How to define volume of mammary gland
Introduction.
Definitionofactualvolumeofmammaryglandhasappliedmeaninginallthebranchesofsurgerythatdealwithproblemsofthisorgan, i.e. inoncology, mammology, plastic andrestorative surgery.
Forthispurposeweuseddifferentmodelsanddevices, like Grosman’s and Rounder’s measuring cones, method with use of polyethylene film according to I.A. Fishberg, method with use of Archimedes’ principle [1, 2, 3]. Allthesemethodshavesomedefects, inparticulartheyarerathermassive and demand for additional devices.
Someauthorsproposetofindalookalikeofmammaryglandincommongeometricalfiguresandtakes it as a cone with spherical contours or as a hemisphere [4, 5], but section of mammary gland shows that its foundation isn’t circle and looks more like an ellipse [6]. Hemisphericorconic “maiden” formofaglandwith age and after lactation changesintofemale drop-shaped one that is far from geometrical.
There are works where the authors try to definesizes of mammary gland through the calculations used at brassieres manufacture [7, 8]. Circumference of thorax underthemammaryglandsismeasured. Heightissubstitutedforthe vertical size of bra cup. Thusitisdefinedthatatthebraof “A” sizebreast size is 115-217 cm3, at “В” size – 140–368 cm3,at“С” size – 262–448 cm3. Bybrasizesit’spossibletoclassifyvolumes of mammary glands. Sizes1–2 areconsideredtobesmall, sizes3–4 – medium, sizes from 5 and more are defined like big.
There’samethodofferedbyL.Sigurdson (2006) for definition of volume of hypertrophic mammary gland. Accordingtothismethodvolumeofmammaryglandisdefinedbytheformulafromtwo linear measurements – circumference of glands’ foundation at the vertical position of patients and vertical space between fold and point on the foundation circumference. As the author writes, this formula can be used in women with glands volume from 500 to 2400cm3, but ideally it can be used for the volume from 877 to 1756cm3 [9].
Thus, there’snocommonapproach for the definition of sizes of mammary glands and also there’s no common classification of the glands by their volumes. Meanwhileithasgreatmeaningfortheplanningofoperationandmoreprecise prediction of postoperative result.
Materials and methods
Braputsdifferentmammaryglandsintosimilarshape (figures 1, 2), all the glands in it look similar and differ only in volumes.
Figure 1a.Figure1b.
PatientK., 32 years,in bra.PatientK., 32 years, without bra.
Figure 2a.Figure 2b.
PatientN., 28 years, in bra.PatientN., 28years, without bra.
Polandsyndrome. Operatedabout 10 years
ago.
Definitionofmammaryglandvolumeisoutpurposeinthisresearch.
Weusedexperienceofproducersofexoimplants– external implants of mammary glands used for reconstruction of body contours after mastectomy. Atthemanufacture of these implants of different sizes definite volume of siliconeis used.Everysizeofimplantdemandsmanufactureofbrawithcorrespondingcupssizes, the main ones are space from submammary fold to the nipple and from the frontal axillary line to the media one through the nipple [10, 11].
Data of manufacturers of external implants and bras were brought together into one table (table 1).
Table 1
Table of correspondence of sizes, volume and linear parameters of mammary gland (MG)
TextilesizeofMG /
Volume of MG (cm3)
/ CrosssizeofMG (cm) / Space from the nipple to the fold (cm)
1 / 00 / 100 ± 20 / 15.5 / 6.00
2 / 0 / 125 ± 20 / 16.2 / 7.05
3 / 1 / 160 ± 30 / 17.3 / 7.60
4 / 1.5 / 200 ± 30 / 18.4 / 8.15
5 / 2 / 230 ± 40 / 19.5 / 8.70
6 / 3 / 290 ± 40 / 20.6 / 9.25
7 / 4 / 380 ± 40 / 21.7 / 9.80
8 / 5 / 490 ± 40 / 22.8 / 10.35
9 / 6 / 560 ± 40 / 23.9 / 10.90
10 / 6.5 / 650 ± 40 / 25.0 / 11.45
11 / 7 / 730 ± 40 / 26.1 / 12.00
12 / 8 / 820 ± 40 / 27.2 / 12.55
13 / 9 / 920 ± 40 / 28.3 / 13.10
14 / 10 / 980 ± 40 / 29.4 / 13.65
15 / 11 / 1150 ± 50 / 30.5 / 14.20
Thetableincludes15 textilesizesofmammaryglands, eachofthemcorrespondswithdefinitevolumeofmammarygland. Thesecondnumberinthethirdcolumnreflectsvariations in silicone volume for every size. Nexttwocolumnsincludelinearsizesofbras. Crosssizeofmammaryglandisthespacefromfront axillary line to the media one through the nipple (fig. 3a). Spacefromthenippletosubmammaryfoldismeasuredfromnipple projection point to the lower edge of bra (fig. 3b).
Figure 3a. Measurement of cross size of mammary gland.
Figure 3b. Measurement of space from the nipple to submammary fold.
All the measurements of the gland are performed in vertical position of the patient in bra. Thereshouldn’tbeanyfoamrubberpaddinginbraanditshouldfit. Measurementsare approximatetakingintoaccountdifferentmodels of bras and physiological asymmetry of mammary glands.Then textile size of a gland and its approximate volume are defined according to the table.
Firstfivesizes(from1 to 5) are determined like small glands, next five (from 6 to 10) – like medium ones and the last five (from 11 to 15) – like large ones.
Example.Ifthecrosssizeofmammaryglandinbrais18,4cm, and space from the nipple to the fold is 8cm, then according to the tableтоtextile size of mammary gland will be 1,5. It’svolumewillbe200±30cm3.
Comparisonoftheeffectivenessofdevelopedmethodofdeterminationofmammaryglandvolumeandthereferentmethodwasperformedin 18 women (average age – 35,6 ± 1,3years), and 33 glands were studied. Archimedes’ principle (basedonthemeasurementofthe volume of liquid displaced at the submersion of mammary gland in vessel) wasusedasthe referent method. Atthegland’ssizemorethan500mlthe comparison of proposed method with L.Sigurdson’s method was performed.
Redults
We revealed that at the determination of volume of tissues of mammary gland by the method based on the Archimedes’ principle the volume of mammary gland had distribution different from Gaussian, with the thread of 350ml and 25–75% quartilesof 180–750ml. Theindexgot with the help of proposed method had distribution with the tread of 380 mland interquartile range [25–75%] of 200–730ml (p0,05) (fig. 2). Correlation coefficient between used methods was 0,98 (р0,001)(fig. 4).
Fig. 4. Distribution of volumes of mammary glands at the measurement by proposed method and by Archimede’s principle.
Themostcontributiontothemistake of measurement was made by the cases with big volumes of glands. Thediagram(fig. 5) showsthatthe limit of the measurement of mammary gland volume according to the proposed method is 1150ml. Thereasonofliesinthefactthatproposedmethodisbasedonthecalculations of silicone volume in external prosthetic devices of mammary glands, and the volume of prosthetic devices is limited by 1150ml.
Fig.5.CorrespondenceofthevolumesofmammaryglandsatthemeasurementwithproposedmethodandwithArchimede’sprinciple.
Distributiongotattheuseofproposedmethodwas practically congruent with one got at the use of referent method for the cases with gland’s volume less than 1150ml:thread 290, quartiles 160–650ml (for proposed method) and thread 300, quartiles 160–600ml (for Archimede’s principle) (p0,05). Correlation coefficient in this case was 0,99 (р0,001).
L.Sigurdson’s method can be used at large volumes of mammary glands. Atthemeasurementofvolumeofmammaryglandsinwomenwith ptosis (oneoftheconditionsofthemeasurement) werevealed that at the comparison of measurements results with ones of the referent method we can see satisfactory correspondence in the description of distribution – thread 1343ml (25–75% quartiles 1126–1576 ml) (for Sigurdson’s method)and thread 1425ml (25–75% quartiles 860–1550 ml) (for Archimede’s principle), correlation coefficient is 0,86 (p0,001) (fig. 6, fig. 7).
Рис.6.Correspondenceofthevolumesofmammaryglandsatthemeasurementby Sigurdson’smethodand by Archimede’s principle.
Fig.7.Distributionofvolumesof mammary glands at the measurement by Sigudson’s and Archimede’s methods.
Discussion.
Consequentlythemeasurementofmammaryglandwithvolumeupto1150 mlisquiteeasilyperformedwithuseoftapemeasureand proposed table.
Volume of mammary gland more than 1150 ml can be determined by Sigurdson’s method.
Glandswithvolumefrom100 to 250 mlaresmall, from 250 to 650 ml–medium, from 650 to 1150 ml–large. Volumefrom1150 to 2400 mlisconsideredas macromastia, volume more than 2400 asgigantomastia.
Informationaboutthevolumeofmammaryglandandthevolumeof malignant growth of it allows oncologiststo determine tactics of operative treatment depending on the ratio of tissues and mammary gland volumes [12].
In plastic surgery this information can be used for planning of the operation and prediction of its outcome.
Applied significanceofthetableisconfirmed by further clinical examples.
Clinicalexample1.
PatientI., bornin1983, initialsizeofmammaryglanddefined as 00, asks to enlarge them to the size 3. Aftersubtractionofpresentgland’svolumefromthedesirable one (290–100 ml) we have approximate volume of necessary implant– 190 cm3. Implants "Mс Ghan" of 180 ml wereplaced (fig. 8, 9).
Fig. 8 a, b, c, d, e. Fig. 9 a, b, c, d, e.
PatientI., 1983,before the operationPatientI., 1983,after the operation.
Fig. 8aFig. 9a
Fig. 8bFig. 9b
Fig. 8cFig. 9c
Fig. 8dFig. 9d
Fig. 8eFig. 9e
Clinicalexapmle2.
PatientM., born in 1957., mammary gland volumedefined as 8, asksto lessen it to the size 6. After subtraction of desirable gland’s volume from the present one (820 – 560 ml) we determine what volume of tissues is necessary to cut at the reduction mammoplasty – approximately 260 cm3. Patient had reduction mammoplasty by Lejour, resection of gland tissued (250 gfrom each side) (fig. 10, 11).
Fig. 10 a, b, c, d, e.Fig. 11 a, b, c, d, e.
PatientM., 1957, before the operationPatientM., 1957,after the operation
Fig. 10aFig. 11a
Fig. 10bFig. 11b
Fig. 10cFig. 11c
Fig. 10dFig. 11d
Fig. 10eFig. 11e
Conclusion
Consequentlyproposedmethodallowedquitepreciselytodefinevolumeofmammarygland in comparison with the measurements based on Archimede’s principle. Butourmethodexcelsthereferentoninitssimplicityandconvenientuse, that’s why in further work all the measurements of mammary gland volume ware performed by proposed method.
We propose for the discussion the method of unite approach to the determination of sizes of mammary gland and classification of mammary gland by their volumes.
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