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A Quantitative Analysis of Animation Deformity in Prosthetic Breast Reconstruction

Kim, John Y. S. M.D.; Qiu, Cecil S. B.A.; Chiu, Wen-Kuan M.D.; Feld, Lauren N. B.S.; Mioton, Lauren M. M.D.; Kearney, Aaron M.D.; Fracol, Megan M.D.

Plastic and Reconstructive Surgery: August 2019 - Volume 144 - Issue 2 - p 291-301
doi: 10.1097/PRS.0000000000005800
Breast: Original Articles

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Chicago, Ill.; and Taipei and Hsinchu City, Taiwan

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.

Received for publication July 17, 2018; accepted November 14, 2018.

Presented at the 57th Annual Meeting of the Midwestern Association of Plastic Surgeons, in Chicago, Illinois, April 14, 2018.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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John Y. S. Kim, M.D., Division of Plastic Surgery, Northwestern Memorial Hospital, 675 North St. Clair, Suite 19-250, Chicago, Ill. 60611,

Copyright © 2019 by the American Society of Plastic Surgeons