Aesthetic Breast Surgery: What Do the Measurements Reveal? A Practical Visual Application of the Results.

BACKGROUND: The results of preoperative and 1-year postoperative measurements in aesthetic breast surgery were outlined in chart form in the Aesthetic Surgery Journal in 2020. Measurements were performed preoperatively and postoperatively, but the authors concentrated on 1-year follow-up because it was generally accepted as the minimum time to define a stable surgical result. Extensive statistical analysis was outlined in the previous paper. OBJECTIVES: This paper translates those results into a visual form so that the surgeon can see the changes that occur in breast reduction, breast augmentation, mastopexy, mastopexy-augmentation, and implant removal with mastopexy. METHODS: There were 548 patients in the breast augmentation group, 388 patients in the breast reduction group, 244 patients for mastopexy-augmentation, and 90 patients for mastopexy. Only primary surgeries that had a full year follow-up comparing preoperative and postoperative measurements were reviewed. Measurements were performed by E.H.F. preoperatively and at each postoperative visit. The measurements that were included in this study were clavicle to upper breast border, upper breast border to nipple, suprasternal notch to nipple, suprasternal notch to inframammary fold, and midline to nipple. RESULTS: The preoperative and postoperative measurement changes in aesthetic breast surgery were consistent, with minimal variation for each of the aesthetic breast surgery procedures. CONCLUSIONS: The visual interpretation of these results allows the surgeon to accurately plan preoperatively to achieve good, predictable results.

BreastGAN: Artificial Intelligence-Enabled Breast Augmentation Simulation.

BACKGROUND: Managing patient expectations is important to ensuring patient satisfaction in aesthetic medicine. To this end, computer technology developed to photograph, digitize, and manipulate three-dimensional (3D) objects has been applied to the female breast. However, the systems remain complex, physically cumbersome, and extremely expensive. OBJECTIVES: The authors of the current study wish to introduce the plastic surgery community to BreastGAN, a portable, artificial intelligence (AI)-equipped tool trained on real clinical images to simulate breast augmentation outcomes. METHODS: Charts of all patients who underwent bilateral breast augmentation performed by the senior author were retrieved and analyzed. Frontal before and after images were collected from each patient's chart, cropped in a standardized fashion, and used to train a neural network designed to manipulate before images to simulate a surgical result. AI-generated frontal after images were then compared with the real surgical results. RESULTS: Standardizing the evaluation of surgical results is a timeless challenge which persists in the context of AI-synthesized after images. In this study, AI-generated images were comparable to real surgical results. CONCLUSIONS: This study features a portable, cost-effective neural network trained on real clinical images and designed to simulate surgical results following bilateral breast augmentation. Tools trained on a larger dataset of standardized surgical image pairs will be the subject of future studies.

Aesthetic Breast Surgery: What Do the Measurements Reveal?

BACKGROUND: Do plastic surgeons really know what happens to the breast after surgery? We often think that we do, but we have very few measurements to show whether we are on the right track. OBJECTIVES: Only when the surgeon can predict the changes can she or he achieve consistent outcomes. Measurements lead to understanding; understanding what the measurements show allows us to refine our approach. METHODS: Consecutive patients in 4 categories were analyzed: breast reduction, mastopexy, augmentation, and mastopexy-augmentation. All procedures were performed by a single surgeon and all measurements were performed by the same surgeon. A standard measuring tape was utilized, and data were collected immediately preoperatively and at each follow-up visit. Only those patients with preoperative and complete 1-year postoperative measurements were included in this review. The parameters measured were clavicle to upper breast border (UBB), UBB to nipple, suprasternal notch (SSN) to nipple, SSN to inframammary fold (IMF), and chest midline to nipple. RESULTS: The changes were consistent. The borders of the breast footprint were expanded with the addition of an implant (UBB and IMF) and reduced with the removal of parenchyma (IMF). The existing SSN to nipple position was stretched when volume was added to the breast mound and it remained unchanged from the preoperatively marked position in a breast reduction. CONCLUSIONS: Although measurements are not necessary to achieve good aesthetic results in breast surgery, surgeons should understand what the measurements show and what happens to the different breast parameters.

Principles of Breast Re-Reduction: A Reappraisal.

BACKGROUND: This article examines outcomes following breast re-reduction surgery using a random pattern blood supply to the nipple and vertical scar reduction. METHODS: A retrospective review was conducted of patients who underwent bilateral breast re-reduction surgery performed by a single surgeon over a 12-year period. Patient demographics, surgical technique, and outcomes were analyzed. RESULTS: Ninety patients underwent breast re-reduction surgery. The average interval between primary and secondary surgery was 14 years (range, 0 to 42 years). The majority of patients had previously undergone primary breast reduction using an inferior pedicle [n = 37 (41 percent)]. Breast re-reduction surgery was most commonly performed using a random pattern blood supply, rather than recreating the primary pedicle [n = 77 (86 percent)]. The nipple-areola complex was repositioned in 60 percent of patients (n = 54). The mean volume of tissue resected was 250 g (range, 22 to 758 g) from the right breast and 244 g (range, 15 to 705 g) from the left breast. Liposuction was also used adjunctively in all cases (average, 455 cc; range, 50 to 1750 cc). Two patients experienced unilateral minor partial necrosis of the areolar edge but not of the nipple itself (2 percent). CONCLUSIONS: Breast re-reduction can be performed safely and predictably, even when the previous technique is not known. Four key principles were developed: (1) the nipple-areola complex can be elevated by deepithelialization rather than recreating or developing a new pedicle; (2) breast tissue is removed where it is in excess, usually inferiorly and laterally; (3) the resection is complemented with liposuction to elevate the bottomed-out inframammary fold; and (4) skin should not be excised horizontally below the inframammary fold. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.