RESUMO
BACKGROUND: Breast surgery often requires changing the diameter of the areola. Recommended areolar size is commonly based on population averages, or surgical judgement. An ideal areola size has not been previously been described. We hypothesized that the ideal areolar diameter would be proportional to two breast measurements not commonly altered during breast surgery: the nipple diameter and breast base width. METHODS: 'The Sun' newspaper (London, UK) publishes photographs of topless models which are selected based on the aesthetic appeal of their non-operated breasts. The publication's archive, from March 2014 to January 2017, was independently reviewed by three authors to identify photographs that presented a clear anterior view of the breast. The base width, nipple diameter and areolar diameter were measured independently by each reviewer. Measurements were pooled, and the mean was included for analysis. Ratios of the areolar diameter to the base width and the nipple diameter were calculated. RESULTS: The photographs of 58 models were eligible for inclusion. The average areolar diameter to base width was 0.29 (SD = 0.05). The average nipple to areolar diameter was 0.29 (SD = 0.06). CONCLUSIONS: In aesthetically pleasing breasts, the areolar diameter is proportional to both the breast base width and nipple diameter. Breast base width is commonly measured preoperatively in aesthetic breast procedures, and is not typically modified. Breast base width can therefore be used to determine the ideal areolar size using the ratio of areola:base width ratio of 0.29 identified in this study.
RESUMO
BACKGROUND: The use of complementary and alternative medicines (CAMs) is common among women being treated for breast cancer. A recent mortality associated with CAM at our center precipitated a systematic review of the Cochrane, EMBASE, and PubMed databases to identify English manuscripts including "CAM" and "breast cancer." METHODS: Papers included for review were selected based on predefined inclusion and exclusion criteria. The primary outcome was the use of CAM by women with breast cancer. Secondary outcomes included timing of use along disease trajectory, attitudes toward CAM by allopathic practitioners, and patient disclosure of CAM use to treating allopathic physicians. RESULTS: Of 701 titles identified by the search strategy, 36 met the inclusion criteria. The weighted average proportion of women with breast cancer who use CAM was 40% (standard deviation: 18%). The diagnosis of breast cancer also prompts the initiation or increase of CAM use. However, up to 84% of patients do not disclose the use of CAM to their allopathic practitioners. CONCLUSIONS: Although CAM is often dismissed as a harmless addition to allopathic therapy, significant complications and interactions can occur. Our review and the dramatic case example provided highlight the need for physicians to educate themselves regarding CAM and to engage with their patients regarding its use.
HISTORIQUE: Les femmes traitées pour un cancer du sein utilisent souvent des approches complémentaires et parallèles (ACP). Un récent décès lié à l'utilisation de telles approches, qui s'est produit au centre des chercheurs, a suscité une analyse systématique des bases de données Cochrane, EMBASE et PubMed pour en extraire les manuscrits anglophones incluant les termes complementary and alternative medicine et breast cancer. MÉTHODOLOGIE: Les chercheurs ont retenu les articles d'après des critères d'inclusion et d'exclusion prédéfinis. Les résultats primaires étaient l'utilisation d'ACP par des femmes atteintes du cancer du sein et les résultats secondaires, le moment de leur utilisation dans la trajectoire de la maladie, les attitudes des praticiens allopatiques envers les ACP et le fait que les patientes informaient ou non les médecins allopathiques qu'elles utilisaient des ACP. RÉSULTATS: Parmi les 701 articles obtenus par la stratégie de recherche, 36 respectaient les critères d'inclusion. La moyenne pondérée de femmes atteintes d'un cancer du sein qui utilisaient des ACP s'élevait à 40 % (ÉT 18 %). Le diagnostic de cancer du sein incite les patientes à utiliser des ACP ou à en accroître l'utilisation. Cependant, jusqu'à 84 % des patients n'informent pas leur praticien allopathique qu'elles utilisent des ACP. CONCLUSIONS: Les ACP sont souvent considérées comme des ajouts inoffensifs au traitement allopathique, mais des complications et des interactions importantes peuvent surgir. L'analyse des chercheurs et l'exemple d'un cas dramatique jettent la lumière sur la nécessité que les médecins s'informent des ACP et discutent de leur utilisation avec leurs patientes.
