Antonella Campanale

The BREAST-V: a unifying predictive formula for volume assessment in small, medium, and large breasts.

Background: Breast volume assessment enhances preoperative planning of both aesthetic and reconstructive procedures, helping the surgeon in the decision-making process of shaping the breast. Numerous methods of breast size determination are currently reported but are limited by methodologic flaws and variable estimations. The authors aimed to develop a unifying predictive formula for volume assessment in small to large breasts based on anthropomorphic values. Methods: Ten anthropomorphic breast measurements and direct volumes of 108 mastectomy specimens from 88 women were collected prospectively. The authors performed a multivariate regression to build the optimal model for development of the predictive formula. The final model was then internally validated. A previously published formula was used as a reference. Results: Mean (±SD) breast weight was 527.9 ± 227.6 g (range, 150 to 1250 g). After model selection, sternal notch–to-nipple, inframammary fold–to-nipple, and inframammary fold–to–fold projection distances emerged as the most important predictors. The resulting formula (the BREAST-V) showed an adjusted R2 of 0.73. The estimated expected absolute error on new breasts is 89.7 g (95 percent CI, 62.4 to 119.1 g) and the expected relative error is 18.4 percent (95 percent CI, 12.9 to 24.3 percent). Application of reference formula on the sample yielded worse predictions than those derived by the formula, showing an R2 of 0.55. Conclusions: The BREAST-V is a reliable tool for predicting small to large breast volumes accurately for use as a complementary device in surgeon evaluation. An app entitled BREAST-V for both iOS and Android devices is currently available for free download in the Apple App Store and Google Play Store. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.

Breast Implant-Associated Anaplastic Large Cell Lymphoma: Proposal for a Monitoring Protocol.

Background: The authors report four cases of breast implant–associated anaplastic large cell lymphoma (ALCL) from a single institution and propose a multidisciplinary protocol. Methods: From 2012 to 2014, four breast implant–associated ALCL cases were diagnosed. The authors performed the original operation, and no patients were referred to their practice. Cases 1, 2, and 4 were CD4+/CD30+/ALK− ALCL with previous textured-implant reconstruction, whereas case 3 was CD8+/CD30+/ALK− ALCL with previous polyurethane-implant augmentation. A retrospective study of all patients who underwent breast implant positioning was performed to identify any misdiagnosed cases. Results: Of 483 patients, 226 underwent reconstruction with latissimus dorsi flap and prosthesis, 115 had skin-sparing/nipple-sparing mastectomy and prosthesis, 117 underwent an expander/implant procedure, and 25 underwent breast augmentation. Fifty-eight cases (12 percent) underwent implant replacement for capsular contracture, 15 (3.1 percent) experienced late-onset seroma, and four (0.83 percent) had both capsular contracture and seroma. Seventy-seven symptomatic patients (16 percent) underwent surgical revision (capsulectomy/capsulotomy) and/or seroma evacuation. The second look on histologic specimens did not identify misdiagnosed cases. A multidisciplinary protocol for suspected implant-associated ALCL was established. Ultrasound and cytologic examinations are performed in case of periprosthetic effusion. If implant-associated ALCL is diagnosed, implant removal with capsulectomy is performed. If disseminated disease is detected through positron emission tomography/computed tomography of the total body, the patient is referred to the oncology department. Conclusions: A multidisciplinary protocol is mandatory for both early diagnosis and patient management. Until definitive data emerge regarding the exact etiopathogenesis of breast implant–associated ALCL, the authors suggest offering only autologous reconstruction if patients desire it. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

The “type V” Skin-sparing Mastectomy for Upper Quadrantskin Resections

Skin-sparing mastectomies (SSMs) are classified according to the type of incision and breast size. In large breasts, if cancer is superficially located in the upper quadrants, SSM type IV is not indicated, because tumor resection interferes with skin flap pattern. For these patients, a modified Wise-pattern SSM has been developed to achieve immediate breast reconstruction. Twenty-four patients, 14 with tumor in the superior-lateral, 7 in the superior-medial, and 3 in the inferior-lateral quadrant, were operated on with modified SSM incisions. To replace the skin area removed with mastectomy from the upper quadrants, a similar size area from the lower pole was used. No local or distant recurrences occurred, with a mean follow-up of 27 months. Natural breast shape was achieved in all cases. Our procedure allows for a skin-sparing mastectomy (SSM type V) with immediate reconstruction, achieving a natural breast shape also in this group of patients previously excluded.

Long-term sensory recovery of nipple-areola complex following superolateral pedicled reduction mammaplasty.

Background: The aim of this study was to investigate nipple-areola complex sensation at 48-month follow-up following superolateral pedicled reduction mammaplasty using the pressure-specified sensory device. Methods: Data regarding nipple-areola complex sensation for static and moving one- and two-point discrimination were collected from 30 active group hypertrophic-breasted patients undergoing superolateral pedicled reduction mammaplasty preoperatively, at 6 months, and at 48 months, and from a control group of 30 unoperated women with normal-sized breasts. Breast volume was assessed using the BREAST-V instrument. Results: For the nipple, static one-point discrimination showed that mean pressure thresholds for the active group at 48 months were 4.10 and 4.19 times higher than preoperatively and in the control group (p < 0.001), respectively; moving one-point discrimination showed that mean pressure thresholds for the active group at 48 months were 4.08 and 3.23 times higher than preoperatively and in the control group (p < 0.001), respectively. For the areola, static one-point discrimination showed that mean pressure thresholds in the active group at 48 months were 4.12 and 4.83 times higher than preoperatively and in the control group (p < 0.001), respectively; moving one-point discrimination showed that mean pressure thresholds from the active group at 48 months were 4.56 and 4.46 times higher than preoperatively and in the control group (p < 0.001), respectively. Conclusions: Despite a slight worsening at 6 months after surgery, patients who had undergone superolateral pedicled reduction mammaplasty showed significant nipple-areola complex sensibility reduction at 48-month follow-up. Although the nipple-areola complex of hypertrophic-breasted patients was seen to be nonsignificantly less sensitive than normal-sized breasts, a significant decrease of sensation was observed following reduction mammaplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Nipple–areola complex cutaneous sensitivity: A systematic approach to classification and breast volume

INTRODUCTION The aim of our study was to develop a systematic approach to provide a data bank on normative cutaneous pressure thresholds of the nipple-areola complex (NAC) in different breast volumes and a classification of the NAC sensitivity function. PATIENTS AND METHODS A population of 150 Caucasian women stratified in five groups of 30 subjects according to the Lalardie-Jouglard classification of breast volume was enrolled in our study. A single evaluator (B.L.) performed breast volume assessments using the BREAST-V and sensory testing on NACs with Pressure-Specified Sensory Device; static and moving one- and two-point discriminations of nipple and areola were collected from each group. Statistical analysis using mixed effects model was performed with significant p-values <0.05. RESULTS Nipple was found to be more sensitive than areola for both static and moving one-point tests. From our analyses emerged an inverse relationship between skin pressure thresholds and breast volume, with NACs from small breasts (group A) statistically more sensitive than NACs from macromastia women (group E). Properly, the group A women were found to be 0.42, 1.89, 4.98, and 9.55 times progressively more sensitive (p < 0.001) than groups B, C, D, and E, respectively, for quickly adapting fibers of nipple, and 0.58, 1.97, 4.97, and 8.67 times more sensitive (p < 0.001) than groups B, C, D, and E, respectively, for quickly adapting fibers of areola. The sensitivity function of the nipple and areola was classified as high (first degree), medium (second degree), and low (third degree) according to mean ± standard deviation of the overall values. CONCLUSION Our study first provides a complete data bank of normative NAC sensitivity in a wide range of breast volumes, and gives three degrees of classification of NAC sensitivity function.

Surgical Approach to Head and Neck Cancer and Postoperative Complications : Are All Patients Eligible?

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