The Standardization of Aesthetic Breast Surgery through Mammometrics: The First Application of this Concept to Evaluate Pseudoptosis in Reduction Mammoplasty Patients
Nolan Karp, MD, Mihye Choi, MD, Oren Tepper, MD, Kevin Small, MD, Jacob Unger, BS, Daniel Feldman, BS, Naveen Kumar, MD.
NYU School of Medicine, New York, NY, USA.
At present, evaluation of aesthetic and reconstructive breast surgery has yet to be standardized. This is quite different from other areas of plastics surgery, such as craniomaxillofacial surgery, which often uses cephalometrics to obtain precise skeletal measurements for pre-and post-operative analysis. In the following study, we introduce a new concept termed Mammometrics, in which 3D-based breast measurements were used to analyze short- and long-term operative results following reduction mammaplasty.
Using three-dimensional breast models obtained from volunteers, a standardized system of mammometrics was developed that consists of points, planes, and vectors. Anatomical points identified on each 3D model included the N (nipple), S (sternal), I (inferior), L (lateral), M (medial), A (anterior), and U (Upper) points. Fixed planes were established for each model, and consisted of the CW (chest wall), HS (horizontal-split), VS (vertical-split), and IMF (inframammary fold) planes. Total volume was measured, as well as the upper and lower pole volumes based on the HS plane. Surface distances and vectors were also calculated. Established mammometrics techniques were then applied to 3D photographs from medial pedicle reduction mammaplasty (RM) patients at 3 months (3M), 1 year (1Y) and 2 years (2Y) post-operatively.
Mammometric analysis was applied to 15 consecutive RM patients with at least 2 year follow-up. Total breast volume at 3M, 1Y, and 2Y was 585, 481, and 490 cc, respectively. This represented a 15.7% volume reduction over the first postoperative year (p<0.05). The percent of tissue in the upper pole significantly decreased by 6.4% (p<0.01) from 3M (75.9%) to 1Y (69.5%), but did not change at 2Y(p=0.97). The point of maximal projection decreased from 3M to 1Y (5.9 vs. 5.3cm; p<0.01) with no significant change at 2Y (5.1 cm).
Mammometrics offers a standardized approach to objectively assess surgical outcomes in aesthetic and reconstructive breast surgery. To our knowledge, the numeric data generated by mammometrics in reduction mammoplasty patients is the first ever mathematical documentation of pseudoptosis (bottoming-out). In this study cohort, mammometric data revealed that bottoming out is significant in the first year following breast reduction surgery. There was no bottoming out the second postoperative year. Mammometrics serves as a valuable adjunct for evaluation of breast morphology, and therefore provides an opportunity to significantly advance aesthetic and reconstructive breast surgery through standardized three-dimensional measurements.