A New Technique for Volume Measurement of Asymmetrical Breasts.
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Introduction Measurement of breast volume is especially important in asymmetry and augmentation mammaplasty. Unsuccessful asymmetrical breast operation, neither the surgeon nor the patient will be satisfied. There are several methods suggested by different authors (1-8). But there is still no commonly accepted standart methods for measuring breast volume. Many surgeons still rely on visual estimations and externally evaluation to measure differences in volume between breast and differences in volume between the mammary prosthesis to be used. To enable the surgeons to base their estimation on an objective evaluation, we have developed a simple method based on inflatable mammary prosthesis. This tecnique was called inner measurement method. This method allows the measurement of the volume differences of asymmetric breast and also helps the surgeon to estimate the size of prosthesis to be used in augmentation mammaplasty. Materials and methods We divided two parts to the tecniques of measurement of breast volume. First technique was called outer measurement method. Our tecnique were called inner measurement method. The outer measurement method comprises visual estimation, Archimedes principle and others methods (1-8). Two objects are needed for the apply of inner method; an used round expander (300-500 mL) and commercial the mammometer developed by Tegtmeier (3). An out of date expander can be gas sterilized for intraoperative use, as is that of Tegtmeier. This expander can be used every patients after gas sterilized. The round expander was put into asymmetrical breast through suprapectoral or subpectoral. Intraoperatively, this expander was filled about other breast volume with saline. Volume of the saline used was measured and added expander tare. Expander tare’s and measured saline physiologic are the difference in volume between the two breasts. To check the reliability of this method, we have used our method for four cases of asymmetry and ten cases symmetrical breasts. This tecnique, with asymettric breast repairing, is used symmetric augmentation mammoplasty. Additionally, the brassieres, which the patients would like to wear, are gas-sterilized for intraoperative use. The expander was inflated after putting subpectorally or suprapectorally. After the inflating procedure, the patient was located to half-sitting position and the brassiere was wore. By increasing or decreasing the saline, breasts size were arranged to fit. The same method was used to equivalane the size of the asymmetric breasts. The amount of saline was measured after providing the adequate size. By adding the weight of the container to this value, the volume of the prosthesis was determined. After mammaplasty to correct asymmetrical and symmetrical breasts for which we used our technique described above, breast volumes were equal in postoperative examinations. Discussion The method developed by Tezel et al. (8) is the most reliable for breast volume measurement. Their method also is based on the principle of water displacement. This method can be used for patients who have minor but no major rib cage asymmetry, as stated in their article. Our method can be used for patients who have minor and major rib cage asymmetry. In schultz et al. Method (7), the breast is submerged into a calibrated cylinder, which is filled with water. But they have a problem that stems from the patient’s participation, i.e., the level of submergence depends on the patients, and this variation affects the accuracy of the measurement. This method is uncomfortable for patients. Two preceding methods of determining volume using the brassiere were based on measuring of void between the brassiere and the breast. (2,6) In these method, the filled bag is between the brassiere and breast which can put pressure on the breast, affecting the accuracy of the measurement. Outer measurements are no precise in sizing the breast for augmentation mammaplasty. In our method, the measurement is realized with putting pressure under the breast. There are no pressure in outer measurement methods. Bigger expanders are seemed to be more useful in patients who would like to have bigger prothesis. As an example, in a case that 250-300 cc prosthesis would be placed, it is appropriate to use an expander with a volume of 300 cc. Expanders with the volumes of 250 to 300 cc may lead to incorrect results in measuring because of the increased tensile strength. Thus, round expanders with bigger volumes should be preferred cases like those. As a result, it will be suitable to use two round expanders with different volumes. Both round expanders and ghel prosthesis can resist equally to the superimposed pressure and the lateral expantion will be in the same degree. This also verifies the accuracy of our evaluation test. An additional test was performed to confirm this test. First, the round expander filled with saline was put on the digital weight scale and a four kilogrammed pressure was administered to its surface. Then the height and circumstance of the expander were measured. The same method was used in the ghel prosthesis also. No significant difference was recorded in both. The advantages of the presented method can be summarized as: 1. it can be used easily in major rib cage asymmetry, 2.This method can be used in confirmation of all outer measurements, 3. The patients are not needed to participate in this procedure, 4.This method seems to be very objective particularly in augmentation mammoplasties, 5. Our method does not require the purchase of a special commercial device. In conclusion, the application of our method has been extended to the perioperative assessment of volume differences between breasts, whatever the cause is. After obtaining these measurements, it was easy to decide on the size of the prosthesis if only one breast was to be augmented or to decide on the sizes of the two different prosthesis in cases of bilateral augmentation. This method can not only be used for asymmetric breasts, but also can be used in normal augmentation mammoplasty. It is a simple method and can be helpful to the inexperienced surgeons or one who deals only occasionally with asymmetric breasts. References 1. Bouman FG. Volumetric measurement of the human breast and breast tissue before and during mammaplasty. Br J Plast Surg 1970, 23: 263. 2. Kirianoff TG. Volume measurement of unequal breasts. Plast Reconstr Surg 1974, 54: 616. 3. Tegtmeier RE. A quick , accurate mammometer. Ann Plast Surg 1978,1: 625. 4. Tegtmeier RE. A convenient, effective mammary sizer. Aesthetic Plast Surg 1979, 3: 227. 5. Grosman AJ., Roudner LA. A simple means for accurate breast volume determination. Plast Reconstr Surg 1980, 66: 851. 6. Brody GS. Breast implant selection and patient satisfaction. Plast Reconstr Surg 1981, 68: 611. 7. Schultz RC., Dolezal RF., and Nolan J. Further application of Archimedes principle in the correction of asymmetrical breasts. Ann Plast Surg 1986, 16: 98. 8. Tezel E., Numanoğlu A. Practical do-it-yourself device for accurate volume measurement of breast. Plast Reconstr Surg 2000, 105: 1019.
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