Using Photogrammetry to Analyze Anatomical Changes in the Nipple in Juvenile and Adolescent Scoliosis Patients.

BACKGROUND: The need for an objective set of anterior trunk measurements, such as nipple and clavicular shoulder joints, is essential to quantify the anterior asymmetry present in scoliosis. This study aims to characterize breast asymmetry (BA) in young individuals with scoliosis using photogrammetry. METHODS: Digital photographs of the anterior trunk of the 51 scoliosis patients aged 4-20 years were taken from an anterior perspective. These images were then transferred to a computer. Ten parameters were measured using the ImageJ software. The positions of patients' nipples were classified into 6 types based on ratios on the x-axis. RESULTS: The majority of patients had a right breast that was larger, intensifying the apparent BA due to trunk rotation. The apical vertebra level in patients was found at T8 in 23.6% and T9 in 45.1%. In 92.5% of the patients, the right breast was consistently larger. The lengths between the lateral boundaries and nipples of the right and left breasts and between the medial boundary and nipple of the right breast were statistically significantly higher in males than in females (p < 0.05). Significant differences were found when comparing the values of the lengths between the medial boundaries and nipples of the right and left breasts, the difference in length between the right and left acromioclavicular joint lines, and the angles of the nipple and acromioclavicular joint with the degrees of scoliosis in juvenile and adolescents (p < 0.05). Pearson regression analysis revealed a significant correlation between BA differences and the Cobb angle with a correlation coefficient of 0.901. Factors related to breast aesthetics, like differences in the height of nipples and the distance from the sternal notch to the nipple, represent 30% of the overall score. CONCLUSION: The study concluded that there is a significant correlation between the severity of scoliosis and BA differences. Augmentation mammaplasty for BA not only decreased the breast difference but also leveled the nipple disparities. Photogrammetry is considered to be an alternative to other methods and is believed to contribute to the follow-up of BA. 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 .

Quantitative Analysis of the Histological Features of Tuberous Breast.

INTRODUCTION: Tuberous breast deformity (TB) is a condition mostly characterized by breast stenosis, areolar widening and glandular asymmetry. The most accredited hypothesis describes an abnormal thickening of the fascia corporis that might influence an alteration in the glandular development, limiting the horizontal growth of breast parenchyma. Alterations in the extracellular matrix components (ECM) might be involved in the abnormal breast development. PATIENTS: The aim of our case control study is to use histological specimens to analyze qualitative and quantitative differences in collagen fibers, elastic fibers and vessel densities in TB and normal breasts of 20 patients using a software for digital pathology. RESULTS: The quantitative findings showed increasing concentrations of collagen fibers and decreasing elastic fibers in TB, compared to normal breasts. No difference was seen in vessel density among the two groups. The qualitative findings highlighted differences in the distribution of the ECM among the TB specimens. Collagen fibers showed a packed appearance rather a scattered distribution, while elastic fibers visibly presented a reduction and a focal distribution of their concentration. CONCLUSIONS: The study proposes a correlation between abnormalities in ECM concentrations and TB, resulting in a higher degree of fibrosis and in the characteristic stenotic and less elastic morphology of the deformity. 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 .

Body Self-Perception After Breast Reconstruction in Young Female Patients Affected by Poland Syndrome.

BACKGROUND: Cosmetic and social aspects of breast anomalies in Poland syndrome are not negligible. Early diagnosis and appropriate therapeutic timing may have a positive impact on quality of life. METHODS: Females affected by Poland syndrome, who had breast reconstruction between 2014 and 2018, were asked to complete the Body Uneasiness Test and the postoperative Breast-Q. Correlation between scores was evaluated. Correlation between scores was statistically evaluated. RESULTS: Thirty patients who had completed breast reconstruction at 20.9 ± 6.5 yo fulfilled the questionnaires at the average age of 26.5 ± 8.1 yo. BUT scores were similar to healthy population considering different age groups, with the exception of Compulsive Self-Monitoring subscale for 16-17-year age group. A correlation between Depersonalization and "Thighs" and "Legs" was present. On average, satisfaction with breast resulted 79.1%, satisfaction with surgical outcome was 94.9%, psychosocial well-being was 78.5%, sexual well-being was 75.3%, and relative physical well-being in chest and upper body was 36.9%. Global Uneasiness, Avoidance, Weight Phobia, Body Image Concern and Depersonalization were significantly correlated with lower psychosocial well-being. Avoidance was significantly correlated with lower sexual well-being. CONCLUSIONS: Breast reconstruction in Poland syndrome can help to improve quality of life. However, general body uneasiness can affect satisfaction with the final result. 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 http://www.springer.com/00266 .

Tuberous Breast, Deformities, and Asymmetries: A Retrospective Analysis Comparing Fat Grafting Versus Mastopexy and Breast Implants.

BACKGROUND: The tuberous breast is considered a breast deformity characterized by varying degrees of herniation of the parenchyma, widened nipple-areolar complex (NAC), absence of the lower quadrants, and may involve several degrees of hypoplasia and asymmetry causing significant psychosocial distress. OBJECTIVES: The paper aimed to compare the results obtained in patients suffering tuberous breast treated with fat grafting (FG), with those of patients treated with a mastopexy and silicone implants (M-SI) also analyzing the influence of breast and chest deformities (degrees of hypoplasia and tuberous breast, volume and NAC asymmetry, pectus excavatum, and carinatum) in the reconstructive outcomes. METHODS: A retrospective, case-control study was conducted. Thirty-five patients affected by tuberous breast with several degrees of hypoplasia and asymmetry were treated with FG, comparing results with those of 30 patients treated with M-SI. Postoperative follow-up took place at 1, 3, 7, 12, 24, 48, weeks, and then annually for 2 years. RESULTS: 77% (n = 27) of patients treated with two FG procedures showed excellent results after 1 year compared with the patients treated with only one M-SI procedure, who showed the same results in 73% (n = 22) of cases, but the naturalness and the satisfaction degree in the FG group were higher than that in the M-SI group (p < .0001 vs. M-SI group). CONCLUSIONS: Patients treated with FG showed natural breasts without scars and excellent cosmetic results after two procedures. Patients treated with M-SI showed more evident and lasting results after only one procedure, presenting though scars and less natural results. 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.

Comparison of Outcomes for One-View Asymmetries Recalled From Digital Breast Tomosynthesis Versus Full-Field Digital Mammography Screening Examinations.

BACKGROUND. Recall rates are lower for digital breast tomosynthesis (DBT) than for full-field digital mammography (FFDM). This difference could have important implications with respect to one-view asymmetries given that missed cancers are often visible on one view. OBJECTIVE. The purpose of this study is to compare the outcomes of one-view asymmetries recalled from DBT versus FFDM screening examinations and to determine predictors of malignancy among recalled asymmetries. METHODS. This retrospective study first determined recall rates associated with one-view asymmetries for screening mammography performed using DBT and FFDM from July 14, 2016, through July 14, 2020. Further analyses included patients recalled for a one-view asymmetry who completed subsequent diagnostic workup and all recommended follow-up. Patient and cancer characteristics were extracted from the electronic health record. RESULTS. The recall rate associated with asymmetries was lower for DBT screening (2.5% [3169/128,755]) than for FFDM screening (3.4% [815/23,898]) (p < .001). Further analyses of patients who completed diagnostic workup and subsequent follow-up included 3119 patients (mean age, 57 years) for DBT screening and 811 patients (mean age, 56 years) for FFDM screening. Distribution of final BI-RADS categories from subsequent diagnostic workup was not different between the two modalities (p > .99). The frequency of malignancy was not different between asymmetries recalled from DBT (1.7% [54/3119]) and FFDM (1.7% [14/811]) (p > .99). Malignant asymmetries identified on FFDM versus DBT were more frequently associated with architectural distortion on diagnostic workup (35.7% [5/14] vs 9.3% [5/54]) (p < .001) and were more commonly invasive ductal carcinoma (92.9% vs 57.4%) and less commonly invasive lobular carcinoma (0.0% vs 24.1%) (p = .05). In multivariable analysis, independent predictors of malignancy among recalled asymmetries from DBT were age (for 55-69 years, odds ratio [OR] = 2.40 [p = .04]; for ≥ 70 years, OR = 7.93 [p < .001]; reference, < 55 years) and breast density (not dense, OR = 2.47 [p = .001]; reference, dense breasts). CONCLUSION. Recalled asymmetries were less frequent for DBT than for FFDM. The malignancy rate was low for both modalities (1.7%). Age 55 years old and older and lower breast density predicted malignancy for DBT-recalled asymmetries. CLINICAL IMPACT. Our results support the use of DBT to reduce unnecessary recalls without altering PPV for asymmetry-associated malignancies. Patient factors should be considered when assessing whether a potential asymmetry on DBT screening represents overlapping fibroglandular tissue or a suspicious finding that requires diagnostic workup.

Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results.

PURPOSE: Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results. METHODS: Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q™), and breast volumetry based on 3D scans (Vectra® H2, Canfield Scientific). RESULTS: Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively. CONCLUSION: Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.

Implants Versus Lipograft: Analysis of Long-Term Results Following Congenital Breast Asymmetry Correction.

AIMS: Congenital breast asymmetry represents a particular challenge to the classic techniques of plastic surgery given the young age of patients at presentation. This study reviews and compares the long-term results of traditional breast augmentation using silicone implants and the more innovative technique of lipografting. METHODS: To achieve this, we not only captured subjective parameters such as satisfaction with outcome and symmetry, but also objective parameters including breast volume and anthropometric measurements. The objective examination was performed manually and by using the Vectra® H2 photogrammetry scanning system. RESULTS: Differences between patients undergoing either implant augmentation or lipograft were revealed not to be significant with respect to patient satisfaction with surgical outcome (p = 0.55) and symmetry (p = 0.69). Furthermore, a breast symmetry of 93 % was reported in both groups. Likewise, no statistically significant volume difference between the left and right breasts was observed in both groups (p < 0.41). However, lipograft patients needed on average 2.9 procedures to achieve the desired result, compared with 1.3 for implant augmentation. In contrast, patients treated with implant augmentation may require a number of implant changes during their lifetime. CONCLUSION: Both methods may be considered for patients presenting with congenital breast asymmetry. 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 .

[Breasts and congenital chest-wall deformities: Surgical strategy with 3D implants]. / Le sein et les malformations thoraciques : stratégie chirurgicale et implants.

Computer-aided design and manufacturing of custom-made elastomer implants leads from a CT scan to fill in with precision, a congenital chest wall congenital deformity, both bone (pectus excavatum) and muscle (Poland Syndrome), resulting in a natural repositioning of the breasts. We report our 25 years' experience in 301 women (234 Pectus+64 Poland). Parietal correction must always be done in first intention. It is common to have to carry out a second stage in women with an additional mammaplasty especially in the presence of insufficient glandular volume or a fairly frequently associated tuberous breast.

Talking about breast symmetry in the breast cancer clinic: What can we learn from an examination of clinical interaction?

BACKGROUND: Breast asymmetry is a common post-operative outcome for women with breast cancer. Quality of cosmetic result is viewed clinically as a critical endpoint of surgery. However, research suggests that aesthetic standards governing breast reconstruction can be unrealistic and may problematically enforce feminine appearance norms. The aim of reconstructive procedures is to help women live well with and beyond breast cancer. Therefore, understanding how patients and clinicians talk about surgical outcomes is important. However, we lack evidence about such discussions. OBJECTIVE: To examine clinical communication about breast symmetry in real-time consultations in a breast cancer clinic. DESIGN: Seventy-three consultations between 16 clinicians and 47 patients were video-recorded, transcribed and analysed using conversation analysis. RESULTS: In most cases, patients do considerable interactional work to persuade clinicians of the validity of their concerns regarding breast asymmetry, and clinicians legitimize these concerns, aligning with patients. In a significant minority of cases, patients appear more accepting of their treatment outcome, but clinicians prioritize symmetry or treat symmetry with the presence of breast tissue as normative, generating misalignment between clinician and patient. CONCLUSION: Current clinical communication guidelines and practices may inadvertently reinforce culturally normative assumptions regarding the desirability of full, symmetrical breasts that are not held by all women. Clinicians and medical educators may benefit from detailed engagement with recordings of clinical communication like those analysed here, to reflect on which communicative practices may work best to attend to a patient's individual stance on breast symmetry, and optimize doctor-patient alignment.

Balancing Nipple and Inframammary Fold in Transaxillary Augmentation Mammaplasty with Anatomical Implant: The 'NIMF' Classification and Surgical Algorithm.

BACKGROUND: This study aims to put forward a new classification of breast asymmetry based on the relative position of the nipple and inframammary fold (IMF) and propose a surgical algorithm of determining new IMF to address breast asymmetry in patients undergoing transaxillary augmentation mammaplasty, which is named as NIMF (nipple inframammary) classification and surgical algorithm. METHODS: Three hundred and forty-five patients received transaxillary augmentation mammaplasty with anatomical implants. Preoperative breast asymmetry was classified into four types. I: asymmetrical nipple with asymmetrical IMF in the same direction; II: symmetrical nipple with asymmetrical IMF; III: asymmetrical nipple with symmetrical IMF; IV: asymmetrical nipple with unapparent IMF. Surgical plans (3 plans for type I, II, IV while 5 plans for type III) to set the new IMF were provided for each patient, who chose one of them as the final surgical plan. Breast-Q and Likert scale were used to evaluate patient satisfaction and symmetry of breast preoperatively and 6 months postoperatively. RESULTS: The incidence of type I, II, III, IV was 30%, 15%, 13%, and 4%, respectively. Ninety-seven percent of patients with breast asymmetry chose plan C, which aimed to balance the relative position of nipple and IMF. Postoperative Breast-Q scores showed a significant rise compared with preoperative scores, but no statistical difference between plan C V.S. other plans. Patients with symmetrical preoperative breasts (Group A) had significantly higher postoperative Breast-Q scores than patients with asymmetrical preoperative breasts (Group B). In breast symmetry assessment, Group A had a significantly higher postoperative score than Group B, but the postoperative score was significantly lowered compared with the preoperative score in both Group A and B. CONCLUSION: The NIMF classification and surgical algorithm provide a systematic and scientific way to analyze and improve breast asymmetry, to achieve optimized patient satisfaction in transaxillary augmentation mammaplasty with anatomical implants. 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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Congenital breast deformities: Anatomical basis and surgical approaches for optimal aesthetic outcomes.

Plastic surgeons routinely encounter patients desiring correction of breast asymmetry, hypoplastic growth, or other aesthetic concerns. An appropriate recognition of congenital breast conditions is critical for plastic surgeons. Without consideration of underlying anatomical abnormalities in these patients, surgical intervention may not result in optimal aesthetic outcomes. Often, patients are unaware of their congenital condition and the limitations and difficulties associated with reconstruction must be discussed with the patient preoperatively to ensure optimal aesthetic outcomes. The goal of this article was to summarize the anatomical basis for common congenital breast conditions and discuss options for surgical correction based on the literature and our experience.

Our 10 Years' Experience in Breast Asymmetry Correction.

BACKGROUND: Breast asymmetry is a common problem in augmentation mammoplasty. The notorious different implant volume approach has been shown ineffective because of recurring breast asymmetry in course of time. A uniform approach to the correction of breast asymmetry is still unavailable. METHODS: Four hundred and two patients underwent breast asymmetry correction with augmentation mammoplasty. We have described our technique providing good results in breast asymmetry correction using similar volume implants and resecting glandular tissue from the larger breast. RESULTS: Good aesthetic results were reported by all patients. No additional management of asymmetry was required in 290 patients (72%). One hundred and twelve (28%) patients received an additional correction of breast asymmetry due to breast ptosis, different levels of submammary folds. No major volume correction was required, and no implant change was needed. CONCLUSION: Our method of breast asymmetry correction allows using identical implants and presents good long-term results and no relapse. 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.

Breast Asymmetry, Classification, and Algorithm of Treatment: Our Experience.

BACKGROUND: In the literature, several classifications of breast asymmetries and treatment protocols have been proposed over time, which are mainly based on etiological or morphological characteristics of the deformity. The aim of this study was to present our new classification, based on patient's self-consciousness of breast asymmetry, a simple and reliable treatment algorithm is also presented. METHODS: The case series included 343 patients treated between January 2006 and January 2015. Only patients presenting with developmental breast asymmetries were included in the study. All patients underwent prior classification in three groups based on the patient's degree of awareness of their asymmetry. A specific treatment algorithm was associated with each group according to breast size, grade of ptosis, and patient's desire. At the 48-month follow-up appointment, patients completed an anonymous questionnaire that addressed satisfaction with breast shape, size, and symmetry, scar appearance, body perception, self-esteem, perceived attractiveness, intimate life, and overall feelings about their breasts. RESULTS: Mean patient age was 24.6 years (range 18-57 years). Mean follow-up was 54.4 months (6 months to 9 years). At the 48-month follow-up, 66.7% of the patients completed a visual analog scale (VAS) satisfaction questionnaire. An overall satisfaction rate of 77.0% was reported, and a statistically significant difference in the distribution of the overall satisfaction between groups was found. No patient expressed complete dissatisfaction. CONCLUSIONS: The proposed classification and the surgical algorithm is a simple, applicable, and reliable method to assess and treat breast asymmetries with a high satisfaction rate as confirmed from our results. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266.

Tuberous Breast Deformity Correction: 12-year Experience.

BACKGROUND: This article shows our 12-year experience in application of the technique of breast parenchyma modification with simultaneous augmentation on the tuberous breast. We undertook the study, and with the results of this study we can say that tuberous breast deformation is a common pathology that is caused not only by a thickening of the superficial fascia but also by breast parenchyma fibrosis. When traditional techniques without parenchyma modification are used during the surgery, it is often that patients come back to treat complications. METHODS: A total of 208 patients (414 breasts) with tuberous breast deformation treated from 2005 to 2017 were included. The mean patient age was 31 years (range, 22-53 years). A periareolar approach, vertical and horizontal glandular scoring, dual-plane pocket creation, and anatomic implants were used in all cases. RESULTS: The mean follow-up was 36 months (range, 3-144 months). Deformities of the types I-IV by Von Heimburg were corrected. The global complication rate for all patients in this study was 8.9%-1.4% had capsular contracture, 1.5% had postoperative malposition, 2% had "double bubble" , 2% had rippling, 2% had areola and nipple sensitivity disorder. CONCLUSION: The authors' experience demonstrates that the described one-stage approach combining mammary gland parenchyma modification (glandular scoring) with dual-plane pocket and anatomic implants provides satisfactory results for treatment of tubular breast deformity with minimal complications and other effects that require repeated treatment. 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Morphometric analysis of iatrogenic breast asymmetry secondary to operative breast shape changes in thoracic adolescent idiopathic scoliosis.

PURPOSE: Spontaneous surgical alterations of the distorted surface shape of thoracic cage in adolescent idiopathic scoliosis (AIS) may relocate and remodel the bilateral breast mounds. The purpose of this study was to analyze the influence of scoliosis correction surgery on female breast morphology and to identify the risk factors for iatrogenic breast asymmetry secondary to operative breast shape changes in AIS. METHODS: Thoracic AIS girls undergoing correction surgery were reviewed. Ten parameters concerning morphometric and CT evaluations of breast profile and symmetry were measured. The degree of asymmetry was determined and comparisons were made for evaluation of operative breast shape changes. The morphologically aggravated breast asymmetry would be considered if the concave and convex difference of either sternal notch-nipple length or sternal notch-nipple tilt angle increased post-operatively. Potential risk factors for iatrogenic breast asymmetry were identified. RESULTS: Sixty-eight AIS girls were reviewed. The concave breasts showed significantly more linear and less angular changes in morphological parameters post-operatively (p < 0.05). The concave and convex difference was significantly increased in morphological parameters and yet decreased in radiographic parameters. Ratio of aggravated morphological breast asymmetry was 61.2 %, and this patient group trended to have a minor pre-operative breast asymmetry though the difference was not statistically significant (p > 0.05). Moreover, patients with apex located at or above T7 showed greater changes in both morphological and radiographic dimensions as compared with those with apex beneath T7 (p < 0.05). CONCLUSION: The incidence of aggravated post-operative breast asymmetry is notable. Those with higher thoracic apex level, combined with minor pre-operative breast asymmetry, were at relatively higher risk of iatrogenic breast asymmetry aggravation post-operatively. Moreover, discrepancy existed between the morphometric and radiographic parameters concerning the surgical influence on breast asymmetry.

[Tuberous breast: Current concept]. / Seins tubéreux.

Tuberous breast deformity is a congenital breast anomaly with different clinical signs. The most consistent sign is the constricting ring at the base of the breast. There is deficiency in the horizontal and/or vertical dimensions of the breast and often herniation of breast parenchyma toward the nipple-areola complex with areola enlargement. Breast asymmetry is frequently associated. This anomaly occurs only in females, during breast development at puberty. The incidence is unknown because of minor forms more difficult to diagnose. This deformity produces psychological morbidity and encourages the patients to consult. In 1999, Grolleau publishes a classification with three types of tuberous breast deformity. The goals of the surgical treatment are the expansion of the constricted base, the redistribution of volume, the correction of areolar size and of herniated subareolar breast tissue. In type II and III, the simple use of breast implant involves the "memory" of the previous inframammary fold line. To avoid this complication, it is necessary to make a glandular rearrangement with parenchymal flaps like Puckett and Ribeiro. It is a real challenge for the plastic surgeon who must reshape the breast and obtain a symmetry of volume. It would be delusive to think all types of tuberous breast can be corrected with the same one-step technique. It is often necessary to plan several surgeries and patient must always be informed about the strategy.

Lipofilling, an efficient solution for breast sequelae after cardiothoracic surgery.

Evolutions in pediatric cardiovascular surgery have allowed the treatment of a various range of cardiovascular malformations in infants. It is a difficult branch of surgery, with vital impact, which can also leave residual thoracic scars, possible sources for thoracomammary deformities in adults. Most thoracomammary deformities after thoracotomy are observed at puberty, when they appear as breast asymmetries. The main cause is the breast bud injured during thoracotomy. Several techniques have been suggested for breast reconstruction, but none give satisfying results. We have been practicing lipofilling since 1998 for breast reconstruction. Since 2001, we have started applying it to breast deformities. The final result is constant in time, natural, and has a good volume filler effect. We describe the fat grafting technique, an original technique, as a solution for this kind of deformities. The technique is illustrated by two clinical cases. In conclusion, fat grafting has really improved breast asymmetry due to iatrogenic deformation. Even if those cases are rare, surgeons have to know this kind of procedure. It is indeed a simple and efficient solution for those patients after childhood, with natural and long standing results.

Breast lipofilling: A new treatment of Becker nevus syndrome.

INTRODUCTION: The association of Becker's nevus with other cutaneous, musculoskeletal or maxillofacial anomalies is called Becker nevus syndrome. Ipsilateral breast hypoplasia is the main reason for female patients to seek medical advice. We present two clinical cases of Becker nevus syndrome with thoracic nevus and ipsilateral breast hypoplasia treated with lipofilling alone (fat grafting). MATERIAL AND METHODS: For the two consecutive cases of Becker nevus syndrome treated by fat grafts, we present the surgical technique and the outcome at one year follow-up. Fat was harvested with cannula after infiltration. The adipose tissue was prepared with a short centrifugation. Fat grafting was realized as backward injections. RESULTS: We have noticed a concomitant improvement of the thoracic nevus color with a stable result after one-year follow-up. The aesthetic result after lipofilling was evaluated as very satisfying by the patient. The breast symmetry was improved. CONCLUSIONS: We believe that the lipofilling technique is a natural and valuable treatment option for thoracic anomalies in Becker nevus syndrome with a major impact on patient's quality of life.

Shoelace Breast Cast.

Implant malposition after breast augmentation surgery remains a common complication. Several surgical options exist to correct the resultant deformity; however, all involve additional risks, costs, and the increased potential for patient dissatisfaction. In my practice, I have developed a nonsurgical therapy using shoelaces, which, when tied and placed in a certain fashion, can correct this deformity. When worn continuously, the shoelaces act as an external breast cast that allows the inframammary fold to be set and heal in the correct position. I have achieved great success in using this nonsurgical technique, and it allows me to be aggressive in cases where I need to raise the inframammary fold because I know that I can easily correct if the fold is lowered too much.

A qualitative study on the experiences of women undergoing surgery for developmental breast asymmetry.

BACKGROUND: Developmental breast asymmetry (DBA) is a largely underreported condition where the natural growth of one breast is smaller than the other. While some degree of asymmetry or difference in size and shape is present in most women, DBA can result in more profound differences that can impact a woman's psychosocial well-being. OBJECTIVES: This study aims to better understand the experiences of women living with DBA, their experiences seeking treatment, and their reconstructive surgical journey and outcomes. DESIGN: This was a qualitative study involving in-depth, one-on-one semi-structured interviews with women diagnosed with DBA. METHODS: Participants were women seeking treatment for DBA through the Plastic and Reconstructive Surgery Unit at Flinders Medical Centre, a tertiary healthcare centre in Adelaide, South Australia. Interviews were recorded digitally, transcribed verbatim and analysed thematically. RESULTS: Fourteen interviews were conducted with 14 women; 13 women had completed their reconstruction and 1 was undergoing reconstruction at the time of their interview. Interviews highlighted the significant psychosocial impact of DBA, the different experiences in seeking help for DBA, the information received or lack thereof, the need for medical and social support throughout the surgical process, and the varied satisfaction with surgical outcomes. CONCLUSION: This study highlighted the subjective experiences of women who have grown up with DBA, improving our understanding of the significant psychosocial impact of DBA. Not all participants experienced post-operative improvements in psychosocial well-being due to surgical complications or unmet expectations. This study also demonstrated the need to raise awareness about DBA and the importance of additional medical and social support for women throughout their surgical journey.