Advertisement

Quantification of gravity-induced skin strain across the breast surface

      Highlights

      • Quantification of breast skin strain to inform incision locations during surgery
      • Up to 75% skin strain in the longitudinal direction in upper region of breast
      • Smaller-breasted participants experienced greater strain on lateral breast regions
      • Larger-breasted participants experienced greater strain on medial breast regions

      Abstract

      Background

      Quantification of the magnitude of skin strain in different regions of the breast may help to estimate possible gravity-induced damage whilst also being able to inform the selection of incision locations during breast surgery. The aim of this study was to quantify static skin strain over the breast surface and to estimate the risk of skin damage caused by gravitational loading.

      Methods

      Fourteen participants had 21 markers applied to their torso and left breast. The non-gravity breast position was estimated as the mid-point of the breast positions in water and soybean oil (higher and lower density than breast respectively). The static gravity-loaded breast position was also measured. Skin strain was calculated as the percentage extension between adjacent breast markers in the gravity and non-gravity loaded conditions.

      Findings

      Gravity induced breast deformation caused peak strains ranging from 14 to 75% across participants, with potentially damaging skin strain (>60%) in one participant and skin strains above 30% (skin resistance zone) in a further four participants. These peak strain values all occurred in the longitudinal direction in the upper region of the breast skin. In the latitudinal direction, smaller-breasted participants experienced greater strain on the outer (lateral) breast regions and less strain on the inner (medial) breast regions, a trend which was reversed in the larger breasted participants (above size 34D).

      Interpretation

      To reduce tension on surgical incisions it is suggested that preference should be given to medial latitudinal locations for smaller breasted women and lateral latitudinal locations for larger breasted women.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Biomechanics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Albornoz C.R.
        • Bach P.B.
        • Mehrara B.J.
        • Disa J.J.
        • Pusic A.L.
        • McCarthy C.M.
        • Matros E.
        A paradigm shift in U.S. Breast reconstruction: increasing implant rates.
        Plast. Reconstr. Surg. 2013; 131: 15-23
        • Borges A.F.
        • Alexander J.E.
        Relaxed skin tension lines, z-plasties on scars, and fusiform excision of lesions.
        Br. J. Plast. Surg. 1962; 15: 242-254
        • Brown T.
        • Ringrose C.
        • Hyland R.
        • Cole A.
        • Brotherston T.
        A method of assessing female breast morphometry and its clinical application.
        Br. J. Plast. Surg. 1999; 52: 355-359
        • Clark J.
        • Cheng J.
        • Leung K.
        Mechanical properties of normal skin and hypertrophic scars.
        Burns. 1996; 22: 443-446
        • Daly C.
        Biomechanical properties of dermis.
        J. Invest. Dermatol. 1982; 79: 17s-20s
        • Finlay B.
        Dynamic mechanical testing of human skin “in vivo”.
        J. Biomech. 1970; 3: 557-568
        • Fisher G.
        • Wang Z.
        • Datta S.
        • Varani J.
        • Kang S.
        • Voorhees J.
        Pathophysiology of premature skin aging induced by ultraviolet light.
        N. Engl. J. Med. 1997; 337: 1419-1428
        • Fujimura T.
        • Haketa K.
        • Hotta M.
        • Kitahara T.
        Loss of skin elasticity precedes to rapid increase of wrinkle levels.
        J. Dermatol. Sci. 2007; 47: 233-239
        • Gallagher A.
        • Ní Anniadh A.
        • Bruyere K.
        • Otténio M.
        • Xie H.
        • Gilchrist M.
        Dynamic tensile properties of human skin, 2012 IRCOBI Conference Proceedings. International Research Council on the Biomechanics of Injury2012
        • Gambichler T.
        • Matip R.
        • Moussa G.
        • Altmeyer P.
        • Hoffmann K.
        In vivo data of epidermal thickness evaluated by optical coherence tomography: effects of age, gender, skin type, and anatomic site.
        J. Dermatol. Sci. 2006; 44: 145-152
        • Gao Z.
        • Desai J.
        Estimating zero-strain states of very soft tissue under gravity loading using digital image correlation.
        Med. Image Anal. 2010; 14: 126-137
        • Gibson T.
        Karl Langer (1819-1887) and his lines.
        Br. J. Plast. Surg. 1978; 31: 1-2
        • Gunkel A.
        • Handler J.
        A Swiss medical doctor's description of Barbados in 1661.
        J. Barb. Museun Hist. Soc. 1969; : 3-13
        • Haake S.
        • Scurr J.
        A method to estimate strain in the breast during exercise.
        Sport. Eng. 2011; 14: 49-56
        • Haake S.
        • Milligan A.
        • Scurr J.
        Can measures of strain and acceleration be used to predict breast discomfort during running?.
        J. Sport. Eng. Technol. 2012; 227: 209-216
        • Hindle W.
        The breast and exercise.
        in: Caring for the Exercising Woman. Elsevier Science Publishing, New York1991: 83-92
        • Hull M.
        • Berns G.
        • Varma H.
        • Patterson H.
        Strain in the medial collateral ligament of the human knee under single and combined loads.
        J. Biomech. 1996; 29: 199-206
        • Jatoi I.
        • Kaufmann M.
        • Petit J.
        Atlas of Breast Surgery.
        Springer, Heidelberg2006
        • Kraissl C.J.
        The selection of appropriate lines for elective surgical incisions.
        Plast. Reconstr. Surg. 1951; 1946: 1-28
        • Lim K.
        • Chew C.
        • Chen P.
        • Jeyapalina S.
        • Ho H.
        • Rappel J.
        • Lim B.
        New extensometer to measure in vivo uniaxial mechanical properties of human skin.
        J. Biomech. 2008; 41: 931-960
        • Lim J.
        • Hong J.
        • Chen W.
        • Weerasooriya T.
        Mechanical response of pig skin under dynamic tensile loading.
        Int. J. Impact Eng. 2011; 38 (Online): 130-135
        • Macéa J.
        • Fregnani J.
        Anatomy of the thoracic wall, axilla and breast.
        Int. J. Morphol. 2006; 24: 691-704
        • Mahmood U.
        • Hanlon A.L.
        • Koshy M.
        • Buras R.
        • Chumsri S.
        • Tkaczuk K.H.
        • Feigenberg S.J.
        Increasing national mastectomy rates for the treatment of early stage breast cancer.
        Ann. Surg. Oncol. 2013; 20: 1436-1443
        • McGhee D.
        • Steele J.
        Optimising breast support in female patients through correct bra fit. A cross-sectional study.
        J. Sci. Med. Sport. 2010; 13: 568-572
        • Miller K.
        How to test very soft biological tissues in extension?.
        J. Biomech. 2001; 34: 651-657
        • Mills C.
        • Loveridge A.
        • Milligan A.
        • Risius D.
        • Scurr J.
        Can axes conventions of the trunk reference frame influence breast displacement calculation during running?.
        J. Biomech. 2014; 47: 575-578
        • Mills C.
        • Sanchez A.
        • Scurr J.
        Estimating the gravity induced three dimensinal deformation of the breast.
        J. Biomech. 2016; 49: 4134-4137
        • Morgan J.
        William Mary Q. “Some Could Suckle over Their Shoulder”: Male Travelers, Female Bodies, and the Gendering of Racial Ideology, 1500-1770. 54. 1997: 167-192
        • Ní Annaidh A.
        • Bruyère K.
        • Destrade M.
        • Gilchrist M.
        • Otténio M.
        Characterization of the anisotropic mechanical properties of excised human skin.
        J. Mech. Behav. Biomed. Mater. 2012; 5: 139-148
        • Page K.-A.
        • Steele J.
        Breast motion and sports brassiere design implications for future research.
        Sport. Med. 1999; 27: 205-211
        • Rajagopal V.
        Modelling Breast Tissue Mechanics Under Gravity Loading.
        (Unpublished doctoral thesis) The University of Auckland, 2007
        • Rajagopal V.
        • Lee A.
        • Chung J.-H.
        • Warren R.
        • Highnam R.
        • Nash M.
        • Nielsen P.
        Creating individual-specific biomechanical models of the breast for medical image analysis.
        Acad. Radiol. 2008; 15: 1425-1436
        • Rinker B.
        • Veneracion M.
        • Walsh C.
        Breast ptosis: causes and cure.
        Ann. Plast. Surg. 2010; 64: 579-584
        • Sanchez A.
        • Mills C.
        • Scurr J.
        Estimating breast mass-density: a retrospecitive analysis of readiological data.
        Breast J. 2016; (in press)
        • Scurr J.
        • Bridgman C.
        • Hedger W.
        • White J.
        Multi-planar breast strain during incremental treadmill activity.
        J. Sports Sci. 2009; 27: S29
        • Scurr J.
        • White J.
        • Hedger W.
        Supported and unsupported breast displacement in three dimensions across treadmill activity levels.
        J. Sports Sci. 2011; 29: 55-61
        • Seo H.
        • Kim S.
        • Cordier F.
        • Choi J.
        • Hong K.
        Estimating dynamic skin tension lines in vivo using 3D scans.
        Comput. Aided Des. 2013; 45: 551-555
        • Silver F.
        • Freeman J.
        • DeVore D.
        Viscoelastic properties of human skin and processed dermis.
        Skin Res. Technol. 2001; 7: 18-23
        • Smalls L.
        • Wickett R.
        • Visscher M.
        Effect of dermal thickness, tissue composition, and body site on skin biomechanical properties.
        Skin Res. Technol. 2006; 12: 43-49
        • Stark H.
        Directional variations in the extensibility of human skin.
        Br. J. Pastic Surg. 1977; 30: 105-114
        • Taylor J.R.
        An Introduction to Error Analysis: The Study of Uncertainties in Physical Measurements.
        University Science Books, 1982
        • Tebbetts J.B.
        • Adams W.P.
        Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process.
        Plast. Reconstr. Surg. 2005; 116: 2005-2016
        • Toms S.
        • Lemons J.
        • Bartolucci A.
        • Eberhardt A.
        Nonlinear stress-strain behavior of periodontal ligament under orthodontic loading.
        Am. J. Orthod. Dentofac. Orthop. 2002; 122: 174-179
        • Winter G.
        Some factors affecting skin and wound healing.
        J. Tissue Viability. 2006; 16: 20-23