Three-dimensional evaluation of breast contour and volume changes following subpectoral augmentation mammaplasty over 6 months

Comparative assessment of 3D surface scanning systems in breast plastic and reconstructive surgery

In this work, we compared accuracy, repeatability, and usability in breast surface imaging of 2 commercial surface scanning systems and a hand-held laser surface scanner prototype coupled with a patient's motion acquisition and compensation methodology. The accuracy of the scanners was assessed on an anthropomorphic phantom, and to evaluate the usability of the scanners on humans, thorax surface images of 3 volunteers were acquired. Both the intrascanner repeatability and the interscanner comparative accuracy were assessed. The results showed surface-to-surface distance errors inferior to 1 mm and to 2 mm, respectively, for the 2 commercial scanners and for the prototypical one. Moreover, comparable performances of the 3 scanners were found when used for acquiring the breast surface. On the whole, this study demonstrated that handheld laser surface scanners coupled with subject motion compensation methods lend themselves as competitive technologies for human body surface modeling.

Measuring volumetric change after augmentation mammaplasty using a three-dimensional scanning technique: an innovative method

BACKGROUND

Measurement of volumetric change after augmentation mammaplasty is of great significance to plastic surgeons. This study aimed to introduce a new method using a three-dimensional (3D) scanning technique to measure volumetric change after augmentation mammaplasty.

METHODS

Preoperative 3D scans of 10 breasts were included in the study. A simulated postoperative breast scan was constructed using software. The true value of volumetric change was calculated. Volumetric change was measured and repeated 10 times by the traditional method and the new method. One investigator used the traditional method, and two investigators used the new method. The difference from the true value between the two methods and the intraclass coefficient (ICC) for each method was evaluated. Comparison of agreement with the true value and comparison of agreement using the new method between the two investigators were made using a Bland-Altman analysis.

RESULTS

The mean breast volumetric change was 256.1 ± 61.1 ml for the new method, 281.9 ± 73.7 ml for the traditional method, and 256.0 ± 61.0 ml for the true value. The difference from the true value for the traditional method was significantly greater than for the new method. The ICC was 0.9999 for the new method and 0.993 for the traditional method. Bland-Altman analysis showed a 95 % confidence interval (CI) of -40.9 to 92.7 ml for the traditional method and -0.9 to 1.2 ml for the new method. Comparison of agreement between investigators 1 and 2 showed a 95 % CI of -0.9 to 1.0 ml. The limits of agreement were ±1.0 ml.

CONCLUSIONS

The proposed new method can provide excellent accuracy, repeatability, and reproducibility in measuring volumetric change after augmentation mammaplasty using a 3D scanning technique.

LEVEL OF EVIDENCE I

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Three-dimensional evaluation of breast augmentation and the influence of anatomic and round implants on operative breast shape changes

BACKGROUND

Currently, postoperative outcome analysis in breast augmentation is essentially subjective, and objective evaluation of treatment efficacy is lacking. This study evaluates the influence of anatomic and round implant parameters on breast contour changes after subpectoral breast augmentation using three-dimensional (3D) surface imaging.

METHODS

3D surface breast scans of 17 patients (34 breasts) undergoing subpectoral breast augmentation with round implants and of ten patients (20 breasts) receiving anatomic implants via an axillary approach under endoscopic assistance or a submammary fold incision were obtained before and 6 months postoperatively. 3D linear distance, breast volume, and surface measurement were correlated with the implanted round and anatomic implant parameters, and the resulting breast shape changes were evaluated.

RESULTS

Total breast volume changed in correlation with the implant size (2.4% difference; r=0.894; p<0.001). Implant volume and type influence the nipple-to-inframammary fold distance (N-IMF). Every inserted 100 ml implant volume enlarges the N-IMF distance by 0.8 cm (anatomic>round; p=0.01). Postoperatively, the IMF dropped by an average of 1.3 cm for round implants and by 1.1 cm for anatomic implants, without relevant differences between the applied surgical incision and the selected implants (p>0.05). Breast projection increased significantly more with anatomic implants (2.4 cm) than with round implants (1.7 cm) (p=0.01). The breast projection increase was 22% less than expected for round implants and 25% less than expected for anatomic implants based on the manufacturer implant parameters (p<0.01), without essential differences regarding the surgical incision.

CONCLUSIONS

3D breast shape changes induced by round and anatomic implants after subpectoral augmentation mammaplasty are objectively documented including breast projection, volume, and N-IMF distance changes. 3D surface imaging may have a potential clinical contribution to objective surgical outcome research.

LEVEL OF EVIDENCE III

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Objective breast symmetry evaluation using 3-D surface imaging

This study develops an objective breast symmetry evaluation using 3-D surface imaging (Konica-Minolta V910(®) scanner) by superimposing the mirrored left breast over the right and objectively determining the mean 3-D contour difference between the 2 breast surfaces. 3 observers analyzed the evaluation protocol precision using 2 dummy models (n = 60), 10 test subjects (n = 300), clinically tested it on 30 patients (n = 900) and compared it to established 2-D measurements on 23 breast reconstructive patients using the BCCT.core software (n = 690). Mean 3-D evaluation precision, expressed as the coefficient of variation (VC), was 3.54 ± 0.18 for all human subjects without significant intra- and inter-observer differences (p > 0.05). The 3-D breast symmetry evaluation is observer independent, significantly more precise (p < 0.001) than the BCCT.core software (VC = 6.92 ± 0.88) and may play a part in an objective surgical outcome analysis after incorporation into clinical practice.