23 февраля 2016г.
Abstract.
Congenital deformity of the chest is a complicating factor in the prognosis of aesthetic breast augmentation. Pectus excavatum is the most common type of congenital chest wall abnormality. Worsening of the chest’s appearance and the onset of symptoms are usually reported during rapid bone growth in the early teenage years leading to occurrence of psychological discomfort, but also to the development of breast asymmetry. The aim of this study was identification of unapparent breast asymmetry in patients with defects of the chest (pectus excavatum) and the upcoming breast augmentation.To detect breast asymmetry were used the following parameters: distance from the sternal notch to the nipple, from the nipple to the midline, position inframammary fold, distance from the middle of line connecting the SIAS to inframammary fold. These parameters are compared with a control group of patients with breast augmentation, but without chest defects. Data analysis of preoperative measurements showed that in patients with a defect of the chest unapparent asymmetry occurs significantly more frequently than in the control group. Received preoperative data were taken into account during the operation. Thus, analysis of the same parameters in the postoperative period showed no difference between the patient with pectus excavatum and the control group
Key words: breast augmentation; chest deformity; brest asymmetry; Introduction.
Originated in the 60s of the last century aesthetic breast augmentation is a popular cosmetic procedure, with an overall risk of complications of approximately 4 percent and a reoperation rate of 8 to 21 percent [1, 2]. One reason for the unsatisfactory result of breast augmentation can be implicit breast asymmetry caused by developmental defects of the chest. Pectus excavatum, pectus carinatum, sunken chest, and Poland syndrome are the most common chest wall deformities [3]. Among these, pectus excavatum occurs most often. It appears as a depression, most often involving the lower or middle part of the sternum, and frequently is associated with asymmetric depressions of the ribs, giving the chest wall a concave appearance. The precise etiology of pectus excavatum is not clear, although it is believed that the deformity is the result of unbalanced overgrowth in the costochondral region [4].
The aim of our retrospective study is to evaluate the significance of breast asymmetry complicating the deformation of the chest and the ability to compensate this deformation during breast augmentation surgery.
Patients and methods. Data were collected retrospectively from the personal archive of the last author from May of 1998 to September of 2012. All patients undergoing aesthetic bilateral breast augmentation alone were included in the analysis. Excluded were those that underwent operations on the breast different from augmentation (i.e., breast reductions), augmentations associated with other operations that could influence the nipple-areola complex (i.e., mastopexy, lifting of the nipple, inverted nipple, reduction of the nipple, capsulectomy), breast revisions, breast implant replacements, or monolateral or asymmetric augmentations. Patients with scoliotic chest deformity were nor included in to the study group.
In the past 15 years, we have treated 18 women with hypoplastic breasts and pectus excavatum. Their ages have varied from 21 to 31 years. They generally were healthy without cardiovascular function impairment.
A retrospective analysis of data prospectively collected using the Excel spreadsheet was performed. The patients were divided into two groups.
In the control group (CG) included patients with hypomastia having no pathology of the chest. In the study group (PE) included patients with hypomastia showing signs of chest wall deformity .
For assessing breast asymmetry and diagnosing possible scoliotic changes following criteria were used :Distance from the jugular notch of the sternum to the nipple on the right and left (1),Distance from the nipple to the midline (2)The distance from the line connecting the SIAS to the nipple (3),The distance from the line connecting the SIAS to the maximum point projecting ribs cartilage X (4), Rib angle (5), Bending angle waist - hips (6), Distance from the middle of the line connecting the SIAS and the inframammary fold (7), Upper mammary teat angle (8),Lower mammary teat angle (9). The first three criteria sufficiently well known and often used sufficiently informative for evaluation of asymmetry latent breast [5]. In this regard, we used additional criteria.
Parameters (sizes, distances , angles ) were determined using PixelStick program for Mac.
All statistical analysis was performed using SPSS version 21.0 (SPSS, Inc., Chicago, Ill.). Descriptive statistics were the mean and standard deviation for parametric continuous variables and the frequencies for qualitative categorical variables. Normality assumptions were demonstrated with histograms, skewness and kurtosis, and the Kolmogorov- Smirnov test homogeneity.
Results.
The analysis of parameters of hidden asymmetry showed that in the PE group almost all parameters of breast asymmetry were significantly greater than in the control group . Thus, the analysis of parameter 1 (the distance from the jugular notch of the sternum to the nipple ) in the PE group differences of right and left index amounted to 4.3 % , the maximum deviation was greater than 7 %. In control group these parameters were respectively 1.6 % and 2.6 %. As a consequence, the location of the inframammary fold (7 ) and the distance from the center of SIAS line to the nipple (3) to be updated and consist of 3.4 % ( 1.68 % in the control ) and 3.2 % (control 1.3%). Bending angle waist - hips (6) did not differ between groups in PE and CG. This observation is explained by the fact that the study did not include patients with scoliotic changes. Parameters upper mammary -nipple angle ( 8) and the lower mammary-nipple angle (9 ) were also varied , which indirectly indicates the selection of a PE and CG patients with the same size of the breast . The data presented were taken into account when preparing for augmentation mammoplasty and during surgery. Analysis of the results indicates that breast asymmetry in the postoperative period showed that there were not difference between PE and the control group (Table 1).
Conclusion.
Hidden breast asymmetry is typical for patients with deformity grudngoy cells due to pectus excavatum. The proposed scheme of examination of patients with chest deformity surgery and augmentation mammoplasty can effectively detect hidden breast asymmetry and get the result mammoplasty qualitatively identical to the control group patients.
List of references
1. Araco A, Gravante G, Araco F, Delogu D, Cervelli V, Walgenbach K. (2007) Retrospective analysis of 3,000 primary aesthetic breast augmentations: Postoperative complications and associated factors. Aesthetic Plast Surg, 31, 532–539.
2. Hodgkinson DJ (2002) The management of anterior chest wall deformity in patients presenting for breast augmentation. Plast Reconstr Surg., 109, 1714–1723
3. McCafferty LR, Casas LA, Stinnett SS, Lin S, Rho J, Skiles M. (2009) Multisite analysis of 177 consecutive primary breast augmentations: Predictors for reoperation. Aesthet Surg J, 29, 213–220.
4. Malek MH, Berger DE, Housh TJ, Marelich WD, Coburn JW, Beck TW (2006) Cardiovascular function following surgical repair of pectus excavatum: a metaanalysis. Chest, 130, 506 -509
5. Milanov NO, Chausheva SI, Melnikov DV. (2011) The asymmetry of the breasts in women with different curvatures of the spine, features of augmentation mammoplasty. Annals Plast. Reconstr. Esthet. Surg.,1, 50-55
