From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine; the Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Municipal Wanfang Hospital, Taipei Medical University; and the Department of Biological Science and Technology, National Chiao-Tung University.
Plast Reconstr Surg. 2019 Aug;144(2):291-301. doi: 10.1097/PRS.0000000000005800.
Animation deformity is characterized by implant deformity with pectoralis contraction after subpectoral implant-based breast reconstruction. Extant methods to measure and analyze animation deformity are hampered by the paucity of objective, quantitative data. The authors endeavored to supplement subjective measures with an in-depth quantitative analysis.
Patients undergoing subpectoral implant-based breast reconstruction were followed prospectively with video analysis of animation deformity. Nipple displacement and surface area of contour deformity in resting and contracted states were quantified using imaging software. Degree of animation was compared to breast size, body mass index, division of pectoralis muscle, complications, and radiation therapy.
One hundred forty-five reconstructed breasts (88 patients) were analyzed. Mean nipple displacement was 2.12 ± 1.04 cm, mean vector of nipple displacement was 62.5 ± 20.6 degrees, and mean area of skin contour irregularity was 16.4 ± 15.41 percent. Intraoperative pectoralis division, smooth/round implants, and bilateral reconstructions were associated with greater deformity. A three-tiered grading system based on thresholds of 2-cm net nipple displacement and 25 percent skin contour irregularity placed 41.4 percent of breasts in grade 1, 35.9 percent in grade 2, and 22.8 percent in grade 3. Interrater variability testing demonstrated 89.5 percent overall agreement (kappa = 0.84).
This study presents the first quantitative analysis of animation deformity in prosthetic breast reconstruction. Geometric analysis of nipple displacement vector and increasing animation with pectoralis division both implicate the inferior pectoralis myotome as a primary driver of animation deformity. A concomitant grading schema was developed to provide a standardized framework for discussing animation from patient to patient and from study to study.
动画畸形的特征是胸肌收缩后的植入物畸形，发生在胸肌下植入物乳房重建后。现有的测量和分析动画畸形的方法受到缺乏客观、定量数据的限制。作者努力用深入的定量分析来补充主观测量。
对接受胸肌下植入物乳房重建的患者进行前瞻性随访，对动画畸形进行视频分析。使用成像软件对静止和收缩状态下的乳头移位和轮廓变形表面积进行量化。比较动画程度与乳房大小、体重指数、胸肌划分、并发症和放射治疗。
分析了 145 个重建乳房（88 例患者）。平均乳头移位 2.12 ± 1.04cm，乳头移位矢量平均 62.5 ± 20.6 度，皮肤轮廓不规则平均面积 16.4 ± 15.41%。术中胸肌分裂、光滑/圆形植入物和双侧重建与更大的畸形有关。基于 2cm 净乳头移位和 25%皮肤轮廓不规则的阈值的三级分级系统，将 41.4%的乳房置于 1 级，35.9%置于 2 级，22.8%置于 3 级。评分者间变异性测试显示总体一致性为 89.5%（kappa = 0.84）。
本研究首次对假体乳房重建中的动画畸形进行了定量分析。乳头移位矢量的几何分析以及随着胸肌分裂而增加的动画都暗示了下胸肌肌束是动画畸形的主要驱动因素。同时制定了一个分级方案，为患者之间和研究之间讨论动画提供了一个标准化的框架。
