Daniel L. Feldman

3D analysis of breast augmentation defines operative changes and their relationship to implant dimensions.

Breast augmentation is one of the most common plastic surgery procedures performed in the United States today. Evaluation of postoperative results lacks true objective measurements. The following study reports the application of 3-dimensional (3D) photography to document changes that occur in breast morphology after breast augmentation. Patients undergoing augmentation mammaplasty with a periareolar incision were offered pre- and postoperative 3D photographs. 3D models were constructed and the following parameters were assessed: maximum anterior-posterior projection from the chest wall, angle of breast projection, total breast volume, volumetric tissue distribution in the superior and inferior poles, and surface and vector distance measurements to key landmarks. A completed series of 3D images were obtained from 14 augmentation patients (28 breasts) at an average postoperative day of 143. Saline and silicone implants were used equally (n = 14 for each). Total volume of the breast changed in correlation with the implant size (1.9% difference, P = 0.83). There were no significant changes in the volumetric distribution within the upper and lower poles of the breasts noted between pre- and postoperative scans (P = 0.81). The internal angle of breast projection was found to increase (13.6 degrees, P < 0.01), as did the sternal notch to nipple distance (11 mm, P = 0.018). Anterior-posterior projection significantly increased by 23.3 mm. However, this increase in projection was 20.9% less than expected based on implant dimensions (72.7–58.7 mm, respectively, P < 0.01). This study documents objective changes in breast morphology after augmentation mammaplasty. 3D imaging scans were able to document true changes that occur with breast augmentation including breast volume, the increase in the internal angle of the breast projection, and the sternal notch to nipple distance. 3D photography further highlighted that breast augmentation results in less than expected anterior-posterior projection, possibly due to tissue attenuation occurring anterior to the implant.

Mammometrics: The standardization of aesthetic and reconstructive breast surgery

The goal of cosmetic and reconstructive breast surgery is to create symmetric and aesthetically pleasing results in a reproducible manner. Although continued progress is dependent on the ability of plastic surgeons to accurately assess surgical outcomes, available methods to objectively evaluate aesthetic and reconstructive breast surgery are limited. This is quite different from other areas of plastic surgery, such as craniomaxillofacial surgery, that often use precise skeletal measurements to provide a platform for preoperative and postoperative analysis. In comparison, systematic evaluation of breast surgery has yet to be standardized. With the advent of three-dimensional photography, objective soft-tissue analysis of the breast is now possible. Recent work from our group and others has validated the use of three-dimensional breast photography in various clinical arenas, including autologous breast reconstruction, prosthetic breast reconstruction, reduction mammaplasty, and augmentation mammaplasty.1–7 Enthusiasm toward three-dimensional imaging technology has stemmed from the ability to not only obtain well-established breast measurements in an accurate manner, but also to generate measurements that were not previously possible with conventional tools, such as total breast volume, volumetric distribution, and breast projection. This article provides an overview of three-dimensional breast photography, with particular emphasis on its potential role to establish a standardized system for breast analysis. We introduce a new concept termed “mammometrics,” in which three-dimensional–based breast measurements can be used to help guide operative planning, objectively analyze surgical results, and document postoperative changes that occur over time.

Re-defining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty

BACKGROUND Bottoming out is a well-known phenomenon described with reduction mammaplasty (RM). To date, the evaluation of post-operative bottoming out remains an imprecise science. The following study reports the application of three-dimensional (3D) photography to objectively investigate changes in breast morphology. METHODS Patients undergoing medial pedicle RM had 3D photographs (Konica Minolta V910) taken during the early and late post-operative period (early=60-120 days; late=400-500 days). 3D images were compared and bottoming out was assessed with 3D parameters and vectors including total breast volume, volumetric tissue distribution above and below the Central (C) plane, distance of the C-plane to the lowest point of the breast, and maximum anterior-posterior projection from the chest wall. RESULTS Post-operative images from 15 consecutive RM patients showed an average volume of 556+/-144 cm3 (early) and 441+/-183 cm3 (late). The percent of tissue in the upper pole of the breast changed from the early to late post-operative period (76% vs. 69%, respectively; p<0.01). The distance from a fixed C-plane to the inferior pole significantly increased (42+/-15 mm early vs. 51+/-18 mm late; p<0.01). AP projection decreased by an average of 6.23 mm (p<0.01). The lateral border of the IMF significantly dropped by 6.27 mm. CONCLUSIONS This study objectively describes both the occurrence of bottoming out and the quantitative amount in terms of changes in volumetric distribution, surface topography and breast projection. With 3D photography, plastic surgeons can perform objective evaluation of breast transformation over time, which ultimately will aid in planning to allow for better surgical outcomes.

Defining the kinetics of breast pseudoptosis after reduction mammaplasty.

Despite the clinical relevance of bottoming out, or pseudoptosis, associated with reduction mammaplasty (RM) its evaluation remains an imprecise science. This study aims to further define the kinetics of postoperative pseudoptosis over an extended period of time, after our previous study investigating pseudoptosis in the early postoperative period. Patients undergoing medial pedicle RM had 3-dimensional photographs taken at year 1 and year 2 intervals postoperatively (year 1 = 300–450 days; year 2 = 700–900 days). Bottoming out was assessed with various 3-dimensional parameters. The total breast volume and the percent tissue distribution in the upper pole of the breast did not change from year 1 to year 2. The anterior-posterior projection as well as vector measurements for internipple distance and sternal notch to nipple distance also remained stable from year 1 to year 2. Although previous data from our group documented the occurrence of bottoming out and continued size reduction over the first postoperative year after breast reduction, the present study shows that pseudoptosis does not seem to occur during the second postoperative year.

The Inspector General: Political Culture and Constraints on Effective Oversight

Their enabling legislation and mission statements ostensibly charge federal inspectors general in the United States with capacity-building and performance-enhancement as well as compliance-monitoring powers and responsibilities. This article reviews the constraints on those powers. It proposes that American distrust of government both historic and current—the former reflected in the institutional conflict built into the constitutional structure, the latter reflected in survey research data on trust in American government—encourages the compliance-monitoring role of the inspector general (IG) and discourages the capacity-building and performance-enhancement roles. It then reviews studies of China’s recent anticorruption efforts as well as survey research data on popular trust in the government of the People’s Republic of China. It suggests that Chinese trust in government would support capacity-building and performance enhancement but discourage compliance monitoring were China to institute an IG system. It concludes that an IG system could prove beneficial even in a nation with an authoritarian government, albeit in a different way than in a constitutional democracy, and that, in general, political culture helps to determine which aspects of the role an IG will be able to pursue most effectively.