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DOI: 10.4103/0970-0358.129625
Inter-observer reliability of clinical measurement of suprasternal notch-nipple distance and breast ptosis
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Publication History
Publication Date:
26 August 2019 (online)
ABSTRACT
Context: Suprasternal notch-nipple distance and breast ptosis are two measurements that are often used in everyday plastic surgical clinical practice. Nonetheless, the reliability of standard breast measurements has never been tested. Aim: The aim of the present study was to test the inter-observer reliability of clinical measurement of ptosis and suprasternal notch-nipple distance. Settings and Design: Six raters measured ptosis and suprasternal notch-nipple distance in 12 breasts on the same day. Statistical Analysis Used: Intra-class correlation (ICC) coefficients, the coefficient of variation (CV) and Bland-Altman plots. Results and Conclusions: The results show that there is certain variation between different raters. The ICC of average measures between raters is 0.92 for the ptosis and 0.94 for the suprasternal notch-nipple distance, that is, the agreement between different raters is high. According to the Bland—Altman plots, the overall assessment of the comparisons of measurements between the different raters shows that the direction of the mean differences is close to zero. This study shows that there is a good reliability for measurements of suprasternal notch-nipple distance and ptosis. Nonetheless, there is a slight inter-rater variability in the measurements. Even though standardised, measurement of breasts is not an exact science and care has to be taken when the measurements are performed. The surgeon should have this in mind when measurements are used in clinical practice to evaluate breasts and to choose the right surgical method, as well as when guidelines for indications for surgery are set up.
Conflict of Interest
None declared
- 1 Lewin R, Göransson M, Elander A, Thorarinsson A, Lundberg J, Lidén M. Risk factors for complications after breast reduction surgery. J Plast Surg Hand Surg 2013; 48: 10-4
- 2 Pérez-Macías JM. Long-lasting evolution of ptosis control after reduction mammaplasty using the hammock technique. Aesthetic Plast Surg 2007; 31: 266-74
- 3 Shulman O, Badani E, Wolf Y, Hauben DJ. Appropriate location of the nipple-areola complex in males. Plast Reconstr Surg 2001; 108: 348-51
- 4 Smith Jr DJ, Palin Jr WE, Katch VL, Bennett JE. Breast volume and anthropomorphic measurements: Normal values. Plast Reconstr Surg 1986; 78: 331-5
- 5 Westreich M. Anthropomorphic breast measurement: Protocol and results in 50 women with aesthetically perfect breasts and clinical application. Plast Reconstr Surg 1997; 100: 468-79
- 6 Qiao Q, Zhou G, Ling Y. Breast volume measurement in young Chinese women and clinical applications. Aesthetic Plast Surg 1997; 21: 362-8
- 7 Loughry CW, Sheffer DB, Price TE, Einsporn RL, Bartfai RG, Morek WM. et al. Breast volume measurement of 598 women using biostereometric analysis. Ann Plast Surg 1989; 22: 380-5
- 8 Brown TP, Ringrose C, Hyland RE, Cole AA, Brotherston TM. A method of assessing female breast morphometry and its clinical application. Br J Plast Surg 1999; 52: 355-9
- 9 Avºar DK, Aygit AC, Benlier E, Top H, Taºkinalp O. Anthropometric breast measurement: A study of 385 Turkish female students. Aesthet Surg J 2010; 30: 44-50
- 10 Kirwan L. A classification and algorithm for treatment of breast ptosis. Aesthetic Surg J 2002; 22: 355-63
- 11 O′Dey DM, Baltes P, Bozkurt A, Pallua N. Importance of the suprasternal notch to nipple-distance (SSN:N) for vascular complications of the nipple areola complex (NAC) in the superior pedicle vertical mammaplasty: A retrospective analysis. J Plast Reconstr Aesthet Surg 2011; 64: 1278-83
- 12 Nicoletti G, Scevola S, Faga A. Is breast reduction a functional or a cosmetic operation? Proposal of an objective discriminating criterion. J Plast Reconstr Aesthet Surg 2009; 62: 1644-6
- 13 Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull 1979; 86: 420-8
- 14 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-10
- 15 Penn J. Breast reduction. Br J Plast Surg 1954; 7: 357-71
- 16 Galdino GM, Nahabedian M, Chiaramonte M, Geng JZ, Klatsky S, Manson P. Clinical applications of three-dimensional photography in breast surgery. Plast Reconstr Surg 2002; 110: 58-70
Address for correspondence:
- 1 Lewin R, Göransson M, Elander A, Thorarinsson A, Lundberg J, Lidén M. Risk factors for complications after breast reduction surgery. J Plast Surg Hand Surg 2013; 48: 10-4
- 2 Pérez-Macías JM. Long-lasting evolution of ptosis control after reduction mammaplasty using the hammock technique. Aesthetic Plast Surg 2007; 31: 266-74
- 3 Shulman O, Badani E, Wolf Y, Hauben DJ. Appropriate location of the nipple-areola complex in males. Plast Reconstr Surg 2001; 108: 348-51
- 4 Smith Jr DJ, Palin Jr WE, Katch VL, Bennett JE. Breast volume and anthropomorphic measurements: Normal values. Plast Reconstr Surg 1986; 78: 331-5
- 5 Westreich M. Anthropomorphic breast measurement: Protocol and results in 50 women with aesthetically perfect breasts and clinical application. Plast Reconstr Surg 1997; 100: 468-79
- 6 Qiao Q, Zhou G, Ling Y. Breast volume measurement in young Chinese women and clinical applications. Aesthetic Plast Surg 1997; 21: 362-8
- 7 Loughry CW, Sheffer DB, Price TE, Einsporn RL, Bartfai RG, Morek WM. et al. Breast volume measurement of 598 women using biostereometric analysis. Ann Plast Surg 1989; 22: 380-5
- 8 Brown TP, Ringrose C, Hyland RE, Cole AA, Brotherston TM. A method of assessing female breast morphometry and its clinical application. Br J Plast Surg 1999; 52: 355-9
- 9 Avºar DK, Aygit AC, Benlier E, Top H, Taºkinalp O. Anthropometric breast measurement: A study of 385 Turkish female students. Aesthet Surg J 2010; 30: 44-50
- 10 Kirwan L. A classification and algorithm for treatment of breast ptosis. Aesthetic Surg J 2002; 22: 355-63
- 11 O′Dey DM, Baltes P, Bozkurt A, Pallua N. Importance of the suprasternal notch to nipple-distance (SSN:N) for vascular complications of the nipple areola complex (NAC) in the superior pedicle vertical mammaplasty: A retrospective analysis. J Plast Reconstr Aesthet Surg 2011; 64: 1278-83
- 12 Nicoletti G, Scevola S, Faga A. Is breast reduction a functional or a cosmetic operation? Proposal of an objective discriminating criterion. J Plast Reconstr Aesthet Surg 2009; 62: 1644-6
- 13 Shrout PE, Fleiss JL. Intraclass correlations: Uses in assessing rater reliability. Psychol Bull 1979; 86: 420-8
- 14 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-10
- 15 Penn J. Breast reduction. Br J Plast Surg 1954; 7: 357-71
- 16 Galdino GM, Nahabedian M, Chiaramonte M, Geng JZ, Klatsky S, Manson P. Clinical applications of three-dimensional photography in breast surgery. Plast Reconstr Surg 2002; 110: 58-70