[Validation of Subjective Estimates of Female Breast Volume and Comparison with Objective Methods]. / Validierung subjektiver Schätzungen des weiblichen Brustvolumen und Vergleich zur objektiven Methode.

INTRODUCTION: To date it remains unclear how well we are doing in subjectively judging breast volume. METHOD: 2 experienced female examiners reviewed images of 88 female breasts and estimated breast volumes. The "true" breast volumes were previously objectively obtained by breast analysis tool (BAT) software. Tests were repeated, and Bland/Altman statistics were utilised. RESULTS: Mean breast volume was at 419±274 cc statistically significantly larger by 59, respectively, 75 cc than estimated breast volume by the 2 examiners. The comparison of the first and second repeated test of subjective estimation of breast volumes revealed a correlation coefficient R of about 0.92 (p<0.001) while the same comparison for the BAT measurements provided a close to perfect correlation coefficient of R>0.99 (p<0.001). With increasing volumes the repeated estimations became less reliable, not so the BAT measurements. Small breast volumes were estimated as too large and large breast volumes were estimated as too small by the examiners and the connection was nearly perfectly linear. The correlation coefficient R between estimations and measurements was lower at 0.86 than in the repeated tests and estimations showed some considerable deviations in individual cases. CONCLUSION: Subjective breast assessments underestimated breast volumes by around 70 cc, with some deviations. Breast volume determination was less reproducible by subjective estimation than by objective measurement with BAT software. With increasing breast volumes the error of the subjective estimations in the repeated tests as well as in comparison to the BAT data increased, not so the error of the BAT data. Small breast volumes were overestimated and large volumes underestimated with some considerable individual deviations. There was a good reliability of the objective measurements without much systematic error, however only limited validity of the subjective method.

Treatment of Giant Fibroadenoma in Young Women: Results after Tumor Excision without Reconstructive Surgery.

Introduction: Giant fibroadenoma (GFA) of the breast is defined as fibroadenoma larger than 5 cm, usually presenting unilaterally and manifesting as breast asymmetry or deformity of the breast. Material and Methods: A retrospective database search was done of all patients with giant fibroadenoma who underwent surgery for GFA in the breast center of Hanover Medical School between 2007 and 2014; all patients with GFA were followed up. Data were analyzed with regard to tumor and patient characteristics and esthetic outcome. Results: A total of 13 patients with symptomatic GFA underwent surgery between 2007 and 2014. Mean patient age was 21.2 years (range 14-31 years). In 8 of 13 patients the tumor had resulted in breast deformity and/or breast asymmetry. Average size of the mass was 10.2 cm (range 8.5-12 cm) and average weight was 203.6 g (range 151.2-323.5 g). Initial clinical suspicion of GFA was confirmed by ultrasound examination. Preoperative core biopsy revealed fibroadenoma in 8/13 cases, cellular fibroepithelial lesions with a differential diagnosis of benign phyllodes tumor in 3 cases and unspecific histological findings in the remaining 2 cases. Conclusion: Excision was done using an inframammary or periareolar approach without reconstructive plasty. The cosmetic results were good, as were the outcomes on follow-up. We therefore favor this surgical technique to treat giant fibroadenoma of similar size to those described above.

Breast reconstruction and revision surgery for implant-associated breast deformities using porcine acellular dermal matrix: a multicenter study of 156 cases.

BACKGROUND: Acellular dermal matrix is increasingly used as caudolateral coverage for breast implants in immediate breast reconstruction after skin-sparing mastectomy or in the correction of implant-associated breast deformities. Matrices of human, bovine, and porcine origin are available. The purpose of this retrospective multicenter study was to report experiences with porcine acellular dermal matrices, as only limited data can be found in the literature. METHODS: In the hospital databases of five institutions, 127 patients were identified who underwent breast reconstructions in 156 breasts using an acellular porcine dermal matrix. Medical records were reviewed. Patients were divided into three groups: immediate expander-implant or direct to implant reconstructions (n = 98), delayed expander-implant reconstructions (n = 14), and revision surgery for implant-associated breast deformities (n = 44). RESULTS: With a mean follow-up of 19.6 months, total major complication rate was 7.1 %: implant loss (3.2 %), skin flap necrosis (2.6 %), delayed skin healing (2.6 %), hematoma (1.9 %), seroma (1.3 %), infection (0.6 %), and capsular contracture (0.6 %). Total minor complication rate was 22.9 %, with seroma being the most frequent complication (19.2 %). In the group of immediate breast reconstructions, 20.4 % of the breasts had received radiotherapy in the past. These patients exhibited a significantly higher rate of seroma than patients without prior radiotherapy (35.0 vs. 14.9 %, p = 0.031). CONCLUSIONS: Complication rates using porcine acellular dermal matrix in breast reconstruction are comparable to complication rates reported in studies using human acellular dermal matrices. Thus, porcine acellular dermal matrices can safely be applied in breast reconstructive surgery.

[Landmark-based statistical procrustes analysis in the examination of breast shape and symmetry]. / Landmark-basierte statistische Procrustes Analyse bei der Untersuchung der Brustform und -symmetrie.

AIM: The aim of this presentation is the explanation of a mathematical analysis of a landmark-based procrustes calculation. The various components of breast symmetry and their impact on breast reconstruction have been examined. METHOD: In an objective breast shape analysis asymmetries are quantified as a measure of the difference between a 3D landmark configuration of a breast and its mirror image. 10 landmarks, 4 on each side and 2 for a definition of the midline were defined. For each landmark the 3D coordinates were calculated statistically with the help of the software Programme R. Over a midline from the jugulum to the manubrium sterni, a mirror image of the breast was constructed. The data for the breast to be reconstructed and the non-operated breast from 44 patients were investigated. The statistical differences of the Procrustes analysis were used for an asymmetry score and the proportions of the individual components were calculated. These included size, location and orientation of the breast as well as the individual inherent morphological surface form data of the breast. RESULTS: All 44 patients exhibited breast asymmetries and the mean asymmetry score amounted to 0.52. A calculation of the proportions of the individual components making up the asymmetry score revealed that morphological surface data made the largest contribution to the asymmetry score, closely followed by location, i. e., positioning of the breast on the thoracic wall. In contrast, the size of the breast and its orientation were of lesser relevance. CONCLUSION: When considering breast symmetry in plastic surgery, the form plays a more important role than the size as objectively calculated by the statistical procrustes analysis. Almost equally important as the form is the positioning of the breast on the thoracic wall which contributes significantly more to total breast symmetry than axial displacements.

[Pyoderma gangrenosum: a rare cause of unexpected wound healing delay]. / Pyoderma gangraenosum--seltene Ursache einer unerwarteten Wundheilungsstörung.

Pyoderma gangrenosum represents a rare but severe disturbance of wound healing following operative interventions. A case report of pyoderma gangrenosum after breast surgery is presented and the aetiology and the various options regarding investigations and treatment are discussed considering the current literature.

The use of Munsell colour charts in nipple-areola tattooing.

Tattooing is an excellent, simple and quick option in nipple-areola reconstruction. Colour mismatch is one of the commonest problems with this procedure. Use of Munsell colour charts allows the premixing of common colours for different patient populations using pigments from various manufacturers. There are significant correlations between nipple colour and Fitzpatrick skin type and between nipple colour and parity. Three nipple-areola colours were more common than others and were found in 50% of patients; these can be premixed ready for use. Adjustment of premixed colours for individual patients can be performed prior to tattooing, speeding up the procedure. Accurate recording of colours also facilitates audit.

[The importance of afterloading technics for radiation protection]. / Die Bedeutung der Afterloadingverfahren für den Strahlenschutz

The importance of afterloading techniques for the improvement in radiological protection is shown. Simplifications of the constructional and operational provisions of radiation protection resulting therefrom are discussed. In this connection, the possibility is accentuated of completely giving up under certain conditions the measurement of the individual exposure doses to personnel working in the irradiation room, using long-term and short-term dosimeters.