The measurement of soft-tissue firmness has many potential applications in medical practice. This study reports a user-friendly, novel device that is capable of measuring changes in soft-tissue firmness in a reproducible manner. The study reports the development of the equipment and how it has been applied to breast implant surgery. The device was tested for both intra- and inter-observer variability on an in vitro model, using a breast implant. Once reproducibility was confirmed, breast firmness was measured on a series of patients who underwent sub-fascial breast augmentation (n = 50) to examine how it varied post-operatively. Firmness in the upper half of the breast increased to a maximum level two weeks post-surgery (0.44-0.61 Pa), reducing to pre-operative levels by 6 weeks (0.37-0.54 Pa). There was no further significant change at 12 weeks. Firmness in the nipple areolar complex (NAC) and at the lower outer quadrant (LOQ) followed a similar pattern, but remained firmer at 12 weeks. We interpret these patterns as implying that measurements taken at the upper half of the breast are indicative of post-operative oedema, whereas those at the NAC and LOQ represent changes in firmness produced by the breast implant composite. We consider the potential for this novel device in the measurement of soft-tissue firmness in aesthetic breast surgery and would encourage other researchers to explore novel applications. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The importance of measuring breast firmness reproducibly to monitor postsurgical progress has been appreciated for many years. This study ascertains whether a durometer can be used to quantify capsular contraction and to provide an objective, reproducible measure of fibrosis around an implant. Patients with clinically detected Baker 3 or 4 capsules following breast augmentation underwent firmness measurements using a durometer prior to corrective surgery. Durometry was undertaken on both breasts by an operator who was blinded to the clinical diagnosis. Firmness measurements were taken in each breast quadrant and directly over the nipple-areolar complex on each side. In the study, 16 patients were included. Capsules presented 16 to 714 weeks following surgery (mean 217, standard deviation (STD) 205.4 weeks). Differences in pressure were demonstrated in all quadrants of the breast and at the nipple-areolar complex except the lower inner quadrant. All significant differences demonstrated a higher pressure in the encapsulated breast. The mean pressure in an encapsulated breast was 0.66 kPa (STD 0.25) and 0.46 kPa (STD 0.16) in the normal breast. The durometer can reproducibly describe changes in pressure associated with capsular contraction compared with the contralateral breast. It provides a means of objectively describing capsular contraction following breast augmentation surgery for research and patient care.

There are numerous measuring systems that practitioners employ as part of their presurgical assessment for breast implant surgery. These range from direct measurements of patients using a tape measure, to assessment of standardized photographs and 3-dimensional scanning technologies. This personal view describes the authors system, developed over 20 years. The data yielded have assisted in assessing breast symmetry, ptosis, and match of implant to patient, with proven benefits for managing patient outcomes and expectations. It is simple, rapid to undertake, and requires inexpensive measuring equipment to provide useful data.