title: Is Breast Asymmetry Present in Girls with Adolescent Idiopathic Scoliosis?
abstract: METHODS
  Cross-sectional descriptive study.
  
  
  OBJECTIVE
  To characterize breast asymmetry (BA), as defined by breast volume difference, in girls with significant adolescent idiopathic scoliosis (AIS), using magnetic resonance imaging (MRI).
  
  
  BACKGROUND
  BA is a frequent concern among girls with AIS. It is commonly believed that this results from chest wall deformity. Although many women exhibit physiological BA, the prevalence is not known in adolescents and it remains unclear if it is more frequent in AIS. Breasts vary in shape and size and many ways of measuring them have been explored. MRI shows the highest precision at defining breast tissue.
  
  
  METHODS
  Thirty patients were enrolled on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception on their BA. MRI acquisitions were performed in prone with a 1.5-Tesla system using a 16-channel breast coil. Segmentation was achieved using the ITK-SNAP 2.4.0 software and subsequently manually refined.
  
  
  RESULTS
  The mean left breast volume (528.32 ± 205.96 cc) was greater compared with the mean right breast volume (495.18 ± 170.16 cc) with a significant difference between them. The mean BA was found to be 8.32% ± 6.43% (p < .0001). A weak positive correlation was observed between BA and thoracic Cobb angle (0.177, p = .349) as well as thoracic gibbosity angle (0.289, p = .122). The left breast was consistently larger in 65.5% of the patients. Twenty patients (66.7%) displayed BA ≥5%.
  
  
  CONCLUSIONS
  We have described BA in patients with significant AIS using MRI. This method is feasible, objective, and very precise. The majority of patients had a larger left breast, which could compound the apparent BA secondary to trunk rotation. In many cases, BA is present independently of thoracic deformity. This knowledge will assist in counseling AIS patients in regards to their concerns with BA.
authors.affiliation: Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; University of Montreal, 2910 Edouard-Montpetit Blvd, Montreal, Quebec H3C 3J7, Canada.
authors.forename: Joyce
authors.initials: J
authors.lastname: Ramsay
authors.affiliation: Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
authors.forename: Julie
authors.initials: J
authors.lastname: Joncas
authors.affiliation: MR Clinical Science, Philips Healthcare, 281 Hillmount Road, Markham, Ontario L6C 2S3, Canada; Hôtel-Dieu University of Montreal Hospital Center, 3840 Saint Urbain Street, Montreal, Quebec H2W 1T8 Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gilbert
authors.affiliation: Hôtel-Dieu University of Montreal Hospital Center, 3840 Saint Urbain Street, Montreal, Quebec H2W 1T8 Canada.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Trop
authors.affiliation: Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec, H3T 1J4 Canada.
authors.forename: Farida
authors.initials: F
authors.lastname: Cheriet
authors.affiliation: Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada.
authors.forename: Hubert
authors.initials: H
authors.lastname: Labelle
authors.affiliation: Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; University of Montreal, 2910 Edouard-Montpetit Blvd, Montreal, Quebec H3C 3J7, Canada. Electronic address: stefan.parent@umontreal.ca.
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
keywords: Adolescent idiopathic scoliosis; Breast asymmetry; Breast volume; Magnetic resonance imaging