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Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. The syndrome is defined by chest wall pain unresponsive to standard pain medications and the presence of exquisite point tenderness along the inframammary fold at the site of the T4 and T5 cutaneous intercostal nerve branches as they exit from the chest wall. Pressure at the site triggers and reproduces the patient’s spontaneous or motion-evoked pain. The likely pathogenesis is neuroma formation after injury to the T4 and T5 intercostal nerves during breast surgery. We assessed the rate of long-term resolution of post-mastectomy pain after trigger point injections (2 mL of 1:1 mixture of 0.5% bupivacaine and 4 mg/mL dexamethasone) to relieve neuropathic pain in a prospective single-arm cohort study. Fifty-two women (aged 31–92) who underwent partial mastectomy with reduction mammoplasty or mastectomy with or without reconstruction, and who presented with PMPS were enrolled at the University of California San Francisco Breast Care Center from August 2010 through April 2018. The primary outcome was a long-term resolution of pain, defined as significant or complete relief of pain for greater than 3 months. A total of 91 trigger points were treated with mean follow-up 43.9 months with a 91.2% (83/91) success rate. Among those with a long-term resolution of pain, 60 trigger points (72.3%) required a single injection to achieve long-lasting relief. Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment for PMPS presenting as trigger point pain along the inframammary fold.

Background: Breast is the true mirror of femininity. Breast cancer is one of the diseases that affect the psychological state of women, not only because of the complications it entails, but also because of the negative impact of treatment on women psychologically and physically. Aim of Study: The aim of this work is to assess the effect of triplicated inferior pedicle technique on improving cosmetic outcome in patients with breast cancer in upper outer quadrant. Patients and Methods: This study conducted at Ain Shams University hospitals, starting January 2020 till May 2020 with follow up 6 months.The study include 15 patients from 30- 50 year. This prospective study started with 15 Female patients with breast cancer in upper outer quadrant or upper pole lesion. During the period of the study at Ain-Shams University Hospitals. The data was collected and presented as followed in several tables and figures. Results: In our study the mean value of immediate post-operative SN-N was 21cm. After 6 months the mean value of postoperative SN-N was 21.5cm. In the current study the mean value of preoperative inframammary fold- nipple distance (IMF-N) was 17.27cm. In our study mean value of immediate postoperative IMF-N was 7.33cm, and After 6 months the mean value of postoperative IMF-N was 8cm. So, triplicated inferior pedicle is to obtain the benefits and avoid the most annoying complication and maintain the shape of breast after breast reduction without significant difference in postoperative complications. Conclusion: Breast reduction is a procedure, which has evolved tremendously over the years due to the continuous and ongoing quest to achieve the objective of reducing the breast size, improving breast shape and relocating the nipple areola complex, while minimizing scars and also preserving lactation and innervation to the nipple-areola complex.

Traditionally, breast cancer patients with centrally located mass always receive mastectomy or the combination of central excision and primary closure. With the development of modern oncoplastic breast-conserving techniques, these patients can conserve their breast, and achieve satisfactory cosmetic outcome as well as clear margin. A variety of techniques are available to deal with centrally located breast cancers (CLBCs). Among these techniques, Grisotti flap technique is special, because it is easy to handle, and only causes minor injury by using a local rotational dermoglandular flap to fill the defection of central part. However, in our clinical practice, we find a lot of women in south China have special properties. Such as short distance from inframammary liner to the nipple, long distance from midclavicular to the nipple, and large breast diameter. Simply apply the Grisotti flap technique to those patients is not very suitable that drive us to modify this technique to suit our patients. We adopt the idea that use pedicled skin flap with skin island to replace the central defection to modify Grisotti flap technique. And applied this technique to two patients. We find modified Grisotti flap technique for Paget’s disease or CLBC had good cosmetic results as well as safety in suitable patients. In the future, we can use superior pedicle with skin island for ptotic breasts, and lateral pedicle is suitable for patients without large and ptotic breasts.

The treatment of early breast cancer using oncoplastic breast surgery (OBS) has been gradually increasing in popularity and is recognized for its efficacy in local control and excellent cosmetic results. We herein report a useful technique for obtaining symmetry of the breast shape for an early breast lesion located in an outer area, close to the nipple-areola, in a Japanese patient with ptotic, fatty breasts. We designed two equilateral triangles: one just upon the resected area and the other on the axilla. They were located on a straight line, with one top pointed to the cranial side and one to the caudal side. A crescent area around the areola was de-epithelialized in the 12 o’clock and 6 o’clock directions. Columnar-shaped breast tissue and an equilateral triangular skin flap and fatty tissue were removed together. To fill the defect, a skin-glandular flap was slid horizontally after suturing the inframammary line. Although an incision scar was formed on the breast and lateral chest wall in a Z-shape, this new technique was able to achieve not only cancer control but also excellent cosmetic results.

Background For the correction of small breasts with grade I ptosis, it is very challenging for plastic surgeons to obtain excellent aesthetic results by performing simultaneous breast augmentation and nipple-areolar complex (NAC) lifting. Previous research has introduced one-stage augmentation mastopexy, but most studies described using the periareolar approach. The current study proposes a technique for augmentation mastopexy using the inframammary fold approach for augmentation and the periareolar approach for mastopexy.Methods Twenty patients were enrolled, and surgery was performed on 40 breasts. A pocket was made with the inframammary fold approach and the dual-plane method; subsequently, a tear-drop shape implant was inserted using a funnel. We performed NAC lifting using the de-epithelialization and interlocking purse-string suture method through the periareolar approach.Results The mean distance from the mid-clavicular line to the nipple was 23.4 cm preoperatively, 19.6 cm at 7 days of follow-up, and 20.3 cm at 12 months of follow-up. Complications such as hematoma, infection, NAC necrosis, capsular contracture, and wound dehiscence were not reported.Conclusions We performed successful breast augmentation and mild ptosis correction. No specific complications were observed during 1 year of postoperative follow-up. Our method is a simple and fast method that enables surgeons to perform augmentation and mastopexy in one stage for breasts with grade I ptosis.

Background Anatomical implants provide a wide range of options in terms of implant dimensions for breast augmentation. Nevertheless, many surgeons choose not to use anatomical implants due to the risk of rotation malposition and because their advantages over round implants are not clearly defined. Methods A retrospective review of medical records was performed on all women who underwent breast augmentation or implant exchange with microtextured anatomical implants from 2012 to 2019 in a single private clinic. The authors focused on the outcomes of a subgroup of women with glandular ptosis and nipple placement below the inframammary fold who underwent breast augmentation with anatomical implants. Furthermore, the incidence and risk factors for implant rotation were analyzed. Results In total, 653 women underwent primary breast augmentation (n = 529) or implant exchange (n = 124) with anatomical implants. The median follow-up period was 2.7 years (interquartile range, 1.6 to 3.9 years). The incidence of implant rotation was 14 (2.6 percent) in the primary augmentation group and four (3.2 percent) in the implant exchange group. Implant rotation was not associated with type of surgery (p = 0.76), implant projection (p = 0.23), or implant height (p = 0.48). The authors successfully used anatomical implants to elevate the nipple in 92.9 percent of the women with glandular ptosis without using a mastopexy. Conclusions The study results indicate that the rotation risk with microtextured implants is similar to that with macrotextured implants. Furthermore, the authors found that high-projection anatomical implants can be used as an alternative to augmentation-mastopexy in women with glandular ptosis. Clinical question/level of evidence Therapeutic, III.

Summary Background The use of acellular dermal matrices (ADMs) in immediate two-stage prosthetic breast reconstruction following mastectomy is now a common practice. The procedure confers several compelling benefits, including coverage of the inferior pole, enhanced definition of the inframammary fold, and reduction of capsular contracture. However, operative techniques used to create the ADM inferolateral sling can be unwieldy in practice, typically involving the placement of the ADM followed by positioning and anchoring of the prosthetic expander. At best, this may be a relatively minor nuisance, but may potentially influence outcomes, including discrepancies in symmetry. Methods We present a novel modification that aims to streamline this procedure. Perforations are made through the allograft, through which the tissue expander tabs are brought through and sutured together ex vivo to allow the ADM and expander to be placed into the inframammary fold position as a single unit. A retrospective chart review was then performed of patients who underwent breast reconstruction utilizing this technique between July 2015 and December 2018. Outcomes including postsurgical complications such as infection, malposition, and reoperation were analyzed. Results Sixty-two patients met the inclusion criteria, corresponding to 108 breasts. The average follow-up was 18 months. The overall complication rate was 29.6% of breasts. The most commonly observed complications were mastectomy skin necrosis (9.3%) and major infection (8.3%). There was a 7.4% rate of malposition. Conclusions This simple but effective modification in ADM technique is associated with a comparable complication rate and allows for greater ease and consistency in tissue expander placement.

This study aims to put forward a new classification of breast asymmetry based on the relative position of the nipple and inframammary fold (IMF) and propose a surgical algorithm of determining new IMF to address breast asymmetry in patients undergoing transaxillary augmentation mammaplasty, which is named as NIMF (nipple inframammary) classification and surgical algorithm. Three hundred and forty-five patients received transaxillary augmentation mammaplasty with anatomical implants. Preoperative breast asymmetry was classified into four types. I: asymmetrical nipple with asymmetrical IMF in the same direction; II: symmetrical nipple with asymmetrical IMF; III: asymmetrical nipple with symmetrical IMF; IV: asymmetrical nipple with unapparent IMF. Surgical plans (3 plans for type I, II, IV while 5 plans for type III) to set the new IMF were provided for each patient, who chose one of them as the final surgical plan. Breast-Q and Likert scale were used to evaluate patient satisfaction and symmetry of breast preoperatively and 6 months postoperatively. The incidence of type I, II, III, IV was 30%, 15%, 13%, and 4%, respectively. Ninety-seven percent of patients with breast asymmetry chose plan C, which aimed to balance the relative position of nipple and IMF. Postoperative Breast-Q scores showed a significant rise compared with preoperative scores, but no statistical difference between plan C V.S. other plans. Patients with symmetrical preoperative breasts (Group A) had significantly higher postoperative Breast-Q scores than patients with asymmetrical preoperative breasts (Group B). In breast symmetry assessment, Group A had a significantly higher postoperative score than Group B, but the postoperative score was significantly lowered compared with the preoperative score in both Group A and B. The NIMF classification and surgical algorithm provide a systematic and scientific way to analyze and improve breast asymmetry, to achieve optimized patient satisfaction in transaxillary augmentation mammaplasty with anatomical implants. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .

Summary Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant reconstruction remains limited by high material costs. The authors describe a technique in which anterior implant coverage in prepectoral reconstruction is split into acellular dermal matrix inferolaterally and synthetic, absorbable mesh superiorly. Use of acellular dermal matrix inferiorly provides coverage and reinforces the inframammary fold, whereas the absorbable mesh is trimmed and sutured to the acellular dermal matrix at the appropriate tension to support the implant and relieve pressure on mastectomy flaps. A retrospective review was performed on all consecutive prepectoral one-stage breast reconstructions using this technique at a single institution. Patient demographics, mastectomy and reconstruction characteristics, reconstructive outcomes, and cost of support materials were queried and analyzed. Eleven patients (21 breasts) underwent prepectoral immediate implant reconstruction with Vicryl and acellular dermal matrix anterior coverage. Average mastectomy weight was 775.8 g. Smooth, round cohesive implants were used in all cases and average implant size was 514.5 ml. Overall complication rates were low and included one minor infection (4.8 percent) and one case of minor mastectomy flap and partial nipple necrosis each (4.8 percent). Calculated cost savings of Vicryl and acellular dermal matrix anterior coverage was up to $3415 in unilateral and $6830 in bilateral cases. Prepectoral breast reconstruction using acellular dermal matrix inferiorly and Vicryl mesh superiorly is a safe technique that decreases material costs associated with support materials and allows the surgeon to precisely control the implant pocket and position. Clinical question/level of evidence Therapeutic, IV.

Background Free nipple grafting indications in breast reduction surgery are outdated. Safety of inferior pedicle technique for large resections and long pedicles has not been clearly defined. We evaluated patients who underwent inferior pedicle reduction mammoplasty to define the safety constraints of the inferior pedicle. Methods A retrospective review of patients who underwent inferior pedicle reduction mammoplasty due to symptomatic macromastia at Mayo Clinic over a six-year period was conducted. Patients with prior breast surgeries were excluded. Demographics, breast measurements, and surgical outcomes were collected. Univariate and multivariate analyses were performed to assess for predictors of necrosis. Results Overall, 288 patients (576 breasts) underwent inferior pedicle breast reduction from 2014 to 2019. The mean sternal notch-to-nipple (SN N) distance was 31.5 cm (standard deviation[SD]:4.2; range[r]:16–48), and the mean nipple-to-inframammary fold (N-IMF) distance was 14.8 cm (SD:4.0; r:7.5–27). The mean resection weight was 699.6 g (SD:310.4; r:125–2,385). The median follow-up was 3.9 months (interquartile range[IQR]:2.8–9.0). The overall skin or nipple areolar complex necrosis rate was 2.1%; the overall complication rate was 14.8%. On multivariate analysis, overall necrosis was not found to be associated with the N-IMF distance (adjusted odds ratio[aOR]:1.05, 95%-CI 0.88–1.16). Resection weight was statistically associated with an increased risk of overall necrosis (aOR:1.003, 95%-CI 1.001–1.005), adjusting for N-IMF and SN N distances. Conclusion Inferior pedicle breast reduction offers low risk of necrosis and can be safely performed in patients regardless of the N-IMF distance. No association was found between N-IMF distance and overall necrosis in our cohort, including lengths >15 cm. However, large resections could increase the risk of necrosis.

Introduction: The aim of this study was to analyse if inframammary fold nipple sparing mastectomy (IMF NSM) could safely accommodate larger implants in relation to weight of the breast as opposed to nipple sacrificing mastectomy (NSacriM) in implant reconstruction with biological mesh. Methods: A review of prospectively collected data of implant-based reconstruction using biological mesh between Nov 2016 and December 2019 by a single surgeon. The volume of the implant was measured against the weight of the breast. The data was analysed using Chi-squared test and independent t-test, and a P value of < 0.05 was considered significant. Results: Sixty-five patients had 86 implant reconstructions during this period. Median follow-up was 18 months (1–38). There was no statistical difference between IMF NSM and NSacriM with regard to smoking, obesity (BMI>30) and radiotherapy (P>0.05). The volume of the implants was more than the weight of the breast in IMF NSM group compared to the NSacriM group (22/34 vs 21/52; P = 0.026). Significantly more patients in IMF NSM group had an implant volume within 100 g of the mastectomy weight compared to NSacriM group (31/34 vs 33/52; P = 0.003). None of the 34 IMF NSM had wound necrosis or threatened wound compared to 7/52 in NSacriM group (P = 0.025); 4 were managed in the clinic and 3 were managed in theatre. One patient in the NSacriM group lost her implant post radiotherapy at 5 months, and another patient lost her implant at 3 years. Comparisons were made between IMF-NSM and skin sparing mastectomy (SSM) having fixed volume silicone implants. The analysis showed that 22/33 (67%) IMF-NSM, had a volume of the implant more than the weight of the breast compared to 15/35 (43%) having SSM, this was statistically significant. There was a statistical difference between these two groups with regard to ischemic complications in favour of IMF-NSM. Conclusion: IMF NSM allows safer insertion of larger volume implants in relation to the weight of the breast as opposed to NSacriM.

Background The placement of a closed suction drain is indispensable for preventing serious infections; however, closed suction drains are inevitably accompanied by increases in local infections, pain, and length of hospital stay, and delays in breast cancer treatment including postoperative chemotherapy and radiotherapy. We analyzed predictive factors of total drainage volume and duration. Methods Among patients who were diagnosed with primary breast cancer between January 2016 and December 2017, we retrospectively analyzed those who underwent immediate implant-based breast reconstruction. Factors that could affect the total volume and duration of drainage, including lipo-prostaglandin E1 use, preoperative chemotherapy, resected breast issue weight, age, body mass index (BMI), serum white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) level, were analyzed. Results The mean volume and duration of drainage were 1,213.6 mL and 14.8 days respectively. BMI and CRP on postoperative day (POD) 1 were correlated with the total drainage volume. Age, BMI, and resected breast tissue weight were correlated with the drainage duration. Multiple regression analysis showed that CRP level on POD 1, age, and resected breast tissue weight significantly affected the drainage duration. Multiple regression analysis also showed that the total drainage volume was significantly affected by BMI and CRP level on POD 1. Conclusions The factors found to affect the duration of drainage in patients undergoing implant-based breast reconstruction were CRP on POD 1, age, resected breast tissue weight, and BMI. The CRP level on POD 1 and BMI influenced the total volume of drainage.

Introduction: Breast reduction is one of the most prevalent plastic surgery procedures in Syria and the world, bottoming out on the other hand is one of the most happened disadvantages after breast reduction with inferior pedicle technique. Different techniques were used to prevent this deformity after inferior pedicle. In this study we tried to prevent bottoming out by using two crossed dermal flaps suspending the inferior pedicle to the periosteum of the 2nd rib. Methods and materials: 32 patients had breast reduction surgery using inferior pedicle technique at Almowassat University Hospital in Damascus. We divide them into 2 groups, 16 patients each. First group we used crossed dermal flaps with the inferior pedicle and the second group was without these flaps, the dermal flaps had a base on the side of the inferior pedicle base, crossed anterior to it in the middle point between the lower edge of the areola and the IMF and then sutured to the periosteum of the 2nd rib on each side. Results: Preoperatively, the average distance between the inframammary fold and areola was 14.5 cm (range, 11 - 18 cm) in the first group without dermal flaps and 14 cm in the second group with dermal flaps. The average amount of breast parenchymal resection was 790 g (range, 140 - 1600 g). The average distance between the inframammary fold and the lower border of the areola was 8.5 cm (range, 7.5 - 9 cm) on the postoperative first-year measurements in the group with flaps and 10.2 cm (8.6 - 11.4 cm) in the other group. Conclusion: Inferior pedicle suspension using crossed dermal flaps has a real role in preventing bottoming out, without using any allogenic or alloplastic materials, making it one of the considered ways in preventing bottoming after breast reduction.

OBJECTIVE Various skin incision methods have been reported for reduction mammoplasty and mastopexy. This report describes a new incision method that may improve on conventional methods, particularly with respect to prevention of hypertrophic scars. METHODS We developed a comma-shaped incision method that results in fewer scars and less strain on the suture line. We then applied this new method to two cases, namely, one case of breast reduction and one case of breast fixation. RESULTS In both cases, we achieved good results. There was no scar at the inframammary fold, and no hypertrophic scar formation. All scars were within the breast area and were not in contact with the brassiere wire; hence, there was less pain after the operation. CONCLUSIONS We developed a new incision method for reduction mammoplasty and mastopexy.

Background and objectives Despite expander-based breast reconstruction being used as a reliable reconstruction method, implant removal due to wound dehiscence and infection still occurs in 0.5% to 15% of cases. This study aimed to compare the outcomes of the new inframammary fold (IMF) incision approach with previous incision in second-stage operation of expander-based 2-stage breast reconstruction. Methods Patients who underwent expander-based 2-stage breast reconstruction between February 2014 and May 2019 were included. After expander inflation, patients undergoing second-stage reconstruction were divided into the previous incision and IMF incision groups and their outcomes were compared. Propensity score matching analysis was performed to compare postoperative 1-year results. Results The previous incision and IMF incision groups comprised 79 and 31 patients, respectively. There were no intergroup differences in general demographics or intraoperative data, except for total inflation volume (426.87 ± 102.63 mL in the previous incision group and 375.48 ± 94.10 mL in the IMF incision group, P = 0.017). Wound dehiscence occurred in 12 and 0 cases in the previous and IMF incision groups, respectively (P = 0.018). Implant removal was performed due to dehiscence in 9 cases (8.18%) and 0 cases (0%) in the previous and IMF incision groups, respectively (P = 0.049). In 1-to-1 propensity score matching analysis, the IMF incision group showed better results at 1-year follow-up (odds ratio: 0, 95% confidence interval: 0-1.09; P = 0.063). Conclusions The IMF approach is a safe method for replacing the expander with an implant, with lower incidence of wound dehiscence and implant explantation.

BACKGROUND The rates of aesthetic breast augmentation have risen substantially in Asia. Outcomes of various breast augmentation approaches in Asia have not been comprehensively studied. In the past, the inframammary approach to breast augmentation was not popular because of conspicuous scarring. In this article, the authors review academic articles related to the use of an inframammary incision for breast augmentation in Asian women and present our recommendations for the available techniques. METHODS A literature search was performed for articles published after 2015 on Asian women with augmentation mammoplasty describing techniques, incision sites, outcomes, and complications. The search was performed using the MEDLINE, Embase, and Cochrane databases. We also included our own technique to demonstrate the outcome of augmentation mammoplasty through inframammary incision. RESULTS Eight articles satisfied our inclusion criteria. Evidence indicates that with proper preoperative design and surgical techniques, scarring resulting from the inframammary approach is not inferior to that resulting from the transaxillary approach in Asian patients. Long-term satisfaction with the inframammary approach to breast augmentation is high in Asian patients.Eight articles reported the outcomes of 1168 women receiving breast augmentation. Inframammary incisions were used in 45.29% of patients (529 patients). After the 2015 publication of Zelken's review paper on Asian breast augmentation, the rate of inframammary incisions increased from 3.1% to 45.29%. CONCLUSIONS With precise design of the new inframammary fold, accurate wound suture fixation, and postoperative scar care, the inframammary approach to breast augmentation offers optimal operative visualization, reduced pain, fewer complications, and desirable esthetic outcomes even in Asian patients. This study demonstrates that the percentage of inframammary fold approach of Asian esthetic mammoplasty grows rapidly after 2015.

BACKGROUND Subfascial placement of breast implants has the advantages of subglandular and submuscular placement without the adverse outcomes. There are few large series with longitudinal follow-up and outcome measures. METHODS Seven hundred eighty-three patients underwent subfascial breast augmentation and were followed up for 10 years. Adverse outcomes, changes in breast morphometry, and patient satisfaction were outcome measures. RESULTS All morphometry increased except soft-tissue thickness at the lateral sternal margin. The distance from the nipple-areola complex to the inframammary crease increased by 40 percent, with a concomitant 6.2 percent increase in the distance from the suprasternal notch to the nipple-areola complex. The capsular contracture rate was 6.48 percent, and correlates with a lateral sternal margin of less than 20 mm (r = 0.57, p < 0.001). Ripples occurred in patients with less than 10 mm of soft tissue at the lateral sternal margin; 11.6 percent of patients would choose a larger implant and 2.7 percent would choose a smaller implant. CONCLUSIONS Subfascial placement of breast implants provides a reliable technique. It can be used in patients with at least 20 mm of soft tissue at the lateral sternal margin. Those with 10 to 20 mm should be counseled that ripples may occur if they lose body fat. The technique is unsuitable for individuals with less than 10 mm measurable at the lateral sternal margin. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

Minimally invasive techniques for myxoma resection are rapidly becoming standard of care for such lesions. Inframammary incisions are commonly used in breast reconstruction. The use of this previous incision for myxoma resection is safe and serves as a cosmetically superior site for female patients. We describe a patient who underwent successful atrial myxoma resection through a previous breast augmentation inframammary incision.

Reconstruction of breast burns are challenging, as it includes both functional and aesthetic components. Transverse myocutaneous gracilis (TMG) flap has been used for postmastectomy breast reconstruction in the absence of abdominal donor site availability. Use of this flap for the breast burns is limited. A 32-year-old female sustained 54% second and third degree burns resulting with bilateral total breast loss. Anterior and posterior thorax, upper and mid abdomen, neck, shoulders, and bilateral upper extremities were also involved. Inner medial thighs had an ample amount of tissue and had never been used as donor sites. The left TMG (28 × 12 cm, 1,413 g) was used for right, and the right TMG (30 × 14 cm, 1,635 g) was used for the left breast, 3 months apart. The contracture on the chest wall was completely excised. Venous anastomosis to the venae commitantes was performed using a 2.5 mm coupler, followed by an end-to-end arterial anastomosis to the internal mammary artery. Flaps were inset in a fashion so that the inferior part became the inframammary fold, and the anterior and posterior wings were joined in the upper pole, creating a conical shape. Minimal wound dehiscence in the postoperative course healed with dressing changes and both flaps survived completely. Nipple reconstruction and areolar tattooing was performed. The patient was very happy with the outcome at seventh year follow-up. TMG may be a valuable option even in bilateral cases of microsurgical autologous free tissue transfer for total aesthetic reconstruction of postburn breast loss.

Studies have demonstrated the importance of anthropometric measurements of the breasts, based on linear measurements for the selection of the volume of breast implants, their positioning, and surgical planning. The objective of this study is to evaluate the main changes in anthropometric measurements in breast augmentation. A prospective, randomized clinical study with 74 female candidates for breast augmentation. All the individuals were split into five groups, according to the implant volume. The implants used were of different textures, from three different brands (LifeSil, Politech, and Silimed). The following measures were taken: distance from the nipple to the inframammary fold (N-IMF), inter-nipple-areolar complex distance (N-N), distance from the Sternal notch to the Nipple (SN-N), areola diameter, and breast projection. The most significant breast anthropometric alteration after mammoplasty was the N-IMF distance; that is, an expansion of the lower pole of the breast, followed by an increase in the areolar diameter. Mostly of measurements showed stability between 3rd and 6th months after the surgery. The projection was the most interesting measure due to presenting two patterns of behavior according to the analysis criteria performed. When comparing the implant projection and the final breast projection, it was observed that the implant profile represented a 27% increase in the final breast projection. This study provides an essential comparative analysis between anthropometric changes in breast augmentations and serves as a predictive tool in the preoperative evaluation of the patient during surgical planning. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .