Jumping Breast Phenomenon Following Subcutaneous Mastectomy: First Description and Grading of a Well-Known Breast Deformity

Abstract

Introduction: One of the goals of breast cancer surgery is to preserve the breast. However, where this is not possible, various breast reconstructive procedures are available. The most common procedure is the immediate insertion of a subpectoral implant after removing the breast tissue. A significant challenge involving subpectoral implants is the deformation of the breast upon contraction of the pectoral muscle causing elevation of the breast and development of wrinkles or ripples in the caudal and cranial quadrants (jumping breast), especially in slim patients with a thin subcutaneous fat layer. Methods: While the jumping breast phenomenon after augmentation is well-known in cosmetic breast surgery, it has never been systematically described. In oncologic breast surgery, this deformity, which at times can be quite severe, has been ignored thus far. Results and Conclusion: In this paper, we present an initial distinction of grades for the so-called jumping breast, show examples for the different grades of severity of breast deformity in response to tensing of the pectoral muscle, and further describe different primary and secondary procedures for the prevention of the jumping breast phenomenon. By means of a 2-stage procedure, we can prevent this complication and reduce the risk of breast deformity after implant-based breast reconstruction.

A simple clinical assessment of breast animation deformity following direct-to-implant breast reconstruction

“…Several methods have been proposed to assess BAD [3,7,10, 20,21]. Most recently, Fracol et al [21] suggested using Kim’s quantitative grading scale to standardize the grading of BAD by nipple displacement in centimeters and the percentage of skin area affected by rippling [21].…”

“…Landmarks on the breast were marked and analyzed on still photos with and without contraction of the PMM. In addition, Kummel et al [10] proposed a more detailed 3-point grading system to describe and distinguish grades of BAD in women undergoing augmentation and suggested how to prevent BAD by performing a two-stage procedure. Furthermore, Vidya and colleagues suggested how to manage BAD in relation to its grading for women undergoing subpectoral reconstruction [7].…”

“…Prepectoral direct-to-implant breast reconstruction may reduce the incidence of BAD. However, its potential disadvantages include an increased incidence of capsular contracture, secondary ptosis, bottoming out, and visible wrinkling [10,11]. The aims of this paper were to assess and quantify the incidence of BAD in women undergoing direct-to-implant breast reconstruction with either prepectoral or dual-plane subpectoral implant placement, to develop a grading scale for the simple clinical assessment of BAD following direct-to-implant breast reconstruction, and to test the reproducibility of the grading system in a clinical setting by assessing its inter- and intra-rater agreement.…”

Evaluation of Breast Animation Deformity following Pre- and Subpectoral Direct-to-Implant Breast Reconstruction: A Randomized Controlled Trial

“…Over the last years, there has been increased focus on BAD and several studies have been conducted to assess the etiology, treatment, and grading. 3 13 22 23 24 This randomized controlled trial is, to the best of our knowledge, the first evaluating and comparing sub- and prepectoral implant placement when performing direct-to-implant breast reconstruction. We found a significant difference in the incidence and degree of BAD between sub- and prepectorally reconstructed groups when evaluating the patients by the NSE grading scale 12 months after surgery ( Table 4 ).…”

Visualized pre- and subpectoral implant placement for immediate breast reconstruction

“…This change however, gives a resurgence of potential problems such as thin tissue coverage allowing visible implant edges, secondary ptosis and possibly increased rates of capsular contracture. These are potential risks, which needs to be examined in future studies (5,6). The aim of this visualized surgery paper was to visualize and highlight the technical disparities between a sub-and prepectoral direct to implant breast reconstructive techniques applied at our institutions.…”