title: Incidence of breast and chest wall asymmetries: 4D photography.
abstract: BACKGROUND
  Few authors have addressed preoperative soft tissue and chest wall analysis as it pertains to asymmetries that must be identified for preoperative breast augmentation planning.
  
  
  OBJECTIVE
  The authors evaluate the incidence of breast and chest wall asymmetries.
  
  
  METHODS
  In the present study, 125 consecutive patients underwent a voluntary dimensional analysis by a single practitioner, followed by a confirmatory 4D photographic analysis. During each patient's evaluation, the following measurements were recorded: distance from nipple to inframammary fold (IMF), base width, distance from sternal notch to nipple, horizontal areolar width, vertical areolar height, upper and lower pole pinch tests, and medial and lateral pinch tests.
  
  
  RESULTS
  Following exclusion of patients who had undergone prior breast surgery, 117 patients were included in the final statistical analysis. Significant differences between right and left breasts were found in 81.7% of patients in one or more of the measured dimensions (p < .05). The manual measurements were confirmed with computerized 4D photography, and there was no significant difference found between the two measurement types in any objective parameter. However, there was a significant difference in the level of chest wall asymmetries identified by 4D photography. Nipple-to-IMF position asymmetry was present in 59.6% of the patients, and sternal notch-to-nipple asymmetry was present in 81.2%. Overall, 100% of the women had some degree of asymmetry (soft tissue and/or chest wall) confirmed by 4D photography.
  
  
  CONCLUSIONS
  The 4D photography measurements in this study were consistent with objective manual measurements but provided the added benefit of identifying chest wall asymmetries more objectively. The data from this study underscore the importance of developing a systematic preoperative breast and chest wall analysis that can be individualized for each patient. The resulting asymmetries should then be discussed with the patient, along with the potential for continued or more pronounced asymmetry postoperatively.
authors.affiliation: Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, California, USA. gabrielallen@yahoo.com
authors.forename: Allen
authors.initials: A
authors.lastname: Gabriel
authors.forename: Sharon
authors.initials: S
authors.lastname: Fritzsche
authors.forename: Craig
authors.initials: C
authors.lastname: Creasman
authors.forename: Waheed
authors.initials: W
authors.lastname: Baqai
authors.forename: David
authors.initials: D
authors.lastname: Mordaunt
authors.forename: G Patrick
authors.initials: GP
authors.lastname: Maxwell
mesh_terms: D001940:Breast / Q000002:abnormalities* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D016462:Mammaplasty / Q000379:methods*; D009558:Nipples; D010781:Photography / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D035441:Thoracic Wall / Q000002:abnormalities*