| Background:Preoperative planning and outcomes predictionof prosthetic breast augmentationdirectly affect the postoperative effect and patient satisfaction. But the preoperative design of prosthetic breast augmentation depends on the surgeon’s clinical experience, and lack of objective evaluation data of the postoperative outcomes for support. How to predict the outcome of breast augmentation, and correspondingly make accurate preoperative design is a problem for the plastic surgeons. This studyfocuses on the widely used dual-plane anatomic implant breast augmentation, tracking the postoperative breast morphological changes with the precise three-dimensional scanning technology, analyzing the differences of the parameters before and after operation, to achieve scientific data and objective evaluation of postoperative outcomes. It will provide objective evidence for precise individualized preoperative design and improve the controllability and predictability of postoperative outcomes.Objective1. Continuously track’ postoperative breast morphological changes in patients with prosthetic breast augmentation, understand the dynamic variation pattern of breast shape after dual-plane anatomic prosthetic breast augmentation and confirm the postoperative time point when the breast form is stable as the postoperative evaluation follow-up time.2. Compare breast morphological changes pre-and postoperatively in patients with breast augmentation, analyze how thecorrelative factors affect these changes and their clinical significance, in order to provide evidence for improving the accuracy and predictability of preoperative planning.Methods1. Acquire preoperative and postoperative three-dimensional scanning of patients who underwent primary breast augmentation and do measurement on three-dimensional model.2. Select 13 patients, total of 26 breasts, underwent dual-planeaugmentation mammaplasty with anatomic implant through transaxillary approach, acquiring their three-dimensional images preoperatively (pre-OP) and postoperatively in four time points (1 month:post-1M,3 months:post-3M,6 months:post-6M,12 months:post-12M) during one year follow-up. The linear distance, breast projection, nipple position, value and percentage of breast volume and surface area measured on the three-dimensional models. Analyze postoperative variation pattern of these measurements over time, and find out the relatively stable time point of these measurements.3. Select 66 patientsunderwent dual-planeaugmentation mammaplasty with anatomic implant through transaxillary approach, acquiring their preoperativeand 6 months or more postoperative three-dimensional images. The linear distance, breast projection, nipple position, value and percentage of breast volume and surface area, breast base width, breast base height, skin elasticity and relaxation on breast lower pole and thickness of the breast soft tissue are measured. Select changes of breast volume, breast projection, nipple position anddistance between nipple and inframammary fold as the research objects for further analysisof the relationship between these changes and possible correlative factors including the implant sizes and the tissue characteristics of patients.Results1. The postoperative linear distances of breast had different changes over time. Between 1 month to 12 months postoperatively, the nipple to inframammary fold distance gradually increased (N-IMFmaximum increase=0.3 ± 0.6 cm). Distance from sternal notch to the level of inframammary fold gradually increased (SN-LIMF maximum increased.5± 0.7cm). Above changes had no significant difference between 6 months and 12 months postoperatively (p> 0.05). Breast projection declined slightly since one month (PN maximum decrease=0.2±0.6cm); nipple position moved laterally, upward and anteriorly, after one month postoperative, the average added values on the X, Y, Z axis were 0.9+ 0.5cm,0.3±1.0cm,2.3±1.0cm respectively, but the differences of breast projection and nipple position in coordinates had no statistical significance (p> 0.05). Postoperative breast volume increased gradually (V maximum increase=18.3±37.7ml), the upper pole volume increased 2.1ml while the lower pole increased16.2ml, the measurements between 6 months and 12 months had no significant difference (p>0.05). The volume increases were mainly distributed on the lower pole of breast, the proportion of lower pole in the total volume gradually increased from 1 month to 12 months after surgery, while the upper pole’s proportion reduced gradually. There were no significant differences compared breast surface area at 1 month with 12 months postoperatively (p> 0.05), but the breast contour had a relatively full upperpole at post-1M and had a relatively full lower pole at post-12M.2. All the postoperative breast linear measurements had significant difference compared with preoperative ones, breast volume increased by 197.8ml±63.8 ml, in which the volume increase in lower pole took 55.2%. Postoperative volume is about 43.4±52.7 ml less than expected volume (preoperative volume±implant volume), accounting for 14.4% of the expected volume, the lost volume was positively correlated with preoperative breast volume, and negatively correlated with preoperative breast surface area. Postoperative breast projection was about 1.7±0.5cm smaller than expected projection, accounting for about 30.7% of the expected projection, the lost projection was positively correlated with preoperative breast projection and implant projection. Nipple shifted laterally, upward and anteriorly postoperatively, compared with preoperative coordinates the maximum shifting on X, Y, Z axis were 0.9±0.5cm,0.3 ± 1.0cm,2.3 ± 1.0cm relatively. The laterally displacement was positively correlated with implant projection, and the upward shifting was positively correlated with preoperative surface area of upper pole of breast and implant projection, but if the implant projection is too high will cause nipple downward displacement. Postoperative surface area increased of 63.4±24.7cm2, of which 72.1% distribution was on the lower pole of breast. The skin relaxation on the lower pole of breast was decreased after surgery. The postoperative base width of breast is positively correlated with the breast soft tissue thickness and preoperative breast volume. The distance between nipple and inframammary fold is positively correlated with implant base width and negative correlated with skin relaxation of breast lower pole.Conclusions1. During the one-year follow-up period postoperative breast morphological changes of the breast augmentation patients showed the following tendency, the inframammary fold level was declined, the distance between nipple and inframammary fold was increased, breast total volume, lower pole volume and the volumetric and surface proportion of lower pole were all increased while the surface area of upper pole decrease gradually, nipple position and breast total surface area remained unchanged.2. The postoperative breast morphological changes at 6 months after surgery had no significant difference when compared with 12 months after surgery, so the measurement data at 6 month after surgery can be used as postoperative outcome evaluation index.3. The distance of nipple to inframammary fold increased after dual-plane breast augmentation, the volumetric proportion of lower pole increased, but the parameters remain the stable after 6 months. It illustrates that dual-plane technique can make the lower pole plump without causing the persistent bulging.4. According to the breast compression, postoperative breast volume is 14.4% less than expected. The greater preoperative breast volume and less sagging will cause greater volumetric compression. Therefore, breast volumetric compression should be considered in preoperative selection of implant.5. Postoperative breast projection is less than expected; the greater preoperative projection and the higher implant projection will cause greater reduction of breast projection. When correct breast asymmetry by implants, the difference of selected implants should be greater than the original difference between two sides of breasts.6. Nipple shifts laterally, upward and anteriorly after breast augmentation, but the lift of nipple on the vertical direction is limited, and the higher projection of implant the more laterally displacement on horizontal direction. Therefore, correcting effect for breast ptosis by implants insertion only is very limited. |
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