spectral log difference (TVSLD) method, which denoises spectral log ratios on a single-channel basis without inter-channel coupling. Therefore, this work proposes a multi-frequency joint framework by coupling information across frequency channels exploiting structural similarities among the spectral ratios to increase the quality of the attenuation images. A modification based on the total nuclear variation (TNV) was considered. Metrics were compared to the TVSLD method with simulated and experimental phantoms and two samples of fibroadenoma in vivo breast tissue. The TNV demonstrated superior performance, yielding enhanced attenuation coefficient slope maps with fewer artifacts at boundaries and a stable error. In terms of the contrast-to-noise ratio enhancement, the TNV approach obtained an average percentage improvement of 34% in simulation, 38% in the experimental phantom, and 89% in two in vivo breast tissue samples compared to TVSLD, showing potential to enhance visual clarity and depiction of attenuation images.

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The practice of hormone therapy is crucial in aligning secondary sex characteristics with the gender identity of transgender adults. This study examines the effects of a commonly used injectable hormone combination, specifically estradiol enanthate with dihydroxyprogesterone acetophenide (EEn/DHPA), on serum hormonal levels and self-reported satisfaction with breast development in transwomen. Our research focused on a retrospective longitudinal study involving a large cohort of transwomen evaluated between 2020 and 2022, comprising 101 participants. We assessed serum levels of estradiol (E2), testosterone (T), luteinizing hormone (LH), and follicle-stimulating hormone (FSH), comparing the EEn/DHPA hormonal regimen with other combined estrogen-progestogen (CEP) therapies. Additionally, a subset of 43 transwomen completed a 5-question survey to evaluate self-reported satisfaction with breast development using Tanner scales. Our findings indicated that participants using the EEn/DHPA regimen exhibited significantly higher serum E2 levels (mean: 186 pg/mL ± 32 pg/mL) than those using other therapies (62 ± 7 pg/mL), along with lower FSH levels, but no significant differences in T and LH levels. Concerning satisfaction with breast development, 76% reported increased fulfillment with breast augmentation while using EEn/DHPA. These results suggest that an injectable, low-cost EEn/DHPA administered every three weeks could serve as an alternative feminizing regimen, particularly considering the extensive long-term experience of the local transgender community. Further longitudinal studies on the efficacy of feminizing-body effects and endovascular risks of various parenteral CEP types are warranted to improve primary healthcare provision for transgender persons.

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The mammary gland is an exocrine gland whose main function is to produce milk. Breast morphogenesis begins in the embryonic period; however, its greatest development takes place during the lactation period. Studies have found the expression of serum amyloid A protein (SAA) in both breast cells and breast milk, yet the function of this protein in these contexts remains unknown. Insufficient milk production is one of the most frequent reasons for early weaning, a problem that can be related to the mother, the newborn, or both. This study aims to investigate the relationship between lactogenesis II (the onset of milk secretion) and the role of SAA in the human breast. To this end, mammary epithelial cell cultures were evaluated for the expression of SAA and the influence of various cytokines. Additionally, we sought to assess the activation pathway through which SAA acts in the breast, its glucose uptake capacity, and the morphological changes induced by SAA treatment. SAA expression was observed in mammary epithelial cells; however, it was not possible to establish its activation pathway, as treatments with inhibitors of the ERK1/2, p38MAPK, and PI3K pathways did not alter its expression. This study demonstrated that SAA can stimulate IL-6 expression, inhibit glucose uptake, and cause morphological changes in the cells, indicative of cellular stress. These mechanisms could potentially contribute to early breastfeeding cessation due to reduced milk production and breast involution.

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Infrared thermography is gaining relevance in breast cancer assessment. For this purpose, breast segmentation in thermograms is an important task for performing automatic image analysis and detecting possible temperature changes that indicate the presence of malignancy. However, it is not a simple task since the breast limit borders, especially the top borders, often have low contrast, making it difficult to isolate the breast area. Several algorithms have been proposed for breast segmentation, but these highly depend on the contrast at the lower breast borders and on filtering algorithms to remove false edges. This work focuses on taking advantage of the distinctive inframammary shape to simplify the definition of the lower breast border, regardless of the contrast level, which indeed also provides a strong anatomical reference to support the definition of the poorly marked upper boundary of the breasts, which has been one of the major challenges in the literature. In order to demonstrate viability of the proposed technique for an automatic breast segmentation, we applied it to a database with 180 thermograms and compared their results with those reported by others in the literature. We found that our approach achieved a high performance, in terms of Intersection over Union of 0.934, even higher than that reported by artificial intelligence algorithms. The performance is invariant to breast sizes and thermal contrast of the images.

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Objective.Accurate simulation of human tissues is imperative for advancements in diagnostic imaging, particularly in the fields of dosimetry and image quality evaluation. Developing Tissue Equivalent Materials (TEMs) with radiological characteristics akin to those of human tissues is essential for ensuring the reliability and relevance of imaging studies. This study presents the development of a mathematical model and a new toolkit (TEMPy) for obtaining the best composition of materials that mimic the radiological characteristics of human tissues. The model and the toolkit are described, along with an example showcasing its application to obtain desired TEMs.Approach.The methodology consisted of fitting volume fractions of the components of TEM in order to determine its linear attenuation coefficient as close as possible to the linear attenuation coefficient of the reference material. The fitting procedure adopted a modified Least Square Method including a weight function. This function reflects the contribution of the x-ray spectra in the suitable energy range of interest. TEMPy can also be used to estimate the effective atomic number and electron density of the resulting TEM.Main results.TEMPy was used to obtain the chemical composition of materials equivalent to water and soft tissue, in the energy range used in x-ray imaging (10 -150 keV) and for breast tissue using the energy range (5-40 keV). The maximum relative difference between the linear attenuation coefficients of the developed and reference materials was ±5% in the considered energy ranges.Significance.TEMPy facilitates the formulation of TEMs with radiological properties closely mimicking those of real tissues, aiding in the preparation of physical anthropomorphic or geometric phantoms for various applications. The toolkit is freely available to interested readers.

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Mobile health apps are widely used for breast cancer detection using artificial intelligence algorithms, providing radiologists with second opinions and reducing false diagnoses. This study aims to develop an open-source mobile app named "BraNet" for 2D breast imaging segmentation and classification using deep learning algorithms. During the phase off-line, an SNGAN model was previously trained for synthetic image generation, and subsequently, these images were used to pre-trained SAM and ResNet18 segmentation and classification models. During phase online, the BraNet app was developed using the react native framework, offering a modular deep-learning pipeline for mammography (DM) and ultrasound (US) breast imaging classification. This application operates on a client-server architecture and was implemented in Python for iOS and Android devices. Then, two diagnostic radiologists were given a reading test of 290 total original RoI images to assign the perceived breast tissue type. The reader's agreement was assessed using the kappa coefficient. The BraNet App Mobil exhibited the highest accuracy in benign and malignant US images (94.7%/93.6%) classification compared to DM during training I (80.9%/76.9%) and training II (73.7/72.3%). The information contrasts with radiological experts' accuracy, with DM classification being 29%, concerning US 70% for both readers, because they achieved a higher accuracy in US ROI classification than DM images. The kappa value indicates a fair agreement (0.3) for DM images and moderate agreement (0.4) for US images in both readers. It means that not only the amount of data is essential in training deep learning algorithms. Also, it is vital to consider the variety of abnormalities, especially in the mammography data, where several BI-RADS categories are present (microcalcifications, nodules, mass, asymmetry, and dense breasts) and can affect the API accuracy model.

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BACKGROUND: Approximately 30 % of cardiac surgeries are conducted on women by median sternotomy, which often causes discomfort such as pain, affects quality of life, and delayed recovery compared with men. Breast size is related to operative wound complications, such as incisional pain, sternum dehiscence, and infection, which may affect hospital costs due to prolonged hospital stays. OBJECTIVE: To evaluate breast size and operative wound complications and the effect of breast support on the incidence of pain, infection, and quality of life in women after coronary artery bypass grafting. METHOD: Women were randomly assigned to one of three groups: group A (surgical breast support), group B (ordinary breast support), and group C (no-support). Observations were taken daily between the second and seventh postoperative days and at 30, 60, and 180 days. Pain was assessed using the Short-Form 36 Health Survey (SF36) for quality of life and a verbal numerical scale. The authors used the nonparametric Kruskal-Wallis and Friedman tests to examine variance. The authors used the Pearson correlation coefficient or the Spearman correlation for correlations between variables. A multivariate study was conducted to evaluate the occurrence of infection, and the logistic regression model with "stepwise" variable selection was used. A linear regression model with the "stepwise" variable selection was also used for hospitalization. The authors used SPSS 17.0 software for Windows, with a significance level of p < 0.05. RESULTS: There was no difference in pain evaluation between the groups in 190 women (p > 0.05). When comparing quality of life, there was a statistically significant difference in the functional capacity domain at 30 and 60 days, with group A having the best functional capacity (p < 0.05). The larger the breast size, the longer the hospital stay (p < 0.001) and the higher the probability of infection (p = 0.032). Patients with a history of stroke had a 3.8 higher incidence of infection (p = 0.040). CONCLUSION: The use of surgical support did not affect acute pain or sternal infection rate in the 6-month follow-up. However, it was effective in the functional capacity domain 30 days after surgery and maintained at 60 days.

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Artifacts and foreign bodies can mimic microcalcifications. We report a series of 17 postsurgical women in whom mammograms showed fine linear radiodensities at the surgical bed. Vacuum-assisted biopsy histopathology of one of the lesions showed foreign bodies of different sizes with macrophage reaction. After discussion with the surgeons, we ascertained that a particular type of gauze was used that had fragmented, and we reproduced the mammographic appearance in a chicken breast. Furthermore, we showed the same pathology was reproduced in mice implanted with the gauze threads. It is important to be aware of this entity to avoid unnecessary examinations and even biopsy. The presence of foreign body linear gauze fragments at the surgical site can pose challenges in the mammographic follow-up of these patients.

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CONTEXT: Ectopic fat depots are related to the deregulation of energy homeostasis, leading to diseases related to obesity and metabolic syndrome (MetS). Despite significant changes in body composition over women's lifespans, little is known about the role of breast adipose tissue (BrAT) and its possible utilization as an ectopic fat depot in women of different menopausal statuses. OBJECTIVE: We aimed to assess the relationship between BrAT and metabolic glycemic and lipid profiles and body composition parameters in adult women. METHODS: In this cross-sectional study, we enrolled adult women undergoing routine mammograms and performed history and physical examination, body composition assessment, semi-automated assessment of breast adiposity (BA) from mammograms, and fasting blood collection for biochemical analysis. Correlations and multivariate regression analysis were used to examine associations of BA with metabolic and body composition parameters. RESULTS: Of the 101 participants included in the final analysis, 76.2% were in menopause, and 23.8% were in premenopause. The BA was positively related with fasting plasma glucose, glycated hemoglobin, homeostasis model assessment of insulin resistance, body mass index, waist circumference, body fat percentage, and abdominal visceral and subcutaneous fat when adjusted for age among women in postmenopause. Also, the BA was an independent predictor of hyperglycemia and MetS. These associations were not present among women in premenopause. CONCLUSION: The BA was related to different adverse body composition and metabolic factors in women in postmenopause. The results suggest that there might be a relevant BrAT endocrine role during menopause, with mechanisms yet to be clarified, thus opening up research perspectives on the subject and potential clinical implications.

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OBJECTIVE: To obtain breast cancer survival estimates in Manizales, Colombia, considering socioeconomic level, health insurance regime and residential area, while adjusting for age, histology and stage at diagnosis. METHODS: Analytical cohort study based on breast cancer incident cases recorded by the Population-based Manizales Cancer Registry between 2008-2015. Patients were followed-up for 60 months. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the Wilcoxon-Breslow-Gehan test for differences. Cox multivariate regression models were fitted. RESULTS: 856 breast cancer cases were included. The 5-year cause-specific survival for the entire cohort was 78.2%. It was higher in women with special/exception health insurance, high socioeconomic level, <50 years old, ductal carcinoma, and stages I and II. Residential area did not impact survival. In Cox models, the subsidized health insurance regime (HR: 4.87 vs contributory) and low socioeconomic level (HR: 2.45 vs high) were predictors of the hazard of death in women with breast cancer, adjusted for age, histology, stage and interactions age-stage and insurance-stage. A positive interaction (synergistic effect modification) between health insurance regime and stage regarding to survival was observed. CONCLUSION: Socioeconomic factors significantly contribute to the inequities in breast cancer survival, independent of the stage at diagnosis. This suggests the need for comprehensive interventions to remove barriers to accessing the health system. This research provides evidence of survival gaps mediated by certain social determinants of health and generates data on the overall performance of the Colombian health system.

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Whether trace metals modify breast density, the strongest predictor for breast cancer, during critical developmental stages such as puberty remains understudied. Our study prospectively evaluated the association between trace metals at Tanner breast stage B1 (n = 291) and at stages both B1 and B4 (n = 253) and breast density at 2 years post-menarche among Chilean girls from the Growth and Obesity Cohort Study. Dual-energy x-ray absorptiometry assessed the volume of dense breast tissue (absolute fibroglandular volume [FGV]) and percent breast density (%FGV). Urine trace metals included arsenic, barium, cadmium, cobalt, cesium, copper, magnesium, manganese, molybdenum, nickel, lead, antimony, selenium, tin, thallium, vanadium, and zinc. At B1, a doubling of thallium concentration resulted in 13.69 cm3 increase in absolute FGV (ß: 13.69, 95% confidence interval [CI]: 2.81, 24.52), while a doubling of lead concentration resulted in a 7.76 cm3 decrease in absolute FGV (ß: -7.76, 95%CI: -14.71, -0.73). At B4, a doubling of barium concentration was associated with a 10.06 cm3 increase (ß: 10.06, 95% CI: 1.44, 18.60), copper concentration with a 12.29 cm3 increase (ß: 12.29, 95% CI: 2.78, 21.56), lead concentration with a 9.86 cm3 increase (ß: 9.86, 95% CI: 0.73, 18.98), antimony concentration with a 12.97 cm3 increase (ß: 12.97, 95% CI: 1.98, 23.79) and vanadium concentration with a 13.14 cm3 increase in absolute FGV (ß: 13.14, 95% CI: 2.73, 23.58). Trace metals may affect pubertal breast density at varying developmental stages with implications for increased susceptibility for breast cancer.

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BACKGROUND: Sentinel lymph node biopsy in breast cancer is considered the standard of staging in cases of clinically negative lymph nodes. Its omission in favor of axillary dissection generates significant morbidity. OBJECTIVE: To determine the total number of sentinel node biopsy procedures in breast cancer in Colombia from 2017 through 2020, model and analyze them as if they were performed only in stage I breast cancer patients, and integrate their results into the concepts of quality of medical care. METHODS: Search in a database of the Ministry of Health and Social Protection of Colombia with sentinel lymph node biopsy codes, and filters of breast cancer and year. Their results are contrasted with the number of cases in stage I of breast cancer. RESULTS: Breast cancer TNM staging was reported in 22154 cases, 3648 stage I. In the same time frame, the number of sentinel lymph node biopsies for breast cancer in Colombia was 1045, 28.64% of the total cases reported in stage I. CONCLUSIONS: Colombia is far from complying with the standard indicator of sentinel lymph node biopsy. It is recommended to concentrate breast cancer cases in hospitals that provide the conditions for its performance.

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PURPOSE: Breast density is a significant risk factor for breast cancer and can impact the sensitivity of screening mammography. Area-based breast density measurements may not provide an accurate representation of the tissue distribution, therefore volumetric breast density (VBD) measurements are preferred. Dual-energy mammography enables volumetric measurements without additional assumptions about breast shape. In this work we evaluated the performance of a dual-energy decomposition technique for determining VBD by applying it to virtual anthropomorphic phantoms. METHODS: The dual-energy decomposition formalism was used to quantify VBD on simulated dual-energy images of anthropomorphic virtual phantoms with known tissue distributions. We simulated 150 phantoms with volumes ranging from 50 to 709 mL and VBD ranging from 15% to 60%. Using these results, we validated a correction for the presence of skin and assessed the method's intrinsic bias and variability. As a proof of concept, the method was applied to 14 sets of clinical dual-energy images, and the resulting breast densities were compared to magnetic resonance imaging (MRI) measurements. RESULTS: Virtual phantom VBD measurements exhibited a strong correlation (Pearson's r > 0.95 $r > 0.95$ ) with nominal values. The proposed skin correction eliminated the variability due to breast size and reduced the bias in VBD to a constant value of -2%. Disagreement between clinical VBD measurements using MRI and dual-energy mammography was under 10%, and the difference in the distributions was statistically non-significant. VBD measurements in both modalities had a moderate correlation (Spearman's ρ $\rho \ $ = 0.68). CONCLUSIONS: Our results in virtual phantoms indicate that the material decomposition method can produce accurate VBD measurements if the presence of a third material (skin) is considered. The results from our proof of concept showed agreement between MRI and dual-energy mammography VBD. Assessment of VBD using dual-energy images could provide complementary information in dual-energy mammography and tomosynthesis examinations.

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This project addresses the global challenge of breast cancer, particularly in low-resource settings, by creating a pioneering mammography database. Breast cancer, identified by the World Health Organization as a leading cause of cancer death among women, often faces diagnostic and treatment resource constraints in low- and middle-income countries. To enhance early diagnosis and address educational setbacks, the project focuses on leveraging artificial intelligence (AI) technologies through a comprehensive database. Developed in collaboration with Ambra Health, a cloud-based medical image management software, the database comprises 941 mammography images from 100 anonymized cases, with 62 % including 3D images. Accessible through http://mamografia.unifesp.br, the platform facilitates a simple registration process and an advanced search system based on 169 clinical and imaging variables. The website, customizable to the user's native language, ensures data security through an automatic anonymization system. By providing high-resolution, 3D digital images and supplementary clinical information, the platform aims to promote education and research in breast cancer diagnosis, representing a significant advancement in resource-constrained healthcare environments.

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BACKGROUND: Masculinizing mammoplasty is a surgical procedure frequently performed in transmale individuals. Despite providing a positive impact for the patient, this surgery has high rates of complications and revisions. In cases requiring a double incision, there are advantages in using an inferior pedicle when possible. METHODS: This was an observational study. Outcomes and complications were analyzed in 104 patients operated on by the author using three techniques: concentric periareolar surgery, double incision with an areola graft, and double incision with an inferior areolar pedicle. The Breast-Q questionnaire adapted for transgender males was applied. RESULTS: The responses of the adapted Breast-Q questionnaires demonstrated high scores regarding quality of life and satisfaction. The rates of complications and surgical revisions were 24.3 and 25.6%, respectively, with no significant difference between the techniques. The most common complication was hematoma (13.6%), which was positively associated with the use of testosterone. Ischemia of the nipple-areola complex was present in 8.7% of the operated breasts. When using the inferior pedicle, areola ischemia occurred more often when the nipple-fold distance was greater than 8 cm. CONCLUSIONS: Quality of life, satisfaction, complications, and revisions were comparable to those observed in the literature. Hematoma was the most frequent complication, and an association with the use of testosterone was observed. When a double incision is indicated, the inferior pedicle is more advantageous than the areola graft; however, it should be used when the distance between the nipple and the inframammary fold is 8 cm or less. 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 .

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BACKGROUND: Scarce evidence exists on barriers to physical activity in Mexican women. Despite evidence from other countries, no research has investigated the influence of the breast on PA in this population. OBJECTIVE: To determine the association between the breast and physical activity in Mexican women. DESIGN: Cross-sectional observational study. METHODS: Volunteers were 279 Mexican women from Veracruz, Durango, and Baja California states, who completed a paper survey of their demographics, brassiere characteristics, breast pain, and frequency and amounts of weekly physical activity. RESULTS: The first barrier to physical activity was time constraints, followed by breast-related issues. Breast pain was reported by 47.1% of women, and the breast as a barrier to physical activity participation was reported by 30.6%. Responses, such as "I am embarrassed by excessive breast movement" and "My breasts are too big" were the most frequently reported breast-related barriers to physical activity. Breast pain was associated with the menstrual cycle and exercise. Breast health knowledge and pain intensity were unrelated to moderate- and vigorous-intensity physical activity. The 36.4% and 6.7% of women did not meet weekly moderate- and vigorous-intensity physical activity guidelines, respectively. Weekly moderate- and vigorous-intensity physical activity was similar between women reporting breast pain and those who did not. CONCLUSIONS: Because the breast was the second most significant barrier to physical activity, it is imperative to increase breast health knowledge in Mexican women to reduce impediments to physical activity.

Perception of Mexican women regarding their breasts as a barrier to physical activityPhysical activity provides numerous health benefits, sometimes associated with reversing or delaying several diseases. However, barriers to increasing physical activity in women remain, as the breast is an anatomical aspect that is unique to women. Breast pain has been reported in more than 50% of women who perform physical exercise. Therefore, the study aimed to determine the associations between breast characteristics and barriers to physical activity in Mexican women. Two hundred and seventy-nine women from three Mexican states voluntarily participated in the study. They answered survey questions on the history of bra use, barriers to physical activity, and essential demographic characteristics. The main findings of this study were that issues related to the breasts were reported as the second barrier to physical activity participation. In addition, time constraints were reported as the main reason impeding physical activity participation. Public health initiatives should support attempts to increase breast satisfaction among women of all breast sizes to stimulate engagement in physical activity throughout their lives.