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Asian women have smaller breast sizes and greater breast density, which suggests specific research on their breast kinematics and biomechanics. To investigate vertical breast displacement of Asian women among exercise modalities (rope skipping, walking, jogging, running) in different support conditions (wearing everyday bra or sports bra), and assess the motion between different parts of the breast, seven participants were selected to participate in this study. Five infrared markers were placed on each of their left breasts, and a three-dimensional motion capture system (NDI Optotrak Investigator) was used to collect the data on vertical breast displacement during walking (5 km/h), jogging (7.5 km/h), running (10 km/h) and rope skipping (2 Hz). No significant difference was found in the vertical displacement of different parts of the breast in the two bra conditions. Also, there was significant difference in vertical breast displacement among rope skipping, jogging and running. Breast size did not significantly affect its vertical displacement. The smaller, denser breast appears to reach a threshold of vertical displacement that is similar at high severities of dynamic exercises (jogging, running and rope skipping). The results might be useful for designing special sports bras for Asian women with small breasts or rope skipping participants to improve the shock absorption function. [ABSTRACT FROM AUTHOR]

Introduction Breast radial scar (RS) management remains controversial. The need for surgical excision is supported by the concern of an associated high-grade lesion missed in the biopsy. The aim of this study was to assess histologic upgrade rate after a percutaneous biopsy, to determine if vacuum assisted biopsy prevents the need for subsequent RS surgical resection and to evaluate the upgrade risk factors. Patients and methods This was a uni-institutional retrospective study of consecutive patients with RS histologically diagnosed from January 2010 to December 2015. Results A total of 113 cases of RS were diagnosed. We verify that there was a histologic upgrade in 22 (19.5%) cases. The upgrade risk factors were the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained in the biopsy ( p < 0.05). The biopsy type was vacuum assisted in 25 (22.1%). The upgrade rate in the vacuum assisted biopsy group was 4.0%, whereas in the standard core needle biopsy group was 23,9% ( p = 0.041). Discussion and conclusion We demonstrated that the risk of upgrade after a RS diagnosis depends on the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained. When a standard core biopsy is performed the risk of upgrade and malignancy is not negligible, and surgery is indicated. When the biopsy is vacuum assisted, the risk of upgrade and malignancy is significantly decreased and so the indication for excisional biopsy seems not to be so imperative. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the capability of enhanced chest computed tomography (CT) for detecting breast abnormalities and to assess the influence of breast composition on this detectability. Materials and Methods: From 2000 to 2013, 75 patients who underwent mammography, breast sonography, and enhanced chest CT within one month and had abnormalities on sonography were included. Detection rate of breast abnormality on enhanced chest CT was compared among 4 types of breast composition by the Breast Imaging Reporting and Data System. Contribution of breast composition, size and enhancement of target lesions to detectability of enhanced chest CT was assessed using logistic regression and chi-square test. Results: Of the 75 target lesions, 34 (45.3%) were detected on enhanced chest CT, corresponding with those on breast sonography; there were no significantly different detection rates among the 4 types of breast composition (p = 0.078). Breast composition [odds ratio (OR) = 1.07, p = 0.206] and enhancement (OR = 21.49, p = 0.998) had no significant effect, but size (OR = 1.23, p = 0.004) was a significant contributing factor influencing the detectability of enhanced chest CT for breast lesions. Conclusion: About half of the cases (45.3%) demonstrated breast lesions on chest CT corresponding with target lesions on sonography. Breast composition defined on mammography did not affect the detectability of enhanced chest CT for breast lesions. [ABSTRACT FROM AUTHOR]

We report a case of recurrent sparganosis of the breast within 6 months following surgical removal of worms from the breast. The patient was referred to our hospital with a palpable mass in the right breast. On admission, breast ultrasonography revealed a tortuous tubular hypoechoic lesion with indistinct margins within a surrounding hyperechoic area, which strongly suggested sparganosis. We performed surgical excision and confirmed sparganosis. After 6 months, the patient detected a new mass in her right breast and visited our hospital. Breast ultrasonography revealed similar features in a different area of the same breast. We confirmed recurrent sparganosis surgically. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background: Symmastia is defined as medial confluence of the breast. The term ‘symmastia’ is modified from Greek (syn meaning ‘together’, and mastos meaning ‘breast’) and was first presented by Spence et al. in 1983. Two forms of symmastia exist: an iatrogenic and a congenital version. Congenital symmastia is a rare condition in which web-like soft tissue traverses the sternum to connect the breasts medially. The literature on congenital symmastia is limited, few cases have been published, and knowledge about ideal treatment is still insufficient. Material and methods: Congenital symmastia was identified as a distinct deformation using a review of the literature and a theoretical model. We analysed the malady using a three-step principle, formulated by Blondeel, which describes the breast as a ‘footprint’, ‘conus’ and ‘skin-envelope’. To date, few papers on congenital symmastia have been published, most of which focus on the application of various surgical approaches. We examined the literature and evaluated the procedures used, and are presenting two recent cases of congenital symmastia as examples. By combining review and analysis we offer a rational treatment practice. Results: The analysis showed that the optimal treatment begins by correcting the ‘footprint’, removing the excess ‘conus’ over the sternum, and finally reattaching the ‘skin-envelope’ to the sternum to recreate the normal medial border of the ‘footprint’. Thus far, the two most common approaches used to treat congenital symmastia are: reduction mammaplasty and liposuction. Conclusion: By combining the Blondeel analysis with a procedural review, we developed a flow chart to offer a possible treatment practice. [Copyright &y& Elsevier]

Summary: Surgeons are commonly confronted with breast contour deformities and defects that result from previous surgical interventions. These soft tissue deformities can be corrected by conventional reconstructive flap surgery using autologous tissue, but there can be donor site morbidity. Smaller volume replacement is possible using temporary fillers such as hyaluronic acid or polylactic acid, or by using ‘permanent’ fillers such as autologous fat, but large defects are notoriously difficult to fill and often the fillers resorb or migrate. The patient described in this case report had an exchange of polyurethane implant (PU) in the left breast and correction of a contralateral breast contour filling deformity. A left breast partial capsulectomy was performed after implant removal and the capsule graft was inserted into a predissected pocket where soft tissue augmentation was required. A biopsy from the PU capsule was reported to show a foreign body type giant cell reaction to PU material in a fibrous capsule, lined by synovial metaplasia. The post-operative result showed satisfactory soft tissue revolumisation. PU breast implant structured capsule has thus been used as filler to correct breast soft tissue deformity and contour defects. Clearly it may have a use in other anatomical sites. [ABSTRACT FROM AUTHOR]

Summary: The internal mammary artery perforator (IMAP) flap represents the evolution from axially pedicled flaps (deltopectoral flap) to perforator flaps. Both flaps are typically used for neck and tracheostoma reconstruction in male patients. We present the case of a 68-year-old obese female patient with a right upper thoracic radionecrosis secondary to breast irradiation. Soft-tissue defect measured 12×18cm. She also complained of left breast hypertrophy. Following radical debridement, a left IMAP flap extending from midline to the anterior axillary fold was raised, based on the second and fourth IMAP vessels. The flap was rotated 180° on its second and fourth perforators to cover the defect and the left breast was reshaped. The flap survived entirely and wound healing was uneventful. Ptosis and breast hypertrophy were corrected at the same time. The IMAP flap can be harvested all the way to the anterior axillary fold and used as a large propeller flap, which makes this flap suitable for contralateral thoracic reconstructions, even in female patients. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ultrasound is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: As a former general radiologist and current full time clinical breast radiologist, I have observed and experienced both good and suboptimal practice patterns, operations, and economics. Proper organization of a high quality, efficient breast center requires basic infrastructure including functional space, quality imaging equipment, data reporting systems, as well as a highly motivated, dedicated, and focused team. People on the breast care team need to share the same passion and commitment to provide superior care for patients and families. Each member of this interdisciplinary team provides an important role that contributes to best practices and patient satisfaction. Efficiency and quality are essential for the long-term survival of clinical breast radiology, a highly regulated and scrutinized medical subspecialty. This paper reflects personal perspectives and perceptions about how to make a good breast care practice great by incorporating strategies such as the simple hedgehog concept used in other successful businesses. [Copyright &y& Elsevier]

Summary: Background: In the quest for reduced scars and better aesthetic outcomes in minimally invasive surgical techniques for gynaecomastia, suction-assisted lipoplasty and ultrasound-assisted lipoplasty are now considered accepted recent advancements. Nevertheless, the fibrous glandular breast disc encountered in young, thin patients requires a separate peri-areolar incision as the disc cannot be removed with suction lipoplasty. The use of a microdebrider (powered shaving rotary device) is a potential solution to this problem. We present a series of eight patients with fibrous gynaecomastia that was successfully treated in this way. Method: The surgery is performed under general anaesthesia. The microdebrider cannula is used to remove the fibrous glandular breast tissue. Drains are inserted and fibrin glue is sprayed subcutaneously. Patients are discharged on the next day. Drains are removed on the 5th postoperative day. A compressive vest is worn for 6 weeks. (A video of the procedure can be seen on http://www.microflap.com/video3.asp). Results: The eight patients were successfully treated. No bleeding, haematoma or seroma was encountered. All patients were satisfied with the results of the surgery. Conclusion: The microdebrider is a viable solution in the treatment of gynaecomastia with a fibrous breast disc. Excellent aesthetic results can be achieved with a single 3-mm incision. [Copyright &y& Elsevier]

Abstract: Breast needle core biopsy is a widely used technique for evaluation of mammographic and clinical breast abnormalities, screen detected and symptomatic. The majority of biopsies can be coded as B2 (benign) or B5 (malignant). However, certain lesions merit a B3 designation, signifying ‘uncertain malignant potential’. This is a heterogenous group including atypical intraduct epithelial proliferation, lobular neoplasia, radial scar, papillary lesions and columnar cell change. Their common denominator is the low but significant rate of malignancy within the lesion or adjacent tissue, necessitating excision biopsy for full histological examination. In this article we review the morphology and biological significance of B3 entities. [Copyright &y& Elsevier]

Abstract: One of the commonest abnormalities identified by breast screening is microcalcification. Of the 1.64 million women screened in England last year, 30,000 underwent further assessment allied to cytological or histological sampling; approximately 40% of these were for microcalcification. Sixty-three per cent of the women undergoing sampling had benign changes only. Benign breast microcalcification is, therefore, a significant clinical issue. Lesions that result in calcification may mimic in-situ and invasive malignancy both radiologically and pathologically. The common benign and borderline pathologies that cause calcification are discussed and correlated with the radiological patterns, highlighting areas of possible diagnostic difficulty. [Copyright &y& Elsevier]

Summary: Purpose of the study: This aim of this study was to evaluate the initial experience of pectus deformity repair using the pectus less invasive extrapleural repair (PLIER) procedure. Methods: PLIER is an open procedure which involves a small midline chest incision, with exposure of the xiphoid which is raised to create a retrosternal space. The costal cartilages are excised to free the sternum and metal struts are implanted to stabilise the reconstructed chest wall. Main findings: Corrections were performed on 35 patients [25 pectus excavatum (PE) and 10 pectus carinatum (PC)] with a median age of 15.2 years (range 13–19 years). The mean size of the incision was 7.5cm (range 7–10.5cm). The mean operation time was 85min (75–115min). There were no intraoperative complications. The follow-up period ranged from 6 months to 2 years. Conclusions: The initial experience with the PLIER procedure demonstrates that it is suitable for the correction of PE and PC. The advantage of PLIER procedure is that it can be performed through small incisions in a short time with minimal loss of blood. Excellent aesthetic results after the procedure indicate the need to offer this method of surgical correction to low risk children. [Copyright &y& Elsevier]

Summary: Gender reassignment procedures are performed more frequently nowadays due to a multidisciplinary approach and improved techniques and selection process. Many male-to-female patients require bilateral breast augmentation as part of the transformation following the gender reassignment if they fail to develop female breast features after hormonal treatment. We report on a very rare incidence of male-to-female gender reassignment in a patient with Poland syndrome. A male-to-female transsexual on hormonal therapy for gender reassignment developed one normal female-shaped breast whereas the other breast remained hypoplastic. As a male, he was not aware of his chest wall deformity but it became a major issue after successful gender reassignment surgery. Our experience with the specific reconstructive considerations and recommendations regarding our surgical approach to this complex reconstructive problem are discussed. [Copyright &y& Elsevier]

ABSTRACT: There is still sparse information published about the surgical correction of female funnel chest deformity. Women with severe asymmetric funnel chest deformity often present with asymmetric, hypoplastic breasts. These patients frequently complain of physiological limitations in connection with gross aesthetic impairment. To correct these two features a combined approach is presented in this study. 10 women were operated with correction of the thoracic wall deformity by open retrosternal mobilisation and metal plate fixation. Either during the same procedure or in a secondary operation, submuscular breast augmentation was performed to correct breast hypoplasia and asymmetry. All patients tolerated the operation very well without any complications. Aesthetic outcome was rated good to excellent in secondary breast augmentation, whereas simultaneous implant positioning was prone to cause symmastia. In conclusion we recommend correction of female asymmetric funnel chest by primary sternal reduction with secondary breast augmentation during metal plate removal 1 year after. [Copyright &y& Elsevier]

Summary: Background: Breast reconstruction with deep inferior epigastric perforator (DIEP) flaps is typically a three-stage procedure, but additional operations may be required to deal with complications or to improve the aesthetic result. The purpose of this study was to evaluate the total number of operations needed after DIEP flap breast reconstruction to achieve a satisfactory end result for the patient. Patients and methods: From December 2002 to October 2006, 99 DIEP flap breast reconstructions obtained an end result in 72 patients. Data were collected in a structured database. Additional operations and complications were evaluated for the entire group. A study-specific questionnaire was used to evaluate patient satisfaction. Results: The mean number of additional operations was 1.4 per patient. Patients with complications required more operations than patients without complications. Women who chose nipple reconstruction were younger than women who did not and were more likely to have had a primary or secondary than a tertiary reconstruction. The number of additional aesthetic operations was neither related to the occurrence of complications during the initial reconstruction, nor to patient satisfaction. Overall, patients were very satisfied with the end result. Conclusions: Completion of DIEP flap breast reconstruction involved the initial reconstruction and an average of 1.4 additional operations. Patients were generally very satisfied with the end result. [Copyright &y& Elsevier]

Abstract: Congenital synmastia, or absence of the intermammary sulcus, is a rare breast anomaly in the pediatric population. While acquired synmastia after breast augmentation is a well-documented entity, congenital synmastia is a rare condition with only four previous cases reported in the surgical literature. We describe the first patient with concurrent presentation of congenital synmastia and multiple fibroadenomas. A combined technique was used to both address the patient''s breast lesions and correct the defect. [Copyright &y& Elsevier]

Summary: Supernumerary nipples are common congenital anomalies, most often occurring along the embryonic milk lines. We present a patient with an ectopic nipple on the foot. We are unable to explain the aetiology of this anomaly; however, several theories have been proposed. They are also associated with disorders of the renal and cardiovascular systems as well as pathology that affect normal breast tissue. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Ultrasound is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article offers clinical information on elastography, an imaging modality for the breast. It explains the concept underlying elastography, along with how such imaging modality is used and its limitations. It discusses the use of palpation to examine the breast and detect tissue abnormalities. It also highlights some reports which evaluated the clinical use of ultrasound elastography.

Polymastia is a rare condition seen in Nilagiri sheep. Overall percentage of polymastia in Nilagiri sheep was 7.70 percent and the incidence of supernumerary teats were 2.20 per cent and 5.50 per cent for ewes with three and four teats, respectively. [ABSTRACT FROM AUTHOR]

The article offers information to help diagnose the case of a 60-year-old woman with a two-year history of a non-scaly erythematous rash on the left breast. There is an occasional itchiness of the area. The patient may have eczema, Paget disease or psoriasis. Paget disease occurs in postmenopausal women.

Summary: Congenital variations of the shape and structure of the nipple lacks coverage in the medical literature. We present four cases of a specific and unique congenital nipple anomaly, the cleft nipple. Each woman had a normal contralateral breast and nipple–areola complex. Three of the four cases were corrected surgically with no complications experienced. Included in the discussion is a description of the techniques used in the corrective surgery and a review of the current literature on associated variations of normality. [Copyright &y& Elsevier]

Summary: Introduction: Bilateral breast reduction (BBR) and bilateral breast augmentation (BBA) represent ideal training procedures. This study prospectively audited BBR and BBA training opportunities at six plastic surgery units. Methods: Operative numbers and training opportunities were audited at 6 plastic surgical units in the south west region. Results: The results demonstrated considerable variations in training opportunities between different hospitals. In some cases, trainees did not operate on a single BBR or BBA, despite relatively high overall operative numbers. These differences did not relate to trainee seniority or patient demographics. Conclusion: The variations and deficiencies in training opportunities identified in this study may be due to a number of factors, such as local attitudes to training, external pressure on operative lists and the EWTD restrictions. These findings are unlikely to be confined to one region and should encourage wider audit of training provision. [ABSTRACT FROM AUTHOR]

Summary: Through a series of 7 patients (8 nipples), we present a technique for the correction of nipple inversion. We use a micro-knife to divide the shortened ducts and fibrous tissues, as well as an internal cerclage suture and reverse strictureplasty skin closure to effectively correct and maintain the position of the inverted nipple. The advantages of the proposed technique include its simplicity, effectiveness in severe cases, and long-lasting results. [Copyright &y& Elsevier]

Summary: Sternal wound dehiscence complicated by macromastia can be difficult to treat by standard musculocutaneous flaps alone. We present our experience with two cases of sternal wound dehiscence complicated by macromastia, and their subsequent healing with a combination of reduction mammoplasty and local musculocutaneous flaps. Reduction mammoplasty is a useful adjunctive procedure in patients with macromastia complicating sternal wound dehiscence. [Copyright &y& Elsevier]

Summary: An 11-year-old girl with massive virginal breast hypertrophy is presented. The breasts had begun to grow rapidly at puberty and had reached an enormous size within a year, to the point of causing physical impairment and respiratory compromise. Routine blood chemistry and endocrine investigation was normal, as was an MRI scan of the pituitary fossa. A bilateral reduction mammaplasty with free nipple grafts was performed, removing 12.5kg of tissue in all (24% of the total body weight). There was no recurrence at a 2 year follow up, and no requirement for additional surgery. A review of the literature reveals that breast regrowth is less frequent when free nipple grafting is used, and this technique is recommended for these extraordinary cases. [Copyright &y& Elsevier]

Abstract: The purpose of this review is to familiarize physicians who provide medical care to the young with knowledge about breast anomalies that present during childhood and adolescence. The scope includes congenital and developmental abnormalities, including breast masses. Both diagnosis and management are addressed. Congenital and acquired anomalies of the breast most often present during adolescence. The most common anomalies are polythelia and breast asymmetry. Surgical intervention for anomalies should be tailored and timed to the individual patient''s situation and need not wait until adolescence is completed. Breast masses in adolescents are most likely to be fibrocystic changes or fibroadenoma. Malignancy of the breast is rare and not likely to be adenocarcinoma. When imaging is needed, ultrasonography is the preferred modality. Not all breast masses, including fibroadenomas, need to be excised. [Copyright &y& Elsevier]