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Physiology (Bethesda, Md.) Mar 2020Although half the world's population will develop breasts, there is limited research documenting breast structure or motion. Understanding breast structure and motion,... (Review)
Review
Although half the world's population will develop breasts, there is limited research documenting breast structure or motion. Understanding breast structure and motion, however, is imperative for numerous applications, such as breast reconstruction, breast modeling to better diagnose and treat breast pathologies, and designing effective sports bras. To be impactful, future breast biomechanics research needs to fill gaps in our knowledge, particularly related to breast composition and density, and to improve methods to accurately measure the complexities of three-dimensional breast motion. These methods should then be used to investigate breast biomechanics while individuals, who represent the full spectrum of women in the population, participate in a broad range of activities of daily living and recreation.
Topics: Activities of Daily Living; Biomechanical Phenomena; Breast; Breast Neoplasms; Female; Humans; Torso
PubMed: 32027563
DOI: 10.1152/physiol.00024.2019 -
Plastic and Reconstructive Surgery Nov 2018It has been two centuries since Petrus Camper identified superficial fascia and over 175 years since Sir Astley Cooper wrote his book on the anatomy of the breast. In... (Observational Study)
Observational Study
BACKGROUND
It has been two centuries since Petrus Camper identified superficial fascia and over 175 years since Sir Astley Cooper wrote his book on the anatomy of the breast. In the 1990s, Ted Lockwood taught us the importance of the superficial fascia layers in body contouring procedures he pioneered. These descriptions, however, fail to explain the three-dimensional fascial system in the breast. The authors set out to discover and describe a theory of superficial fascia structures responsible for breast shape.
METHODS
The nature of the superficial fascia system that surrounds the breast and its attachments to the chest were studied in 12 cadaver breast dissections and in clinical cases of both cosmetic and reconstructive breast procedures.
RESULTS
The authors found a three-dimensional, closed system of fascia and fat surrounding the corpus mammae, which attaches to the skin by means of specialized vertical cutaneous ligaments, or Cooper ligaments, and which attaches to the chest wall by means of a three-dimensional zone of adherence at the breast's periphery.
CONCLUSIONS
The breast is shaped by a three-dimensional, fibrofatty fascial system. Two layers of this system surround the corpus mammae and fuse together around it, and anchor it to the chest wall in a structure we have called the circummammary ligament.
Topics: Breast; Cadaver; Dissection; Fascia; Fasciotomy; Female; Humans; Medical Illustration
PubMed: 30511967
DOI: 10.1097/PRS.0000000000004948 -
European Radiology Jun 2022Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women...
Breast density is an independent risk factor for the development of breast cancer and also decreases the sensitivity of mammography for screening. Consequently, women with extremely dense breasts face an increased risk of late diagnosis of breast cancer. These women are, therefore, underserved with current mammographic screening programs. The results of recent studies reporting on contrast-enhanced breast MRI as a screening method in women with extremely dense breasts provide compelling evidence that this approach can enable an important reduction in breast cancer mortality for these women and is cost-effective. Because there is now a valid option to improve breast cancer screening, the European Society of Breast Imaging (EUSOBI) recommends that women should be informed about their breast density. EUSOBI thus calls on all providers of mammography screening to share density information with the women being screened. In light of the available evidence, in women aged 50 to 70 years with extremely dense breasts, the EUSOBI now recommends offering screening breast MRI every 2 to 4 years. The EUSOBI acknowledges that it may currently not be possible to offer breast MRI immediately and everywhere and underscores that quality assurance procedures need to be established, but urges radiological societies and policymakers to act on this now. Since the wishes and values of individual women differ, in screening the principles of shared decision-making should be embraced. In particular, women should be counselled on the benefits and risks of mammography and MRI-based screening, so that they are capable of making an informed choice about their preferred screening method. KEY POINTS: • The recommendations in Figure 1 summarize the key points of the manuscript.
Topics: Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening
PubMed: 35258677
DOI: 10.1007/s00330-022-08617-6 -
Journal of Translational Medicine Aug 2023Over the last five decades, breast density has been associated with increased risk of developing breast cancer. Mammographically dense breasts are considered those... (Review)
Review
Over the last five decades, breast density has been associated with increased risk of developing breast cancer. Mammographically dense breasts are considered those belonging to the heterogeneously dense breasts, and extremely dense breasts subgroups according to the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS). There is a statistically significant correlation between the increased mammographic density and the presence of more glandular tissue alone. However, the strength of this correlation is weak. Although the mechanisms driving breast density-related tumor initiation and progression are still unknown, there is evidence suggesting that certain molecular pathways participating in epithelial-stromal interactions may play a pivotal role in the deposition of fibrillar collagen, increased matrix stiffness, and cell migration that favor breast density and carcinogenesis. This article describes these molecular mechanisms as potential "landscapers" for breast density-related cancer. We also introduce the term "Breast Compactness" to reflect collagen density of breast tissue on chest CT scan and the use of breast stiffness measurements as imaging biomarkers for breast cancer screening and risk stratification.
Topics: Humans; Female; Radiology; Breast Neoplasms; Breast; Tomography, X-Ray Computed; Risk Factors
PubMed: 37649088
DOI: 10.1186/s12967-023-04457-0 -
Asian Pacific Journal of Cancer... Feb 2022Breast surgery requires a high aesthetic outcome and should be individualized according to anthropometric breast and body characteristics. This study aimed to measure...
OBJECTIVES
Breast surgery requires a high aesthetic outcome and should be individualized according to anthropometric breast and body characteristics. This study aimed to measure the anthropometric parameters and volume of Vietnamese female breasts and their application in breast surgery.
SUBJECTS AND METHODS
A cross-sectional descriptive study enrolled 240 women treated at Vietnam National Cancer Hospital aged 18 to 78 years old. The measurements were obtained with the patient sitting upright in the anatomic position based on key landmarks and breast volume was also assessed. Differences in breast anthropometric measurements and breast volume were compared between groups of age, BMI, and the number of children. The correlation between breast volume calculated by anthropometric method and surgical specimen volume was evaluated to determine the accuracy of this method.
RESULTS
The mean values of the right and left breast volumes are less statistically different. Mean breast volume of the right breast and left breast were 396.1±182.3ml and 399.4±182.2ml, respectively. The proportion of breast ptosis increased with age (p=0.027), Body mass index (p<0.0001), and the number of children (p=0.004). The most important factor affecting the size and shape of the breast was body mass index (BMI). Mastectomy specimen volume and breast volume calculated by the anthropometric method are highly correlated with r=0.966.
CONCLUSIONS
The results of this study should be applied in clinical practice in breast surgery for Vietnamese women.
.Topics: Adolescent; Adult; Age Factors; Aged; Anatomic Landmarks; Anthropometry; Asian People; Body Mass Index; Breast; Cross-Sectional Studies; Female; Gravidity; Humans; Mastectomy; Middle Aged; Organ Size; Pregnancy; Sitting Position; Vietnam; Young Adult
PubMed: 35225480
DOI: 10.31557/APJCP.2022.23.2.665 -
European Journal of Radiology Nov 2022Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy... (Review)
Review
Contrast-enhanced mammography (CEM) is a promising vascular-based breast imaging technique with high diagnostic performance in detecting breast cancer. Dual-energy acquisition using low and high energy x-ray spectra following intravenous iodinated contrast injection provides both anatomic and functional information in the same examination. The low-energy images are equivalent to standard digital mammography and the post-processed recombined images depict enhancement analogous to contrast-enhanced breast magnetic resonance imaging (MRI). Thus, CEM has the potential to detect abnormal morphologic features as well as neovascularity associated with breast cancer. Since its emergence in 2011, CEM has consistently demonstrated superior performance compared with standard mammography and mammography plus ultrasound, particularly in women with dense breasts, with high sensitivity approaching that of MRI, supporting its use as a cost-effective diagnostic and screening tool. CEM has been primarily used in the diagnostic setting to evaluate patients with screening abnormalities or with symptomatic breasts, to perform preoperative staging of newly diagnosed breast cancer, and to evaluate response to neoadjuvant chemotherapy. More recently, CEM has been performed to screen women who have an intermediate to high lifetime risk of developing breast cancer. In addition to its high diagnostic performance, CEM is less expensive and more accessible than MRI and potentially better tolerated by patients. Minor drawbacks to CEM include a slightly increased radiation dose compared with standard mammography and a low risk for contrast allergy reaction. The aim of this study is to review the background, current literature, and future applications of CEM in breast cancer screening.
Topics: Female; Humans; Breast Neoplasms; Early Detection of Cancer; Mammography; Breast; Contrast Media; Magnetic Resonance Imaging
PubMed: 36108478
DOI: 10.1016/j.ejrad.2022.110513 -
JAMA Network Open Feb 2022Family history of breast cancer (FHBC) and mammographic breast density are independent risk factors for breast cancer, but the association of FHBC and mammographic...
IMPORTANCE
Family history of breast cancer (FHBC) and mammographic breast density are independent risk factors for breast cancer, but the association of FHBC and mammographic breast density in premenopausal women is not well understood.
OBJECTIVES
To investigate the association of FHBC and mammographic breast density in premenopausal women using both quantitative and qualitative measurements.
DESIGN, SETTING, AND PARTICIPANTS
This single-center cohort study examined 2 retrospective cohorts: a discovery set of 375 premenopausal women and a validation set of 14 040 premenopausal women. Data from women in the discovery set was collected between December 2015 and October 2016, whereas data from women in the validation set was collected between June 2010 and December 2015. Data analysis was performed between June 2018 and June 2020.
EXPOSURES
Family history of breast cancer (FHBC).
MAIN OUTCOMES AND MEASURES
The primary outcomes were mammographic breast density measured quantitatively as volumetric percent density using Volpara (discovery set) and qualitatively using BI-RADS (Breast Imaging Reporting and Data System) breast density (validation set). Multivariable regressions were performed using a log-transformed normal distribution for the discovery set and a logistic distribution for the validation set.
RESULTS
Of 14 415 premenopausal women included in the study, the discovery set and validation set had similar characteristics (discovery set with FHBC: mean [SD] age, 47.1 [5.6] years; 15 [17.2%] were Black or African American women and 64 [73.6%] were non-Hispanic White women; discovery set with no FHBC: mean [SD] age, 47.7 [4.5] years; 87 [31.6%] were Black or African American women and 178 [64.7%] were non-Hispanic White women; validation set with FHBC: mean [SD] age, 46.8 [7.3] years; 720 [33.4%] were Black or African American women and 1378 [64.0%] were non-Hispanic White women]; validation set with no FHBC: mean [SD] age, 47.5 [6.1] years; 4572 [38.5%] were Black or African American women and 6632 [55.8%] were non-Hispanic White women]). In the discovery set, participants who had FHBC were more likely to have a higher mean volumetric percent density compared with participants with no FHBC (11.1% vs 9.0%). In the multivariable-adjusted model, volumetric percent density was 25% higher (odds ratio [OR], 1.25 ;95% CI, 1.12-1.41) in women with FHBC compared with women without FHBC; and 24% higher (OR, 1.24; 95% CI, 1.10-1.40) in women who had 1 affected relative, but not significantly higher in women who had at least 2 affected relatives (OR, 1.40; 95% CI, 0.95-2.07) compared with women with no relatives affected. In the validation set, women with a positive FHBC were more likely to have dense breasts (BI-RADS 3-4) compared with women with no FHBC (BI-RADS 3: 41.1% vs 38.8%; BI-RADS 4: 10.5% vs 7.7%). In the multivariable-adjusted model, the odds of having dense breasts (BI-RADS 3-4) were 30% higher (OR, 1.30; 95% CI, 1.17-1.45) in women with FHBC compared with women without FHBC; and 29% higher (OR, 1.29; 95% CI, 1.14-1.45) in women who had 1 affected relative, but not significantly higher in women who had at least 2 affected relatives (OR, 1.38; 95% CI, 0.85-2.23) compared with women with no relatives affected.
CONCLUSIONS AND RELEVANCE
In this cohort study, having an FHBC was positively associated with mammographic breast density in premenopausal women. Our findings highlight the heritable component of mammographic breast density and underscore the need to begin annual screening early in premenopausal women with a family history of breast cancer.
Topics: Adult; Female; Humans; Middle Aged; Breast; Breast Density; Breast Neoplasms; Mammography; Medical History Taking; Premenopause; Retrospective Studies; White; Black or African American
PubMed: 35175341
DOI: 10.1001/jamanetworkopen.2021.48983 -
Breast Cancer Research and Treatment Jul 2022Mammographic Density (MD) refers to the amount of fibroglandular breast tissue present in the breast and is an established risk factor for developing breast cancer. The...
PURPOSE
Mammographic Density (MD) refers to the amount of fibroglandular breast tissue present in the breast and is an established risk factor for developing breast cancer. The ability to evaluate treatment response dynamically renders neoadjuvant chemotherapy (NACT) the preferred treatment option in many clinical scenarios. Previous studies have suggested that MD can predict patients likely to achieve a pathological complete response (pCR) to NACT. We aimed to determine whether there is a causal relationship between BI-RADS breast composition categories for breast density at diagnosis and the pCR rate and residual cancer burden score (RCB) by performing a retrospective review on consecutive breast cancer patients who received NACT in a tertiary referral centre from 2015 to 2021.
METHODS
The Mann-Whitney U Test was used to test for differences between two independent groups (i.e. those who achieved pCR and those who did not). A binary logistic regression model was used to estimate odds ratios (OR) and corresponding 95% confidence intervals (CI) for an association between the independent variables of molecular subtype, MD, histological grade and FNA positivity and the dependant variable of pCR. Statistical analysis was conducted with SPSS (IBM SPSS for Mac, Version 26.0; IBM Corp).
RESULTS
292 patients were included in the current study. There were 124, 155 and 13 patients in the BI-RADS MD category b, c and d, respectively. There were no patients in the BI-RADS MD category a. The patients with less dense breast composition (MD category b) were significantly older than patients with denser breast composition (MD category c, d) (p = 0.001) and patients who had a denser breast composition (MD category d) were more likely to have ER+ tumours. There was no significant difference in PgR status, HER2 status, pathological complete response (pCR), FNA positivity, or RCB class dependent upon the three MD categories. A binary logistic regression revealed that patients with HER2-enriched breast cancer and triple-negative breast cancer are more likely to achieve pCR with an OR of 3.630 (95% CI 1.360-9.691, p = 0.010) and 2.445 (95% CI 1.131-5.288, p = 0.023), respectively.
CONCLUSION
Whilst dense MD was associated with ER positivity and these women were less likely to achieve a pCR, MD did not appear to independently predict pCR post-NACT.
Topics: Breast; Breast Density; Breast Neoplasms; Female; Humans; Mammography; Neoadjuvant Therapy
PubMed: 35606616
DOI: 10.1007/s10549-022-06616-1 -
Diagnostic and Interventional Imaging Oct 2019Three-dimensional automated breast ultrasound system (3D ABUS) is an innovation in breast ultrasound that has been developed to uncouple detection from image acquisition... (Review)
Review
Three-dimensional automated breast ultrasound system (3D ABUS) is an innovation in breast ultrasound that has been developed to uncouple detection from image acquisition and to address the limitations of handheld ultrasound (HHUS). 3D ABUS provides a large field of view using high frequency transducers, producing high-resolution images and covering a large portion of the breast with one sweep. As more data become available on breast density and the impact of supplemental screening, 3D ABUS has gained wider acceptance as an adjunct tool to mammography. Computer-aided detection software significantly reduces interpretation time, improving the workflow for the utilization of 3D ABUS as a supplemental screening tool. In the diagnostic setting, 3D ABUS offers valuable impact in the detectability of breast lesions and the differentiation of malignant from benign lesions, with a high inter-observer agreement. State-of-the art technique, including uniform compression and proper positioning, tends to reduce artifactual posterior shadowing, while combined 3D ABUS-mammography interpretation improves radiologists' diagnostic performance. Promising results have supported the enhanced efficiency of 3D ABUS in detecting the extent of breast cancer and assessing response to neoadjuvant chemotherapy, whereas its correlation with molecular subtypes of breast cancer is remarkable. Future perspectives include the integration of radiomics and deep learning in the further development of 3D ABUS.
Topics: Artifacts; Breast; Breast Density; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Observer Variation; Ultrasonography, Mammary
PubMed: 30962169
DOI: 10.1016/j.diii.2019.03.012 -
International Journal of Surgery... 2012To reconstruct a breast mound from cutaneous mastectomy flap tissue alone, obviating the need for additional flap or implant techniques.
OBJECTIVE
To reconstruct a breast mound from cutaneous mastectomy flap tissue alone, obviating the need for additional flap or implant techniques.
SUMMARY BACKGROUND DATA
With growing numbers of obese and elderly women facing breast cancer, options outside of simple mastectomy without reconstruction and formal breast reconstruction using complex autologous flap harvesting techniques or artificial implants need to be explored.
METHODS
Patients who declined traditional methods of breast reconstruction were offered standard skin sparing mastectomy with closure utilizing a standard Wise pattern. A completely autologous breast mound was created by preserving and de-epithelializing residual mastectomy flap tissue.
RESULTS
Over 24 months, 32 women (50 breasts) underwent mastectomy and closure using this technique. Seromas occurred in 1 of 50 operated breasts and cellulitis developed in 3 of 50 breasts. One of the two patients had active hidradenitis at the time of surgery which made expander placement a contraindication and post operative infection a high risk. There has been no incidence of locoregional breast cancer recurrence.
CONCLUSIONS
Some patients are poor candidates for traditional methods of breast reconstruction secondary to medical comorbidities, while others may decline for more personal reasons. For these patients, we describe an additional option. The procedure is performed in a single stage and does not necessitate closure by a reconstructive surgeon, although a team approach can improve aesthetic results. Disadvantages include limited applicability in patients with small, non-ptotic breasts. Deemed the "Goldilocks Mastectomy", it is neither amputation of the breast, nor is it full reconstruction. It is a third, middle option. This offers an aesthetic advantage for women over simple mastectomy without reconstruction and potentially decreases cost and number of procedures sometimes associated with formal reconstruction.
Topics: Adult; Aged; Aged, 80 and over; Breast; Breast Neoplasms; Female; Humans; Mammaplasty; Mastectomy; Middle Aged; Surgical Flaps
PubMed: 22892093
DOI: 10.1016/j.ijsu.2012.08.003