Public Perception of Ideal Breast Shape

Background In the past decade there has been a dramatic increase in trends related to body-shaping procedures. According to the American Society of Plastic Surgeons, nearly 300,000 breast augmentation procedures were conducted in 2019. 1 Learning the ideal shape of a breast, and which esthetics lead to public perception of the most attractive breast is beneficial to properly performing these procedures. Objectives The authors aimed to quantify public perception of the attraction to breast shape by measuring public opinion for various esthetic elements of breast anatomy, and linking this to various demographic factors. Methods Survey responses were collected from 1,000 users of Amazon Mechanical Turk to collect demographic data as well as ask users to rank preferences for randomized image panels of breast proportions. Responses were collected and analyzed to find the overall ideal breast proportions. Results In total, 1000 responses were collected, with 960 being used for analysis. Overall, a majority of respondents were male (60%), with a plurality belonging to the age group of 25-34 years old (49.3%). The most notable preference between all groups was the breast projection proportion and the preferred nipple direction, with preferences of 1.0 and a frontal nipple direction, respectively. Breast width to shoulder width ratio also had a clear preference among the crowd, with 105% being the preferred percentage, and the 25-34 age group having a very strong preference for this. Conclusions The authors used a crowdsourcing survey technique with randomized image panels to analyze ideal breast preference using images of various anatomical traits of the female breast. It was concluded that crowdsourcing can be a favorable technique for learning ideal overall preferences for specific anatomy.

Inferior pedicle with inverted-T procedure for bilateral reduction mammoplasty provided satisfactory surgical and aesthetic outcome

Background: The objective of the study was to evaluate surgical and aesthetic outcomes of bilateral reduction mammoplasty (RM) through the inferior pedicle with inverted-T approach (PO).Methods: 23 women with bilateral symptomatizing macromastia underwent preoperative breast measurements, calculation of breast volume (BV), determination of quality of life (QoL) and self-esteem scorings using the breast reduction assessed severity scale (BRASS) and the Rosenberg self-esteem scale (RSES). RM was performed and intraoperative and PO data were collected. At 3-m PO, aesthetic outcome was evaluated using the ABNSW score, which assesses breasts asymmetry and shape, nipple deformation, skin condition and wound scar, and QoL outcome and overall satisfaction were determined.Results: Mean operative time was 240.4±39.7 min and mean weight of excised breast tissue was 2778.3±307.7 gm. Minor PO complications were managed conservatively and no patient required revision surgery. PO breast measurements were significantly improved with decreased BV and increased breast projection. Median ABNSW score was 10 and PO median BRASS and RSES scores were 9 and 17 with significant change in comparison to preoperative data. Preoperative BRASS score was negatively correlated age and body mass index, while RSES score was positively correlated with age. Nine women were highly satisfied by aesthetic outcome, 10 women were satisfied and 16 women were highly satisfied with overall outcome.Conclusions: RM significantly improved women QoL, aesthetic appearance and psychological status. Inferior pedicle with inverted T-mammoplasty is a safe, and applicable pattern of mammoplasty, allow significant reduction of BV with improved breast measurements and projection and provide satisfactory aesthetic outcome.

The “Hug Flap”: Surgical Technique to Enhance the Aesthetic Breast Projection in Autologous Breast Reconstruction

Background Obtaining a natural breast mound shape contributes profoundly to a symmetrical and successful outcome in breast reconstruction. Objectives The authors sought to describe a new and efficient technique that enhances breast projection in delayed breast reconstruction employing abdominal free flaps and compare it with the current standard methods utilized. Methods The charts of 490 consecutive patients who underwent delayed breast reconstruction employing free abdominal perforator flaps were reviewed between 2007 and 2017. Three methods of breast reconstruction were compared: undermining, de-epithelialization, and the “hug flap” (HF). In the newly described technique, the caudal mastectomy skin was de-epithelialized, and then the medial and lateral thirds were undermined and folded over to cover the central part. The rates of complications and secondary corrections were analyzed between the 3 groups. Results There were 570 free abdominal flaps performed. The de-epithelization technique was the most commonly utilized (328 cases) followed by the undermining technique (153 cases). The HF technique was employed in 89 cases. The majority of HFs were performed in unilateral breast reconstruction. Bilateral cases were conducted in only 12 patients. The need for additional fat grafting was significantly (P = 0.003) less required in the HF group compared with the undermining and de-epithelializing groups (12% vs 28% and 21%, respectively). Conclusions Although all breast-enhancing options can be mixed and matched based on the surgeon’s preference and experience as well as each patient’s needs, the HF can be considered as an adjunct tool to provide adequate flap projection and enhance breast symmetry. Level of Evidence: 4

No-Scar Breast Reduction Utilizing Power-Assisted Liposuction Mammaplasty, Loops, and Lipofilling

Background In the context of continuous interest to develop and refine minimally invasive procedures, recent publications reported a scarless approach in breast lifting. Objectives The authors describe a power-assisted lipomodeling technique combined with surgical loops to achieve breast reduction and reshaping with minimal scars. Methods Between 2014 and 2018, a total of 94 patients underwent breast reduction by combined liposuction and loops. Following infiltration of the breasts, liposuction of the outer quadrants and the lower pole was achieved to reduce the breast footprint and the lateral and inferior heaviness of the breast. After multiaxial multiplanar tunnelization, three types of loops were taken around the breast to suspend and elevate the breast skin envelope and parenchyma. Each loop was guided through a 3 mm, three-hole cannula passed through skin stab incisions. The first loop was designed to reduce the breast footprint and enhance the breast projection, whereas the second loop is designed to achieve breast conus remodeling and can be performed three to five times. The third loop was passed circumferentially around the areola and then cephalad along the breast axis and pulled until the desired NAC elevation was reached. Each loop was pulled to achieve the desired breast projection and shape. Results The authors achieved breast reduction with a mean nipple elevation of 7.3 cm, and 88% of patients were satisfied with their breast shape. The total complication rate was 1%, including mild cellulitis in one breast, treated efficiently with oral antibiotics. Conclusions The proposed technique is a novel, simple, and safe alternative to achieve breast reduction and reshaping without a scar.

Lower Pole Mastopexy-Augmentation: Indications and Applications

Background Breast augmentation in primary or secondary patients with long lower pole lengths but appropriately sited nipples is at high risk of “bottoming out” following surgery. The lower pole mastopexy-augmentation (LPMA) was developed to correct long lower pole lengths or preempt bottoming out in breasts deemed at risk, avoiding the requirement for periareolar and vertical breast scar as well as minimizing the requirement for the utilization of synthetic mesh. Objectives The goal of this short report was to analyze outcomes in patients who underwent the LPMA to determine its application and limitations. Methods The author reviewed 12 consecutive cases of both primary and secondary situations over a 6-year period. Cases were objectively assessed according to the relationship of the nipple to the point of maximal breast projection on lateral view as well as the upper to lower pole breast proportions. Results All cases provided good outcomes, with improvements in both the position of the nipple in relation to the point of maximal breast projection and with respect to the upper to lower pole breast ratios. Conclusion LPMA is a useful addition to the armamentarium in dealing with complex situations in breast augmentation. Level of Evidence: 4

The Hybrid Breast Reduction; Taking Advantages of from Both the Vertical and Wise Pattern Reductions

Reduction mammaplasty is one of the most commonly performed procedures by plastic surgeons. The Wise and vertical scar techniques are two of the most commonly published and performed techniques. The superior technique has long been argued. The advantages and disadvantages of each are well documented. We show a technique which combines the best aspects of the Wise and vertical pattern reductions. In this “Hybrid” technique, we use a typical superior medical pedicle that would be typically used in a vertical pattern and use a skin incision and tissue resection pattern of that of a Wise type pattern. By doing using this technique , the surgeon is able to utilize advantages of the two well-known reduction types. The hybrid reduction uses a robust and reliable superior type pedicle which also allows for a quick de epithelization and dissection of the pedicle. By using the Wise type (anchor shaped skin incision) a large amount of tissue is able to be harvested and the breast projection is restored and is aesthetically favorable. This paper outlines several important points which can aid in achieving an optimal aesthetic result when performing the hybrid breast reduction.