Arch Plast Surg.  2019 Nov;46(6):535-543. 10.5999/aps.2019.00493.

A simple clinical assessment of breast animation deformity following direct-to-implant breast reconstruction

Affiliations
  • 1Department of Plastic Surgery, Odense University Hospital, Odense and Lillebaelt Hospital, Vejle, Denmark. joern.bo.thomsen@rsyd.dk
  • 2Department of Plastic Surgery, Telemark Hospital, Skien, Norway.
  • 3Department of Plastic Surgery, Odense University Hospital, Odense, Denmark.

Abstract

BACKGROUND
A high incidence of breast animation deformity (BAD) has been reported following immediate breast reconstruction with subpectorally placed implants. The aim of this study was to assess and compare the incidence of BAD in women who underwent either subpectoral or prepectoral immediate breast reconstruction. Therefore, we developed a grading tool and tested its reproducibility in a clinical setting.
METHODS
Video recordings of 37 women who had undergone unilateral or bilateral immediate breast reconstruction were evaluated by two consultant plastic surgeons. The degree of BAD was assessed by our grading tool, named the Nipple, Surrounding Skin, Entire Breast (NSE) grading scale, which evaluates the degree of tissue distortion in three areas of the breast. Blinded assessments were performed twice by each observer.
RESULTS
Eighteen patients were reconstructed with subpectoral implant placement and 19 with prepectoral implant placement. Using the NSE grading scale, we found a significant difference in the degree of BAD between the groups, in favor of patients who underwent prepectoral immediate breast reconstruction (0.2 vs. 4, P=0.000). Inter- and intraobserver agreement was moderate (74%) to strong (88%).
CONCLUSIONS
The incidence and severity of BAD was significantly lower in women reconstructed with a prepectorally placed implant than in those who underwent subpectoral immediate breast reconstruction. All patients reconstructed using the subpectoral technique had some degree of BAD. The inter- and intraobserver agreements were high when using the NSE grading scale, suggesting it is an easy-to-use, reproducible scale for assessing BAD in women who undergo immediate breast reconstruction.

Keyword

Mammaplasty; Breast deformity; Breast implant; Treatment outcome; Incidence

MeSH Terms

Breast Implants
Breast*
Congenital Abnormalities*
Consultants
Female
Humans
Incidence
Mammaplasty*
Nipples
Plastics
Skin
Surgeons
Treatment Outcome
Video Recording
Plastics
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