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Liu, Yuen-Jong, M.D.; Thomson, J Grant, M.D., M.Sc.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 2194-2195
doi: 10.1097/PRS.0b013e3181bcf7e0

Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass., Yale University School of Medicine, New Haven, Conn. (Liu)

Yale University School of Medicine, New Haven, Conn. (Thomson)

Correspondence to Dr. Thomson, Section of Plastic and Reconstructive Surgery, Yale University School of Medicine, P.O. Box 208041, New Haven, Conn. 06520-8041,

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We would like to congratulate Catanuto et al. on their work in developing a method with which to analyze the surface contour of the breast. We are excited that other experimental groups share our enthusiasm for attempting to add science to a field that previously has been approached completely subjectively.

Their work has focused on defining a Gaussian curvature parameter that they used to describe convex and concave portions of the breast surface.1,2 This type of analysis may be useful in studying patients' and surgeons' preferences in breast shape, as in our previous work.3 As they indicated in their articles, their work has yet to be validated. Our own work sought to experimentally validate our optical method of quantifying volume and surface area. Furthermore, we demonstrated that measurements of the female breast in the prone position are equivalent to those taken in the upright position, thus avoiding shadows at the inframammary fold and other limitations as documented in their articles.

In an upcoming article regarding phase II of our experiment, we use the volume-to-surface area ratio as a conceptually simple approximation of fullness or convexity of the breast. We perform a clinical application of our optical method, coupled with a series of online surveys, and we derive ideal anthropomorphic measurements and a mathematical relationship between volume and surface area for an aesthetically acceptable shape. We also quantify aesthetic features such as cleavage and asymmetry. These results are based on aesthetic feedback from plastic surgeons, cosmetic breast surgery patients, and reconstructive breast surgery patients, culminating in the first set of democratically representative and scientifically derived aesthetic values available in the literature. Previous studies relied on the aesthetic judgments of one plastic surgeon evaluator alone4 or conveyed no aesthetic judgment.5

We agree that in addition to surface area it is important to quantify the surface curvature of the breast, and we look forward to future publications from Catanuto et al. Perhaps our combined efforts will stimulate other groups to pursue scientific rigor in aesthetic plastic surgery.

Yuen-Jong Liu, M.D.

Beth Israel Deaconess Medical Center

Harvard Medical School

Boston, Mass.

Yale University School of Medicine

New Haven, Conn.

J. Grant Thomson, M.D., M.Sc.

Yale University School of Medicine

New Haven, Conn.

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The authors have no financial interests to disclose.

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1.Catanuto G, Spano A, Pennati A, et al. Experimental methodology for digital breast shape analysis and objective surgical outcome evaluation. J Plast Reconstr Aesthet Surg. 2008;61:314–318.
2.Farinella GM, Impoco G, Gallo G, Spoto S, Catanuto G, Nava MB. Objective outcome evaluation of breast surgery. Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv. 2006;9:776–783.
3.Hsia HC, Thomson JG. Differences in breast shape preferences between plastic surgeons and patients seeking breast augmentation. Plast Reconstr Surg. 2003;112:312–320; discussion 321–322.
4.Penn J. Breast reduction. Br J Plast Surg. 1955;7:357–371.
5.Smith DJ Jr, Palin WE Jr, Katch VL, Bennett JE. Breast volume and anthropomorphic measurements: Normal values. Plast Reconstr Surg. 1986;78:331–335.

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