Linear Regression Algorithm for Male Nipple-Areolar Complex Anthropometry and Placement, Using Body Mass Index.

ObjectiveTo evaluate diagnostic value of body mass index (BMI) in screening and diagnosing obstructive sleep apnoea-hypopnoea syndrome and to determine the reference standard of body mass index (BMI) in both...

Successful nipple-areolar complex (NAC) reconstruction greatly influences patient outcomes for transgender patients undergoing chest masculinization. Despite the recent rise in case volume, little is known on designing the ideal NAC that maintains its aesthetics in dynamic settings. This study aimed to examine the characteristics of male NACs and their dimensional variability to help develop guidelines on designing the neo-NAC. Thirty cisgender male participants were enrolled. NAC height and width, sternal notch-to-nipple distance, and internipple distance (IND) were measured in standing and supine positions with stable room temperature to prevent measurement bias. Other variables recorded included chest circumference, NAC angulation, body mass index, weight, height, age, and ethnicity. Mean standing and supine measurements were as follows: NAC height, 21.2 mm (SD, 3.9) versus 23.4 mm (SD, 4.7); NAC width, 29.0 mm (SD, 5.1) versus 29.7 mm (SD, 5.6); sternal notch-to-nipple distance, 20.8 cm (SD, 2.1) versus 19.3 cm (SD, 1.8); and IND, 22.4 cm (SD, 2.3) versus 23.5 cm (SD, 2.5). NAC height-to-width ratio decreases from supine to standing, as well as IND, indicating a medialization of the NACs when upright. Our findings suggest that during chest masculinization surgery, the design of the male neo-NAC has a risk of being positioned too medial and elliptical with upright positioning. Care must be taken intraoperatively to account for changes in neo-NAC dimensions that occur with body position changes. We strongly recommend that surgeons determine the final position of the neo-NAC intraoperatively while having the patient in upright sitting position.

Breast mound and nipple creation are the goals of the reconstructive process. Unlike in normal body mass index (BMI) women, breast reconstruction in the obese is associated with increased risk of perioperative complications. Our aim was to determine if reconstruction technique and the incidence of perioperative complications affect the achievement of reconstruction completion in the obese female. Consecutive obese women (BMI ≥30) who underwent mastectomy and implant or autologous reconstruction were evaluated for the completion of breast reconstruction. Two hundred twenty-five women with 352 reconstructions were included. Seventy-four women underwent 111 autologous reconstructions and 151 women underwent 241 implant-based reconstructions. Chemotherapy, radiation, and delayed reconstruction timing was more common in the autologous patients. Major perioperative complications (requiring hospital readmission or unplanned surgery) occurred more frequently in the implant group (p ≤ 0.0001). Breast mounds were completed in >98% of autologous cases compared with 76% of implant cases (p ≤ 0.001). Nipple areolar complex (NAC) creation was completed in 57% of autologous patients and 33% of implant patients (p = 0.0009). The rate of successfully completing the breast mound and the NAC was higher in the autologous patient group (Mound odds ratio or OR 3.32, 95% confidence interval or CI 1.36-5.28 and NAC OR 2.7, 95% CI 1.50-4.69). Occurrence of a major complication in the implant group decreased the rate of reconstruction completion. Obese women who undergo autologous breast reconstruction are more likely to achieve breast reconstruction completion when compared with obese women who undergo implant-based breast reconstruction.

Subcutaneous mastectomy is an accepted procedure for surgical reassignment in female-to-male (FtM) transsexuals. However, fatty degeneration of the mammary gland (FDMG) is sometimes observed in FtM transsexuals, with implications for mastectomy outcomes. In this study, we describe the characteristics and risk factors of FDMG. A total of 48 FtM transsexual patients underwent bilateral subcutaneous mastectomies (96 subcutaneous mastectomies) at our clinics from January 2015 to February 2016. The patients were divided into FDMG and non-FDMG groups after evaluation of the cut surface of the resected mammary gland. The groups were compared in terms of age, smoking, hormonal therapy (testosterone), body mass index (BMI), breast size (top–under perimeter), distance between sternal notch and nipple–areolar complex (NAC), breast ptosis grade, weight of resected breast tissue, and complication rate. FDMG tissue specimens were examined histologically. Comparing the FDMG and non-FDMG groups, hormonal therapy was more common (91.3 vs. 72.0%, p = 0.049), BMI was higher (24.3 vs. 21.1%, p < 0.001), and distance between the sternal notch and NAC was longer (20.5 vs. 18.8%, p = 0.03). Hormonal therapy, high BMI, and long distance from the sternal notch to the NAC are risk factors for FDMG and should be considered prior to mastectomy in FtM transsexuals. Level of Evidence: Level III, risk/prognostic study

Introduction: High body mass index (BMI) values are associated with a lower risk of ischemic complications after percutaneous coronary intervention (PCI). Hypothesis : Higher BMI values may correlate with fewer bleeding after PCI in patients meeting or not the High Bleeding Risk (HBR) criteria of the Academic Research Consortium (ARC). Methods: All patients undergoing PCI between 2012 and 2019 at the Mount Sinai Hospital were included and stratified in 5 BMI categories according to World Health Organization definition. Patients where considered at HBR if they fulfilled ≥1 major or ≥2 minor ARC-HBR criteria. The primary outcome was major bleeding, the secondary outcome was post-discharge major bleeding at 1 year after PCI. Risks for these outcomes were obtained using a multivariable Cox regression model adjusted for the ARC-HBR criteria. Results: Among 16,229 patients, 20.2% had a BMI ≥18.5-25 (normal), 40.7% had a BMI ≥25-30, 24.4% had a BMI ≥30-35, 9.2% had a BMI ≥35-40, and 4.8% had a BMI ≥40 kg/m 2 . The proportion of patients meeting the ARC-HBR criteria progressively decreased from 48% in the normal BMI group to 41% in the highest BMI group. As compared to the normal BMI group (6.0%), the 1-year risk of major bleeding was significantly lower (p&lt;0.05) in the groups with BMI ≥25-30 (4.1%, adj. HR 0.73, 95% CI 0.60-0.88), with BMI ≥30-35 (3.5%, Adj. HR 0.62, 95% CI 0.49-0.77), with BMI ≥35-40 (4.2%; Adj. HR 0.72, 95% CI 0.54-0.9), while it was similar in the group of BMI ≥40 (4.9%, Adj. HR 0.83, 95% CI 0.58-1.18) ( A ). These differences were driven by lower rates of in-hospital bleeding in patients with BMI ≥25-40 kg/m 2 . Among HBR patients, 1-year rates of major bleeding were consistently above 4% in each BMI category, but relatively lower for BMI ≥25-40 kg/m 2 ( B ). Conclusions: BMI values between 25 and 40 kg/m 2 were associated with an attenuated risk of major bleeding at 1-year in patients undergoing PCI and this association was consistent among HBR individuals.

This study aims to evaluate a potential selection effect caused by exclusion of children with non-identifiable infancy peak (IP) and adiposity rebound (AR) when estimating associations between age and body mass index (BMI) at IP and AR and later weight status. In 4744 children with at least 4 repeated measurements of height and weight in the age interval from 0 to 8 years (37 998 measurements) participating in the IDEFICS (Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants)/I.Family cohort study, fractional polynomial multilevel models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z-scores (mean age at outcome assessment: 9.2 years). Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r⩾0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4-6 years (r⩾0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z-scores where associations increased with age. Associations between BMI velocities and later BMI z-scores were largest at ages 5 and 6 years. Results differed for children with non-identifiable IP and AR, demonstrating a selection effect. IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead.

Endometrial cancer begins in the layer of cells that form the lining (endometrium) of the uterus. Endometrial cancer is often detected at an early stage because it frequently produces abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial cancer is discovered early, removing the uterus surgically often cures endometrial cancer. The study included all patients who had been evaluated for vaginal bleeding in Obstetrics and Gynecology Department of Clinical Emergency County Hospital, Timisoara between 2016-2018. Of the 195 cases of uterus scraping, 19 cases were labelled as malignant endometrial pathology. For the statistical analysis we calculated some descriptive statistics for the age parameter and the BMI (body mass index) parameter in our disease sample and we compared the BMI values to the BMI values from the control sample As well, we tested to see if there is an association between the Ki-67 values and the HER-2 / neu status in patients with or without endometrial carcinoma. In order to test the significance we applied a Mann -Whitney test, for a = 0.05 set as a confidence level. Unfortunately, in the case of our study group, type 1 endometrial cancers are found in only 5 cases, unlike other countries where most of endometrial cancers are diagnosed early (80% in the first stage) and the 5-year survival rate is about 95%. In any case, the 5-year survival rate is much lower if there is involvement of regional lymph nodes or distant metastasis (68% and 17%, respectively) - as in our case where all cases were classified as Stage III and IV. By running the statistical test we obtained extremely significant differences in the BMI of our patients (p[0.001), the diseased patients tend to have higher BMI values. As well, when we tested the possible association between the Ki-67 values and the HER-2 / neu status in our two groups (patients with or without endometrial carcinoma) we obtained extremely significant differences (p[0.001). The Ki-67 values are increasing proportionally with the carcinoma staging. An endometrial biopsy is the most commonly used test for endometrial cancer and is very accurate in postmenopausal women.

Body mass index trend as a new parameter for evaluating children's nutritional status

Mastectomy is the first single surgery that transgender men and nonbinary people frequently undergo. We present a prospective series of 155 cases of double incision mastectomy (DIM) with nipple-areolar complex (NAC) graft. From January 2019 to December 2022, 165 outpatients were operated on, and 155 are included in the study. We analyzed age, resection weight, blood loss, duration of the procedure, complications, and follow-up. The Student t test combined with the nonparametric Mann-Whitney U test was used for statistical analysis. If the P value was less than 0.05, the test was considered significant. A total of 111 (72.6%) patients experienced no complications. Complications (27.4%) were minor: 4 seromas, 8 hematomas, 10 partial necrosis of the NAC, and 8 depigmentation of the NAC. Thirteen patients presented axillary dog ears requiring secondary excision. Two patients had hypertrophic scars. No case of infection was observed. We find a statistically significant correlation between hematoma and perioperative blood loss (P < 0.05), and between dog ears requiring secondary procedure and body mass index (P < 0.001), weight of resection (P < 0.01), and blood loss (P < 0.001). DIM with NAC graft is a safe, reliable, top surgery procedure. Complications are minor, and postoperative morbidity is low. This study shows a correlation between blood loss during surgery and postoperative hematoma, and between dog ears requiring a surgery and body mass index, weight of resection, and blood loss. This surgery gives nice aesthetic results enhancing patients' quality of life by improving body image.

To investigate the impact of body mass index (BMI) of men in their 20s and the effects of subsequent changes in body weight upon medication rates, prevalence of hypertension and diabetes, and medical costs in their 40s. A total of 10,125 men who were in their 20s in 1989 were recruited as subjects and grouped according to their BMI and a combination of BMI and increase in body weight over a 20-year period. A logistic regression analysis was performed to evaluate subsequent medication rates, prevalence of hypertension and diabetes, and consultation rate. Analysis of covariance was performed for mean medical costs on the basis of the BMI value in their 20s. All data were adjusted for age in 1989 and changes in body weight over the subsequent 20 yr. A mean increase of 7 kg in body weight was observed over the 20-year period. Medication rates and prevalence of hypertension and diabetes in the men in their 40s increased significantly in correlation with the BMI values in their 20s (men with higher BMI showed higher medication and symptom prevalence rates). The 25.0 or higher BMI group showed a 6.81-fold higher prevalence of hypertension and a 16.62-fold higher prevalence of diabetes than the 18.5-19.9 BMI group. Similarly, men with higher BMI values in their 20s incurred greater outpatient and total medical costs in their 40s. The mean total medical costs in 2009 of men in the 18.5 or lower BMI group in their 20s was 818.7 yen and that for men in the 25.0 or higher BMI group was 5,311.5 yen. Furthermore, men in their 40s showed increased risk of hypertension and diabetes, if their body weight increased by 10 kg or more in the subsequent 20 yr, even when they had BMI values between 20.0 and 24.9 in their 20s. Men with high BMI values in their 20s showed higher prevalence of hypertension and diabetes and incurred greater medical costs in their 40s. Even men with a BMI of less than 25.0 in their 20s, showed increases in the prevalence of hypertension and diabetes which were dependent on their weight gain in the subsequent years. Healthcare activities in Japanese corporations based on lifetime employment should promote anti-obesity strategies among young employees and help not only those employees who are obese but also those who are not controlling their weight.

Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are the standard techniques for achieving a cosmetic outcome, but necrosis of a cutaneous flap including the nipple-areolar complex (NAC) is a serious complication. To analyze the risk factors for skin flap necrosis, we retrospectively evaluated a clinical database of breast cancer patients treated with mastectomy followed by immediate breast reconstruction. Four hundred and twelve cases were consecutively recorded between 2006 and 2016. Body weight (BW), body mass index (BMI), distance from NAC to referent tumor, distance from overlying skin to the tumor and weight of breast resection (WBR) as measured in the operating theater were included in the statistical analysis. NSM, SSM and total mastectomy were performed in 123 (30%), 96 (23%) and 193 cases (47%), respectively. A tissue expander was used in 379 cases (92%), a silicone implant in 8 (2%) and autologous breast reconstruction in 25 (6%). Skin flap necrosis was found in 7% of all cases and NAC necrosis in 13% of NSM cases. In a univariate analysis, BW, NSM and WBR were risk factors for skin flap necrosis, and BW, BMI and WBR were risk factors for NAC necrosis. In a multivariate analysis, NSM and WBR remained significant risk factors for skin flap necrosis, and WBR was a significant risk factor for NAC necrosis. WBR is an important risk factor for skin flap necrosis. Especially, NAC necrosis should be considered for patients with large-volume breasts who undergo NSM and immediate breast reconstruction.

BackgroundDriver license departments in many US states collect data on individuals’ height and weight. These data can be useful to researchers in epidemiological and public health studies. As height and weight on driver license are self-reported, they may be prone to reporting bias. We compare height and weight obtained from driver license records and clinically measured height and weight, as well as body mass index (BMI) values calculated using the two data sources for the same individual.MethodsWe linked individual height and weight records obtained from the Driver License Division (DLD) in the Utah Department of Public Safety to clinical records from one of the largest healthcare providers in the state of Utah. We then calculated average differences between height, weight and BMI values separately for women and men in the sample, as well as discrepancies between the two sets of measures by age and BMI category. We examined how well self-reported height and weight from the driver licenses classify individuals into specific BMI categories based on clinical measures. Finally, we used two sets of BMI values to estimate individuals’ relative risk of type II diabetes.ResultsIndividuals, on average, tend to overestimate their height and underestimate their weight. Consequently, the value of BMI calculated using driver license records is lower than BMI calculated using clinical measurements. The discrepancy varies by age and by BMI category. Despite the discrepancy, BMI based on self-reported height and weight allows for accurate categorization of individuals at the higher end of the BMI scale, such as the obese. When used as predictors of relative risk of type II diabetes, both sets of BMI values yield similar risk estimates.ConclusionsData on height and weight from driver license data can be a useful asset for monitoring population health in states where such information is collected, despite the degree of misreporting associated with self-report.

In reduction mammoplasty, preserving an appropriate skin flap is crucial to achieve a favorable postoperative appearance and prevent blood supply disorders in the nipple-areolar complex (NAC). Previous studies have indicated that a thinner or narrower flap is more favorable for breast shaping, but also increases the risk of blood supply disorders. Accessing the blood perfusion of the NAC and determining the critical threshold for NAC viability are essential aspects of reduction mammoplasty. The aim of this study was to utilize indocyanine green (ICG) angiography to assess NAC perfusion during reduction mammoplasty. It also sought to identify critical thresholds of various indicators affecting NAC survival and provide guidance for skin flap trimming. Thirty-eight patients who underwent reduction mammoplasty were included. Each patient received ICG angiography before and after skin flap trimming. Data on NAC perfusion, skin flap length, width, thickness, and other relevant indicators were collected. Among the patients, 5 experienced NAC blood supply disorders. Multiple linear regression analysis demonstrated that the NAC blood supply had a significant correlation with the tissue thickness at the pedicle base (P < .001) and with the length-to-width ratio across the nipple (P < .05). To optimize NAC survival and achieve favorable breast shaping, cutoff points for the thickness at the pedicle base and the length-to-width ratio across the nipple of 1.15 cm and 1.71, respectively, were established. ICG angiography provides an effective means to assess NAC blood supply and postoperative survival. The cutoff points established in this study help to predict the survival of the NAC and guide flap trimming.

Robotic-assisted nipple-sparing mastectomies with multiport robots have been described in the US since 2015; however, significant hurdles to multiport robotic surgery exist in breast surgery. To demonstrate that the single-port da Vinci SP (Intuitive Surgical) robotic system is feasible in patients undergoing robotic nipple-sparing mastectomy (rNSM). An initial case series of 20 patients at a large university hospital underwent bilateral single-port robotic nipple-sparing mastectomies (SPrNSM) with tissue expander reconstruction from February 1, 2020, through January 4, 2023. Participants included women who met surgical criteria for nipple-sparing mastectomies, per standard of care. Surgery using a single-port robot and the surgical technique of the authors. Age, indication, body mass index, breast size, operative time, conversion to open surgery, systemic complications, postoperative skin necrosis, and reported skin and nipple areolar complex (NAC) sensation. Twenty women aged 29 to 63 years (median, 40 years) underwent bilateral SPrNSM. Eleven patients completed prophylactic surgery due to a high risk for breast cancer (more than 20% lifetime risk) and 9 patients had breast cancer. Breast size ranged from A through D cup with median B cup and a body mass index range of 19.7 through 27.8 (median 24.4). The total duration of the procedure from incision to skin closure for both sides ranged from 205 minutes to 351 minutes (median, 277). The median robotic time for bilateral SPrNSM was 116 minutes and varied by cup size (A cup, 95 minutes; B cup, 140 minutes; C cup, 118 minutes; D cup, 114 minutes) with no inflection point in learning curve. No cases were converted to open and no immediate complications, such as hematoma, positive margins, or recurrence, were seen. In the first 10 patients prior to routine sensation testing, 20 resected breasts had measurable NAC sensation at a range from 4 to 36 months post-index resection (65%). In the second 10 patients of the cohort, measurable NAC was preserved in 13 of 20 resected breasts 2 weeks following the index operation (65%). In this case series, SPrNSM with immediate reconstruction was feasible and performed safely by an experienced breast surgeon with limited previous robotic training. Further studies confirming the preliminary data demonstrating improved NAC and skin sensation following SPrNSM are warranted. ClinicalTrials.gov Identifier: NCT05245812.

Purpose: Transient elastography (TE) has emerged as an important non-invasive technique of evaluating hepatic fibrosis. However, recent data suggest that greater hepatic steatosis may downgrade TE values relative to the degree of hepatic fibrosis on biopsy in nonalcoholic fatty liver disease (NAFLD) patients. This prospective study evaluates the relationship between TE values and hepatic steatosis as measured on magnetic resonance imaging (MRI) of the liver. Other variables which may affect TE accuracy in NAFLD were also investigated, including higher patient body mass index (BMI) and greater subcutaneous fat overlying the liver. Methods: All adult patients at a tertiary care centre in London, Canada, who met diagnostic criteria for NAFLD were invited to participate in this study. All patients underwent liver biopsy, TE and had anthropomorphic measurements, liver transaminases and measures of metabolic dysfunction measured. Liver biopsies were read by a single, blinded pathologist and scored according to the validated nonalcoholic steatohepatitis activity score (NAS). The FibroScan 502 system (Echosens) was used to conduct TE measurements for all study patients. Subcutaneous fat and hepatic steatosis measured as hepatic fat fraction was measured using Magnetic Resonance Imaging with Iterative Decomposition of water and fat with Echo Asymmetry and Least-squares estimation (IDEAL-MRI), a computer-based quantification method separating fat and water signals in MRI images allowing accurate, validated and reproducible measurement of subcutaneous fat thickness. Linear regression analysis was used to evaluate the correlation between BMI and TE values; subcutaneous fat thickness and TE values; and degree of fibrosis on liver biopsy and TE values. Results: Linear regression demonstrated a positive correlation between TE values and the degree of fibrosis on liver biopsy (P<0.001). There was no correlation between subcutaneous fat thickness and TE values (P=0.699), between BMI and TE values (P=0.883), between subcutaneous fat thickness and liver fibrosis score (p=0.183), nor between BMI and liver fibrosis score (p=0.057). There was no correlation between hepatic fat fraction and TE values (p=0.152), nor hepatic fat fraction and liver fibrosis score (p=0.0118). Conclusion: This study demonstrates that TE correlates well with the degree of hepatic fibrosis on liver biopsy in NAFLD patients, and suggests that common anthropomorphic features of such patients such as increased hepatic steatosis, increased BMI, and peri-hepatic subcutaneous fat does not adversely affect the reliability of TE. This finding supports the continued use of this important diagnostic modality in a population that is becoming increasingly prevalent.