Asymmetry Of Nipple And IMF Position In Augmentation Mammaplasty Patients

Background:High incidence of asymmetry of nipple or IMF occurred among augmentation mammaplasty patients.After the vertical position of nipple and inframammary fold(IMF)in the preoperative 3D scanning images of patient with augmentation mammaplasty is measured,this study aims to put forward a "NIMF" classification of breast asymmetry based on relative position of nipple and IMF and surgical algorithm of determining new IMF to address the corresponding breast asymmetry in augmentation mammaplasty patients.At same time,preoperative and postoperative breast asymmetry score and Breast-Q score are counted.Methods:①Based on 3D scanning images of 345 breast augmentation patients,patients were divided into group of symmetrical breast and asymmetrical breast.Considering relative position of nipple and IMF,the breast asymmetry was classified into four types.Ⅰ:asymmetrical nipple with asymmetrical IMF in same direction;Ⅱ:symmetrical nipple with asymmetrical IMF;Ⅲ:asymmetrical nipple with symmetrical IMF;Ⅳ:asymmetrical nipple with unapparent IMF.② Surgical Algorithm1)As for type Ⅰ asymmetry,there were three options available for patient to choose.Plan A:The P-IMF was set as the new IMF for each breast.Plan B:The new IMF of the two breasts was set in the same level of the P-IMF of the breast with lower nipple.Plan C:The middle line between Plan A(P-IMF of the breast with higher nipple)and Plan B(P-IMF of the breast with lower nipple)was set as the new IMF of the breast with higher nipple.The breast with lower nipple used its P-IMF as the new IMF.2)As for type Ⅱ asymmetry,considering the expected result of Plan A and Plan B was similar to that of Plan C,Plan C was routinely recommended.3)As for type Ⅲ asymmetry,there were five options available for patient to choose.Plan A,Plan B and Plan C were similar to that of type Ⅰ asymmetry.Plan D:The new IMF of the two breasts was set in the same level of the P-IMF of the breast with higher nipple.Plan E:On the basis of plan D,the round block lifting was performed on the breast with lower nipple.4)As for type Ⅳ asymmetry,three options similar to type Ⅰ were available for patient to choose.③ Objective evaluation:Breast-Q was used to evaluate patient satisfaction and Likert scale was used to evaluate preoperative and postoperative breast symmetry.Results:①130(37.6%)patients showed symmetrical nipple and IMF while 215(62.4%)patients showed asymmetrical nipple and IMF.The incidence Type Ⅰ,Ⅱ,Ⅲ,Ⅳ were 48%(104/215),24%(52/215),21%(45/215),7%(14/215),respectively.② Plan C was universally welcomed among patients of four types of breast asymmetry.98%(102/104)of patients of type Ⅰ asymmetry and 88.8%(40/45)of patients of typeⅢ chose Plan C.All Patients of type Ⅱ asymmetry and type Ⅳ asymmetry decided to adopt Plan C.③ 63.7%(220/345)of patients had completely finished preoperative and postoperative Breast-Q and Likert scale,including 65 patients of symmetrical breast group and 155 patients of asymmetrical breast group.1)Results of Breast-Q:①Preoperative score:there were no statistically significant between symmetrical breast group and asymmetrical breast group.②Postoperative score:Scores of satisfaction with breasts and results in symmetrical breast group(76.6;74.7)were higher than asymmetrical breast group(60.8;58.7)and differences had statistically significant(P<0.05).③Symmetrical breast group:Scores of satisfaction with breasts,psychosocial well-being and sexual well-being were 22.5,40.7,29.4 in pre-operative evaluation,significantly increased to 76.6,67.8,61.5 in post-operative evaluation and differences had statistically significant(P<0.05).④Asymmetrical breast group:Scores of satisfaction with breasts,psychosocial well-being and sexual well-being were 16.1,41.4,30.5 in pre-operative evaluation,significantly increased to 60.8,71.9,62.4 in post-operative evaluation and differences had statistically significant(P<0.05)..Seventy-five percent of patients were satisfied with postoperative breast symmetry.2)Results of Likert scale:Preoperative score:there were no statistically significant between symmetrical breast group and asymmetrical breast group.Postoperative score:Mean scores in symmetrical breast group(3.4)were higher than asymmetrical breast group(3.2)and differences had statistically significant(P<0.05).Conclusion:The NIMF classification and surgical algorithm provides a systematic and scientific way to analyze and improve breast asymmetry and educate patients.The appearance of asymmetrical nipple and IMF could be concealed and alleviated through surgical procedure.With the help of good preoperative communication and patient’s participation in surgical decision-making,higher patient satisfaction in augmentation mammaplasty could be achieved.