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CC BY-NC 4.0 · Arch Plast Surg 2019; 46(06): 535-543
DOI: 10.5999/aps.2019.00493
Original Article

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

Diana Lydia Dyrberg 
Department of Plastic Surgery, Odense University Hospital, Odense and Lillebaelt Hospital, Vejle, Denmark
,
Gudjon Leifur Gunnarsson 
Department of Plastic Surgery, Telemark Hospital, Skien, Norway
,
Camilla Bille 
Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
,
Jens Ahm Sørensen 
Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
,
Jørn Bo Thomsen 
Department of Plastic Surgery, Odense University Hospital, Odense and Lillebaelt Hospital, Vejle, Denmark
› Author AffiliationsThis article was presented at the 37th Congress of the Scandinavian Association of Plastic Surgeons on June 14, 2018, in Copenhagen, Denmark.
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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.

Keywords

Mammaplasty - Breast deformity - Breast implant - Treatment outcome - Incidence


Publication History

Received: 09 April 2019

Accepted: 12 October 2019

Article published online:
25 March 2022

© 2019. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Pelle-Ceravolo M, Del Vescovo A, Bertozzi E. et al. A technique to decrease breast shape deformity during muscle contraction in submuscular augmentation mammaplasty. Aesthetic Plast Surg 2004; 28: 288-94
    CrossrefPubMedGoogle Scholar
  • 2 Strasser EJ. Results of subglandular versus subpectoral augmentation over time: one surgeon’s observations. Aesthet Surg J 2006; 26: 45-50
    CrossrefPubMedGoogle Scholar
  • 3 Becker H, Fregosi N. The impact of animation deformity on quality of life in post-mastectomy reconstruction patients. Aesthet Surg J 2017; 37: 531-6
    CrossrefPubMedGoogle Scholar
  • 4 Gabriel A, Sigalove S, Sigalove NM. et al. Prepectoral revision breast reconstruction for treatment of implant-associated animation deformity: a review of 102 reconstructions. Aesthet Surg J 2018; 38: 519-26
    CrossrefPubMedGoogle Scholar
  • 5 Spear SL, Schwartz J, Dayan JH. et al. Outcome assessment of breast distortion following submuscular breast augmentation. Aesthetic Plast Surg 2009; 33: 44-8
    CrossrefPubMedGoogle Scholar
  • 6 Dyrberg DL, Bille C, Gunnarsson GL. et al. Breast animation deformity. Arch Plast Surg 2019; 46: 7-15
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Vidya R, Tafazal H, Salem F. et al. Management based on grading of animation deformity following implant-based subpectoral breast reconstruction. Arch Plast Surg 2018; 45: 185-90
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Bertozzi N, Pesce M, Santi P. et al. One-stage immediate breast reconstruction: a concise review. Biomed Res Int 2017; 2017: 6486859
    PubMedGoogle Scholar
  • 9 Gunnarsson GL, Thomsen JB. Prepectoral hammock and direct-to-implant breast reconstruction in 10 minutes: a focus on technique. Plast Reconstr Surg Glob Open 2018; 6: e1931
    CrossrefPubMedGoogle Scholar
  • 10 Kummel S, Kummel A, Hagemann F. et al. Jumping breast phenomenon following subcutaneous mastectomy: first description and grading of a well-known breast deformity. Breast Care (Basel) 2018; 13: 354-8
    CrossrefPubMedGoogle Scholar
  • 11 Egeberg A, Sorensen JA. The impact of breast implant location on the risk of capsular contraction. Ann Plast Surg 2016; 77: 255-9
    CrossrefPubMedGoogle Scholar
  • 12 Gunnarsson GL, Borsen-Koch M, Wamberg P. et al. How to perform a NAC sparing mastectomy using an ADM and an implant. Gland Surg 2014; 3: 252-7
    PubMedGoogle Scholar
  • 13 Dyrberg DL, Bille C, Gunnarsson GL. et al. Visualized pre- and subpectoral implant placement for immediate breast reconstruction. Gland Surg 2019; 8 Suppl 4 S251-4
    CrossrefPubMedGoogle Scholar
  • 14 Random.org. True random number service [Internet]. Dublin: Randomness and Integrity Services Ltd; [cited 2019 Feb 21]. Available from: https://www.random.org/
    Google Scholar
  • 15 Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas 1960; 20: 37-46
    CrossrefGoogle Scholar
  • 16 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-74
    CrossrefPubMedGoogle Scholar
  • 17 Elmore JG, Wells CK, Lee CH. et al. Variability in radiologists’ interpretations of mammograms. N Engl J Med 1994; 331: 1493-9
    CrossrefPubMedGoogle Scholar
  • 18 Fleiss JL. Measuring nominal scale agreement among many raters. Psychol Bull 1971; 76: 378-82
    CrossrefGoogle Scholar
  • 19 Ibrahim AM, Koolen PG, Ganor O. et al. Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction?. Aesthetic Plast Surg 2015; 39: 359-68
    CrossrefPubMedGoogle Scholar
  • 20 Cheffe MR, Valentini JD, Collares MV. et al. Quantifying dynamic deformity after dual plane breast augmentation. Aesthetic Plast Surg 2018; 42: 716-24
    CrossrefPubMedGoogle Scholar
  • 21 Fracol M, Feld LN, Chiu WK. et al. An overview of animation deformity in prosthetic breast reconstruction. Gland Surg 2019; 8: 95-101
    CrossrefPubMedGoogle Scholar
  • 22 Chandarana MN, Jafferbhoy S, Marla S. et al. Acellular dermal matrix in implant-based immediate breast reconstructions: a comparison of prepectoral and subpectoral approach. Gland Surg 2018; 7(Suppl 1): S64-9
    CrossrefPubMedGoogle Scholar
  • 23 Chatterjee A, Nahabedian MY, Gabriel A. et al. Early assessment of post-surgical outcomes with pre-pectoral breast reconstruction: a literature review and meta-analysis. J Surg Oncol 2018; 117: 1119-30
    CrossrefPubMedGoogle Scholar