Commentary on: evidence-based evaluation technique to assess augmentation mammaplasty results: a simple method to objectively analyze mammary symmetry and position.

نویسنده

  • Steven Teitelbaum
چکیده

Breast Surgery This article makes the case for a breast measurement system as well as for a surgical technique to minimize breast asymmetry during augmentation. 1 Their stated objective is to " devise an objective method to evaluate mammary symmetry based on statistical analysis of objective manual breast measurements and validate the method by applying it to results of a randomized controlled trial on the correction of breast asymmetry. " But such reasoning is tautological. To use their measurement system to prove that their adjustable implant method creates better symmetry, they must first validate the measurement system. To use their adjustable implant method to prove their measurement system works, they would have to first validate their surgical technique. So neither conclusion made in this article is justified. Nonetheless, these authors made a Herculean effort in taking measurements and doing statistical analysis. There are 9 measurements to take, and I found them to be relatively easy to do. Repeated measurements were consistent with the original. Such reproducibility is important. Meanwhile, the authors point out that other measurement systems with only 3 or 4 measurements are " very complex, " so it is unlikely that many surgeons would embrace their system either. This system does not measure the most critical determinants of breast shape: base width and the nipple to infra-mammary fold distance (NIMF). Ideal NIMF is a function of base width, and both NIMF distances must be equal. The NIMF is too long on the patient in the Figure 1, which is why there is too much lower fill, leaving the nipples too high on the breast mound. In Figure 6F, the inframammary folds are even. But because the left nipple is higher, the left NIMF is longer than the right NIMF, and the result is that there is more fill below the plane of the nipple on the left than on the right. The result in Figure 5 is outstanding, but credit is due to a perfectly planned and executed unilateral mastopexy rather than the choice of implant sizes. It also does not evaluate distribution of fill (eg, empty upper pole vs fuller lower pole, fold asymmetries, projection , edge visibility and palpability, the fullness of the breast envelope, the degree of ptosis, chest wall irregularities). Other measurements are not relevant to asymmetry, such as the circumference of the torso on inspiration and exhalation, or for which different implant sizes …

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Evidence-based evaluation technique to assess augmentation mammaplasty results: a simple method to objectively analyze mammary symmetry and position.

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عنوان ژورنال:
  • Aesthetic surgery journal

دوره 34 8  شماره 

صفحات  -

تاریخ انتشار 2014