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Utsunomiya H, Tanaka R, Akamine S, Kusano T, Kuroki T, Kadomatsu K. Longitudinal Volume Assessment of Reconstructed Breast Using Three-Dimensional Measurement: How Do DIEP and LD Flap Change Immediately after Surgery? Indian J Plast Surg 2024; 57:99-105. [PMID: 38774730 PMCID: PMC11105820 DOI: 10.1055/s-0044-1781447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
Background The deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps are two widely used autologous breast reconstructions. Despite studies on flap-volume changes, the time of the first measurement is not immediately after surgery. Therefore, this study aimed to investigate the change in volume over time from the immediate postoperative period using a three-dimensional (3D) scanner. Methods Patients who underwent breast reconstruction with a DIEP or LD flap between October 2019 and December 2020 at Showa University Koto Toyosu Hospital were included. The Kinect 3D scanner was used to measure the reconstructed and healthy breast volumes immediately after surgery and at 1, 3, 6, and 12 months. The control group was the healthy side, and the volumes obtained at each time point and ratios (to the immediate postoperative period) were calculated and analyzed using a linear mixed model. Results Of the 25 patients and 26 breasts examined, the postoperative increase in volume ratios was statistically significant in the DIEP flap group, except for the sixth month, but decreased significantly in the LD group. Compared with the control group, the volume ratio was significantly higher up to 3 months in the DIEP flap group and decreased significantly after 3 months in the LD flap group. Conclusions The volume of the LD flap continued to decrease immediately after surgery, whereas the volume of the DIEP flap increased by 10% up to 1M. Therefore, this increase in volume should be taken into consideration in studies where the initial measurements were not taken immediately after surgery.
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Affiliation(s)
- Hiroki Utsunomiya
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ryutaro Tanaka
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Shuryo Akamine
- Department of Surgery–Plastic Surgery, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | | | - Tomoaki Kuroki
- Department of Plastic and Reconstructive Surgery, Showa University Hospital, Tokyo, Japan
| | - Koichi Kadomatsu
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Tokyo, Japan
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Batiukov D, Podgaiski V. Nonadherence of Polyurethane Implants: A Retrospective Cohort Study. Indian J Plast Surg 2024; 57:24-30. [PMID: 38450018 PMCID: PMC10914532 DOI: 10.1055/s-0043-1778644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Background Biointegration of polyurethane (PU) implants providing their stable position years after surgery ensures predictable results of breast augmentation and reconstruction almost eliminating implant factor as a cause of complications. However, in rare cases PU implants appear to be not connected to the surrounding tissues. The aim of the study was to determine the incidence of PU implant nonadherence after primary breast augmentations and augmentation mastopexies with dual plane implant position, to analyze possible causes, and to propose preventive measures and treatment possibilities of this complication. Methods The results of primary aesthetic surgeries in 333 patients with dual plane PU implant placement were analyzed. Patients were evaluated clinically, and pictures and videos taken in different periods after the surgery were compared. Particular attention was given to the changes in implant position and the appearance of asymmetries over time. Results PU implant nonadherence was found in seven patients. It can be divided into primary and secondary and may be complete or partial. Primary nonadherence was found in two cases (0.6%), and secondary in five (1.5%) cases. Possible influencing factors could have been traumatic surgical technique, seroma, hematoma, or physical trauma. The average follow-up was 33 months (1 month-15 years). Conclusion Biointegration is mandatory for the long-term predictable results with PU implants. PU implant nonadherence leads to implant malposition and may cause typical complications connected to non-PU implants. Improvements in surgical maneuvers, manufacturing process, and weight reduction of the implant may be beneficial for the stability of the results. Level of Evidence V.
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Zhou LC, Hong WJ, Cao MB, Zeng L, Peng T, Li XR, Zhu GS, Luo SK. Morphological Aesthetics Assessment of the Predicted 3D Simulation Results and the Actual Results of Breast Augmentation. Aesthetic Plast Surg 2024; 48:568-579. [PMID: 37608189 DOI: 10.1007/s00266-023-03597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Although three-dimensional (3D) simulations are becoming more common in preoperative breast augmentation planning, this does not necessarily imply that the simulated results are highly accurate. OBJECTIVES We aimed to evaluate the accuracy of the 3D simulation technique by comparing the differences in breast morphology between the 3D prediction model and the actual results. METHODS The simulation and actual postoperative results of 103 patients who underwent breast augmentation were analyzed retrospectively. Therefore, a 3D model was created, and the parameters of line spacing, nipple position, breast projection, surface area, and volume were evaluated. Furthermore, consider the difference in chest circumferences and breast volume. RESULTS In comparison with the simulation results, the actual results had a mean increase in the nipple to the inframammary fold (N-IMF) of 0.3 cm (P < 0.05) and a mean increase in basal breast width (BW) of 0.3 cm (P < 0.001), a difference that was not statistically significant in patients with larger breast volumes. There was a significant difference in the mean upper and lower breast volume distribution between simulated and actual breasts (upper pole 52.9% vs. 49.2%, P < 0.05, and lower pole 47.1% vs. 50.8%, P < 0.001). However, it was not statistically significant in patients with larger chest circumferences. CONCLUSIONS Our study shows that 3D simulation has uncertainties related to the patient's chest circumference and breast volume. Therefore, these two critical factors must be considered when using simulation assessment in preoperative planning. 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 .
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Affiliation(s)
- Ling-Cong Zhou
- The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wei-Jin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Mi-Bu Cao
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Li Zeng
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Tong Peng
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Xin-Rui Li
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Guo-Sheng Zhu
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China
| | - Sheng-Kang Luo
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, 466 Middle Xin Gang Road, Guangzhou, 510317, Guangdong, China.
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Colwell AS, Ramly EP, Chung KC. Measuring Outcomes in Aesthetic Surgery by Board-Certified Plastic Surgeons. Plast Reconstr Surg 2024; 153:98-105. [PMID: 37566517 DOI: 10.1097/prs.0000000000010985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
SUMMARY Aesthetic surgery is a visual specialty in which plastic surgeons and patients work together to enhance or restore facial and body harmony. The field of aesthetic surgery is advanced through descriptive technical procedures and outcomes research. With increasing competition in cosmetic medicine, aesthetic surgery stands to benefit from an evidence-based approach to document the high standards of care from board-certified plastic surgeons. In this article, the authors highlight challenges, current objective and subjective outcomes, and a path forward.
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Affiliation(s)
- Amy S Colwell
- From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Elie P Ramly
- From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School
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Loucas R, Loucas M, Leitsch S, Danuser K, Reichard G, Haroon O, Mayer JM, Koban K, Holzbach T. Evaluation of Intraoperative Volumetric Assessment of Breast Volume Using 3D Handheld Stereo Photogrammetric Device. J Pers Med 2023; 13:1262. [PMID: 37623512 PMCID: PMC10456100 DOI: 10.3390/jpm13081262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/26/2023] Open
Abstract
Methods for assessing three-dimensional (3D) breast volume are becoming increasingly popular in breast surgery. However, the precision of intraoperative volumetric assessment is still unclear. Until now, only non-validated scanning systems have been used for intraoperative volumetric analyses. This study aimed to assess the feasibility, handling, and accuracy of a commercially available, validated, and portable device for intraoperative 3D volumetric evaluation. All patients who underwent breast surgery from 2020 to 2022 were identified from our institutional database. Intraoperative 3D volumetric assessments of 103 patients were included in this study. Standardized 3D volumetric measurements were obtained 3 months postoperatively to compare the intraoperatively generated volumetric assessment. All of the study participants were women with a mean age of 48.3 ± 14.7 years (range: 20-89). The mean time for intraoperative volumetric assessment was 8.7 ± 2.6 min. The postoperative 3D volumetric assessment, with a mean volume of 507.11 ± 206.29 cc, showed no significant difference from the intraoperative volumetric measurements of 504.24 ± 276.61 cc (p = 0.68). The mean absolute volume difference between the intraoperative simulations and postoperative results was 27.1 cc. Intraoperative 3D volumetric assessment using the VECTRA H2 imaging system seems to be a feasible, reliable, and accurate method for measuring breast volume. Based on this finding, we plan to investigate whether volumetric objective evaluations will help to improve breast symmetry in the future.
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Affiliation(s)
- Rafael Loucas
- Thurgau Hospital Group, Department of Hand and Plastic Surgery, CH-8500 Frauenfeld, Switzerland; (M.L.); (S.L.); (K.D.); (G.R.); (O.H.); (T.H.)
| | - Marios Loucas
- Thurgau Hospital Group, Department of Hand and Plastic Surgery, CH-8500 Frauenfeld, Switzerland; (M.L.); (S.L.); (K.D.); (G.R.); (O.H.); (T.H.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8010 Graz, Austria
| | - Sebastian Leitsch
- Thurgau Hospital Group, Department of Hand and Plastic Surgery, CH-8500 Frauenfeld, Switzerland; (M.L.); (S.L.); (K.D.); (G.R.); (O.H.); (T.H.)
| | - Katarina Danuser
- Thurgau Hospital Group, Department of Hand and Plastic Surgery, CH-8500 Frauenfeld, Switzerland; (M.L.); (S.L.); (K.D.); (G.R.); (O.H.); (T.H.)
| | - Gabriela Reichard
- Thurgau Hospital Group, Department of Hand and Plastic Surgery, CH-8500 Frauenfeld, Switzerland; (M.L.); (S.L.); (K.D.); (G.R.); (O.H.); (T.H.)
| | - Omar Haroon
- Thurgau Hospital Group, Department of Hand and Plastic Surgery, CH-8500 Frauenfeld, Switzerland; (M.L.); (S.L.); (K.D.); (G.R.); (O.H.); (T.H.)
| | - Julius Michael Mayer
- Department of Plastic and Hand Surgery, Inselspital, University Hospital Bern, CH-3012 Bern, Switzerland;
| | - Konstantin Koban
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital LMU, 81377 Munich, Germany;
| | - Thomas Holzbach
- Thurgau Hospital Group, Department of Hand and Plastic Surgery, CH-8500 Frauenfeld, Switzerland; (M.L.); (S.L.); (K.D.); (G.R.); (O.H.); (T.H.)
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Makram M, Noaman A, Abozeid M. 3D Volume Assessment as an Objective Tool in Breast Asymmetry Management. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4904. [PMID: 37038412 PMCID: PMC10082228 DOI: 10.1097/gox.0000000000004904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/09/2023] [Indexed: 04/12/2023]
Abstract
Throughout history, the female breast has been a universal symbol of femininity. The breast's normal symmetrical appearance is an important aspect of the female form. Female breasts are not perfectly symmetrical by nature, and minor differences in shape or volume are common. However, it can be psychologically distressing for patients and affect their perception of their bodies. Aesthetic breast surgeons strive to minimize these differences in order to make them more acceptable to patients. This study aimed to provide an objective and practical strategy for effectively managing breast asymmetry. Method This study was conducted between November 2017 and September 2021 on 20 female patients seeking breast asymmetry correction at Kasr El-Ainy Hospital. All patients had volumetric breast assessment using a three-dimensional (3D) imaging system (3D LifeViz, Quantificare system), and MRI breast volumetry was done preoperatively in all patients. The patients were managed with different single-stage surgical procedures depending on the objective assessment of the volume differences between their breasts. Results Breast volume assessment using the 3D camera was done preoperatively and postoperatively. The preoperative mean volume difference was 159.45 cm3, and the postoperative mean difference was 16.75 cm3 with an overall reduction in mean volume difference of 89.5%. Comparing the 3D camera and MRI in assessing breast volume difference showed no statistical significance. Conclusions The 3D technology is a useful objective tool to augment the surgeon's experience. It helped achieve an 84.57% reduction in volume difference in managing breast asymmetry with a single-stage procedure.
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Affiliation(s)
- Mahmoud Makram
- From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ayman Noaman
- From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Abozeid
- From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
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Liu Y, Zhang X, Luan J. Breast Morphological Comparison Between Anatomic and Round Implant Augmentation: A Prospective Study. Ann Plast Surg 2023; 90:19-26. [PMID: 36534096 DOI: 10.1097/sap.0000000000003353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The choice of implant shape (anatomic or round) is one of the most critical issues for breast augmentation. Determining whether there are differences in the postoperative breast morphology of the 2 implants is pivotal for surgical planning. This issue has been controversial and lacking in evidence. The aim of this study was to provide reference for implant selection by comparing breast morphology after dual-plane augmentation with anatomic and round implants using 3-dimensional scanning technology. METHODS Patients with implant volume less than 300 mL who underwent transaxillary dual-plane augmentation were included in this study and were grouped according to implant shape. Three-dimensional scans were performed preoperatively and 6 months postoperatively. Postoperative breast height (BH), breast width (BW), BH of upper pole (BHUP), BH of lower pole (BHLP), breast projection (BP), BP of upper pole (BPUP), and BP of lower pole (BPLP) were measured separately, resulting in corresponding ratios (BH/BW, BHUP/BHLP, BP/BH, BPUP/BPLP). Breast volume, and the volumes of each pole (breast volume of upper pole [BVUP], breast volume of lower pole [BVLP]) and its ratio (BVUP/BVLP) were calculated. Correlation and regression analysis on the influencing factors of breast volume were performed. RESULTS Thirty patients with anatomic implants and 26 with round implants were enrolled in this study. The mean volumes of anatomic and round implants were 260.5 ± 26.7 and 267.9 ± 21.7 mL (P = 0.192). The ratios of BH/BW in the 2 groups were 1.39 ± 0.12 and 1.37 ± 0.19, respectively (P = 0.582). The BHUP/BHLP values of 2 groups were 1.35 ± 0.22 and 1.41 ± 0.25 (P = 0.160). Two sets of BPUP/BPLP were 0.68 ± 0.19 and 0.73 ± 0.17 (P = 0.133). The ratios of BP/BH in the 2 groups were 0.39 ± 0.08 and 0.39 ± 0.06 (P = 0.830). The BVUP/BVLP ratios for both groups were 0.75 ± 0.11 and 0.77 ± 0.12 (P = 0.287). There was a volume loss rate of 13.3% ± 3.9% and 13.9% ± 5% (P = 0.489). The postoperative volume showed a positive correlation with both the preoperative volume and the implant volume. CONCLUSIONS For patients with breast dysplasia undergoing transaxillary dual-plane augmentation with anatomic or round implants less than 300 mL, the difference in postoperative breast morphology is not obvious. Using these 2 shapes of implants results in a similar degree of volume loss.
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Affiliation(s)
- Yue Liu
- From the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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8
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Breast Morphological Changes after Transaxillary Dual-Plane Augmentation with Smooth Round Implants: A Prospective Study. Aesthetic Plast Surg 2022; 47:966-978. [PMID: 36216919 DOI: 10.1007/s00266-022-03130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Breast augmentation is the most performed cosmetic surgery in the world. Although smooth round implants are widely used, the trend in breast morphology change after dual-plane augmentation with such implants remains unclear. In this study, we analyzed the issue with the support of 3D scanning technology, which may help provide an objective basis for the evaluation of postoperative outcomes and the determination of follow-up time points. METHODS Patients undergoing dual-plane augmentation with smooth round implants were prospectively included in this study. The variation trend of postoperative breast morphology was analyzed by measuring the specified linear distance, body surface distance, breast projection, nipple position and breast volume at different follow-up time points (1st month, post-1M; 3rd month, post-3M; 6th month, post-6M; 12th month, post-12M). RESULTS A total of 18 patients were included in this study. During the postoperative follow-up period, breast height prolonged while interval of the medial border gradually widened. Breast width was maintained without significant alterations from post-1M. The N-MBB lengthened with shortening of the N-LBB, meanwhile the N-IMF was prolonged by 0.6 cm. Breast volume was gradually reduced with the decrease in breast projection. The position of the nipple gradually shifted laterally, superiorly, and posteriorly after surgery. There was no statistically significant difference between the linear distance at post-3M and post-12M, while the surface distance, breast projection, nipple position and breast volume tended to be stable at post-6M. CONCLUSIONS After dual-plane augmentation with smooth round implants, the base contour of the breast shifted outwards and downwards, and stabilized after 3 months. The remaining breast morphological parameters reached a relative steady state by post-6M, which could be regarded as the time point for objective evaluation of postoperative effect. LEVEL OF EVIDENCE IV 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 .
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Brébant V, Weiherer M, Noisser V, Seitz S, Prantl L, Eigenberger A. Implants Versus Lipograft: Analysis of Long-Term Results Following Congenital Breast Asymmetry Correction. Aesthetic Plast Surg 2022; 46:2228-2236. [PMID: 35296928 PMCID: PMC9592638 DOI: 10.1007/s00266-022-02843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
Aims Congenital breast asymmetry represents a particular challenge to the classic techniques of plastic surgery given the young age of patients at presentation. This study reviews and compares the long-term results of traditional breast augmentation using silicone implants and the more innovative technique of lipografting. Methods To achieve this, we not only captured subjective parameters such as satisfaction with outcome and symmetry, but also objective parameters including breast volume and anthropometric measurements. The objective examination was performed manually and by using the Vectra® H2 photogrammetry scanning system. Results Differences between patients undergoing either implant augmentation or lipograft were revealed not to be significant with respect to patient satisfaction with surgical outcome (p = 0.55) and symmetry (p = 0.69). Furthermore, a breast symmetry of 93 % was reported in both groups. Likewise, no statistically significant volume difference between the left and right breasts was observed in both groups (p < 0.41). However, lipograft patients needed on average 2.9 procedures to achieve the desired result, compared with 1.3 for implant augmentation. In contrast, patients treated with implant augmentation may require a number of implant changes during their lifetime. Conclusion Both methods may be considered for patients presenting with congenital breast asymmetry. 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.
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Affiliation(s)
- Vanessa Brébant
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Vivien Noisser
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Lukas Prantl
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- University Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Regensburg Center of Biomedical Engineering (RCBE), OTH Regensburg and Regensburg University, Regensburg, Germany
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Noisser V, Eigenberger A, Weiherer M, Seitz S, Prantl L, Brébant V. Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results. Arch Gynecol Obstet 2022; 306:1395-1397. [PMID: 35267076 PMCID: PMC9470597 DOI: 10.1007/s00404-021-06392-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Vivien Noisser
- University Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- University Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Lukas Prantl
- University Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- University Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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11
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Breast Reconstruction- Developing a Volumetric Outcome Algorithm. Aesthetic Plast Surg 2022; 46:2078-2084. [PMID: 35132459 DOI: 10.1007/s00266-021-02759-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 11/01/2022]
Abstract
Postoperative loss of breast volume represents a significant parameter for outcome evaluation of breast reconstruction. Breast volume broadly varies- depending of reconstruction method as well as surgical differences. A structural pattern of breast volume loss provides an essential parameter for preoperative design, helps to reduce postoperative breast asymmetry rate and thereby the need for reoperation. Therefore we hereby compare volume change of the three main reconstruction techniques: autologous flap-based, prosthesis-based and autologous fat transplantation breast reconstruction. LEVEL OF EVIDENCE V: 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 .
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12
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Hammond DC, Kim K, Bageris MH, Chaudhry A. Use of Three-Dimensional Imaging to Assess the Effectiveness of Volume as a Critical Variable in Breast Implant Selection. Plast Reconstr Surg 2022; 149:70-79. [PMID: 34936604 DOI: 10.1097/prs.0000000000008682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In breast augmentation, breast base diameter has been recognized as an important variable in implant selection. However, breast implant volume also has a tremendous impact on the final result. Previous methods of preoperative volume determination have been limited to external devices in a bra. Computer-based three-dimensional simulation technology now allows the physician to effectively communicate with the patient preoperatively regarding volume. METHODS A cohort of 40 consecutive patients underwent routine breast augmentation with either anatomically shaped or round implants. Five methods of preoperative volume determination including the Crisalix three-dimensional computer imaging system (Crisalix Virtual Aesthetics, Lausanne, Switzerland), along with an associated virtual reality tool, were used to assess the preoperative desires of the patients. A postoperative questionnaire was used to assess patient satisfaction with each volume determination method. RESULTS Of the 40 patients, 100 percent were satisfied with their result; however, given the opportunity, 12 percent would have chosen a larger implant. The virtual reality tool and external sizers were shown to be the most effective in choosing an implant. The virtual reality tool was judged to be very helpful (62 percent), very accurate (78 percent), and important (88 percent) in helping patients choose their desired implant size. CONCLUSION Prioritizing volume as an implant selection variable in breast augmentation results in a very high rate of patient satisfaction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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13
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Intraoperative 3D Comparison of Round and Anatomical Breast Implants: Dispelling a Myth. J Clin Med 2021; 11:jcm11010149. [PMID: 35011890 PMCID: PMC8745801 DOI: 10.3390/jcm11010149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Thanks to 3D imaging, it is possible to measure the influence of different parameters on breast augmentation. In this study, we compare the effect of different shapes and sizes of breast implants on the topography of the resulting breast. Furthermore, the impact of different breast implants on inter-landmark distances and on changes of the nipple position was assessed. Methods: This interventional prospective study was carried out on 10 female patients after collecting informed consent. 3D scans of the native and augmented breasts were performed intraoperatively with small, medium, and large sizes of both anatomical and round implants, resulting in a total of n = 130 single breast scans. These scans were analyzed for topographic shift quantification, nipple migration, and inter-landmark distances of the breast. Results: Implant size, but not implant shape leads to significant topographic shifts of the breast (p < 0.001 and p = 0.900, respectively). Both round and anatomical implants lead to a significantly higher volumetric increase in the upper quadrants compared to the lower quadrants (p < 0.001). Nipple migration into the superomedial quadrant was seen in about 90% of augmentations. No evident differences in inter-landmark distances were observed when round and anatomical implants of different sizes were compared. Conclusions: Implant size rather than shape influences the postoperative aesthetic results. No significant difference in topographic shift was found comparing round and anatomical implants, suggesting that both implant shapes result in comparable aesthetic outcomes.
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An Analysis of Ptosis following Subfascial Breast Augmentation: Calculations That Explain Dogma. Plast Reconstr Surg 2021; 148:993-1004. [PMID: 34529594 DOI: 10.1097/prs.0000000000008477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Implant placement can improve ptosis due to the position of the nipple, inframammary crease, and base of the breast acting together. The interrelationship between these was quantified via changes in morphometry following subfascial augmentation, and explains the circumstances under which dogma holds true. METHODS One hundred seventy-five patients underwent a series of static measurements before and 3 months after subfascial breast augmentation. Ptosis in the nipple and base of the breast was calculated before and after surgery. RESULTS All measurements except that of the the lateral sternal margin increased after surgery. All grades of ptosis reduced following surgery. There was lowering of the base in grade 1 patients, but not for other grades. Increased base ptosis correlated with reduced lateral sternal margin (1.9 cm compared with 2.9 cm; left, H5 = 24.7, p < 0.01; right, H5 = 24.5, p < 0.01). Implant volume did not correlate with change in ptosis at the nipple or base. Reduced ptosis was associated with implants that are a narrow match of implant to breast (0.52 to 0.95) (left, H5 = 28.3, p < 0.01; right, H5 = 24.9, p < 0.01). Decreasing ptosis correlated with lower lateral sternal margin compared to breasts that increased ptosis. Change in ptosis following surgery does not correlate with having children. CONCLUSIONS Subfascial placement has varying effects on ptosis. Non-ptotic or mildly ptotic breasts appear to improve due to a disproportionate descent of the inframammary crease relative to the nipple and base. Patients with little breast tissue are more susceptible to an increase in "bottoming out," particularly if broad implants are used. A ratio matching implant to the base width has predictive value on outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Noisser V, Eigenberger A, Weiherer M, Seitz S, Prantl L, Brébant V. Surgery of congenital breast asymmetry-which objective parameter influences the subjective satisfaction with long-term results. Arch Gynecol Obstet 2021; 305:95-102. [PMID: 34480228 PMCID: PMC8782804 DOI: 10.1007/s00404-021-06218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/20/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results. METHODS Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q™), and breast volumetry based on 3D scans (Vectra® H2, Canfield Scientific). RESULTS Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively. CONCLUSION Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies.
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Affiliation(s)
- Vivien Noisser
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Maximilian Weiherer
- Regensburg Medical Image Computing (ReMIC), Ostbayerische Technische Hochschule Regensburg (OTH Regensburg), Regensburg, Germany
| | - Stephan Seitz
- Department of Obstetrics and Gynecology, Caritas Hospital St. Josef, University of Regensburg, Regensburg, Germany
| | - Lukas Prantl
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Lin F, Hong W, Zeng L, Kong X, Feng W, Luo S. A Prospective Study of Breast Morphological Changes and the Correlative Factors After Periareolar Dual-Plane Augmentation Mammaplasty with Anatomic Implant. Aesthetic Plast Surg 2020; 44:1965-1976. [PMID: 32152710 DOI: 10.1007/s00266-020-01665-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dual-plane breast augmentation is a popular cosmetic procedure. However, objective evaluations on the effects of dual-plane breast augmentation on breast morphology are lacking. This study evaluated the breast morphological changes and correlative factors after dual-plane anatomic implant augmentation with a periareolar incision via a Vectra 3-dimensional (3D) scanning technique. METHODS The dynamic changes in linear distance, breast projection, nipple position, and breast volume and surface over time (preoperatively; 1 month, 3 months, 6 months, and 12 months after surgery) were analyzed in 21 patients with the Vectra 3D scanning technique. In another group of 65 patients, the influence of the implant parameters and tissue characteristics of the patients on breast morphological changes were evaluated. RESULTS The breast measurements changed significantly up to 6 months postoperatively and remained stable thereafter. The inframammary fold dropped by 0.8 cm at 1 month postoperatively and by 0.5 cm in the following 11 months. The preoperative implant volume and a lower pole skin elasticity lead to an increase in the nipple-to-inframammary fold distance. Compared with the expected values, the final volume was 10.9% smaller, and the projection was 25% smaller. Both the reduced volume and projection were correlated with the implant parameters and preoperative values. The nipple level was slightly elevated by approximately 0.8 cm. CONCLUSIONS This study provides objective information regarding the breast morphological changes and correlative factors after dual-plane breast augmentation. These information may help to further understand the operation effects of dual-plane breast augmentation and to guide medical practice. LEVEL OF EVIDENCE IV 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 .
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Affiliation(s)
- Fuchuan Lin
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Weijin Hong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Li Zeng
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiangxue Kong
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wenjie Feng
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Shengkang Luo
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
- Department of Plastic and Reconstructive Surgery, Guangdong Second Provincial General Hospital, Guangzhou, China.
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Improved accuracy of breast volume calculation from 3D surface imaging data using statistical shape models. PLoS One 2020; 15:e0233586. [PMID: 33232326 PMCID: PMC7685503 DOI: 10.1371/journal.pone.0233586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
Background Three-dimensional (3D) scanning is an established method of breast volume estimation. However, this method can never be entirely precise, since the thoracic wall cannot be imaged by the surface scanner. Current methods rely on interpolation of the posterior breast border from the surrounding thoracic wall. Here, we present a novel method to calculate the posterior border and increase the accuracy of the measurement. Methods Using principal component analysis, computed tomography images were used to build a statistical shape model (SSM) of the thoracic wall. The model was fitted to 3D images and the missing thoracic wall curvature interpolated (indirect volumetry). The calculations were evaluated by ordinary least squares regression between the preoperative and postoperative volume differences and the resection weights in breast reduction surgery (N = 36). Also, an SSM of the breast was developed, allowing direct volumetry. Magnetic-resonance images (MRI) and 3D scans were acquired from 5 patients in order to validate the direct 3D volumetry. Results Volumetry based on a SSM exhibited a higher determination coefficient (R2 = 0,737) than the interpolation method (R2 = 0,404). The methods were not equivalent (p = 0.75), suggesting that the methods significantly differ. There was no influence of BMI on the correlation in either method. The MRI volumetry had a strong correlation with the 3D volumetry (R2 = 0,978). Conclusion The SSM-based method of posterior breast border calculation is reliable and superior to the currently used method of interpolation. It should serve as a basis of software applications aiming at calculation of breast volume from 3D surface scanning data.
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Lotter L, Brébant V, Eigenberger A, Hartmann R, Mueller K, Baringer M, Prantl L, Schiltz D. "Topographic Shift": a new digital approach to evaluating topographic changes of the female breast. Arch Gynecol Obstet 2020; 303:515-520. [PMID: 33079242 PMCID: PMC7858205 DOI: 10.1007/s00404-020-05837-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE To assess precise topographic changes of the breast, objective documentation and evaluation of pre- and postoperative results are crucial. New technologies for mapping the body using digital, three-dimensional surface measurements have offered novel ways to numerically assess the female breast. Due to the lack of clear demarcation points of the breast contour, the selection of landmarks on the breast is highly dependent on the examiner, and, therefore, is prone to error when conducting before-after comparisons of the same breast. This study describes an alternative to volumetric measurements, focusing on topographic changes of the female breast, based on three-dimensional scans. METHOD The study was designed as an interventional prospective study of 10 female volunteers who had planned on having aesthetic breast augmentation with anatomical, textured implants. Three dimensional scans of the breasts were performed intraoperatively, first without and then with breast implants. The topographic change was determined as the mean distance between two three-dimensional layers before and after augmentation. This mean distance is defined as the Topographic Shift. RESULTS The mean implant volume was 283 cc (SD = 68.6 cc, range = 210-395 cc). The mean Topographic Shift was 7.4 mm (SD = 1.9 mm, range = 4.8-10.7 mm). The mean Topographic Shifts per quadrant were: I: 8.0 mm (SD = 3.3 mm); II: 9.2 mm (SD = 3.1 mm); III: 6.9 mm (SD = 3.5 mm); IV: 1.9 mm (SD = 4.3 mm). CONCLUSION The Topographic Shift, describing the mean distance between two three-dimensional layers (for example before and after a volume changing therapy), is a new approach that can be used for assessing topographic changes of a body area. It was found that anatomical, textured breast implants cause a topographic change, particularly on the upper breast, in quadrant II, the décolleté.
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Affiliation(s)
- Luisa Lotter
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Vanessa Brébant
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Andreas Eigenberger
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Faculty of Mechanical Engineering, Ostbayrische Technische Hochschule Regensburg, Regensburg, Germany
| | - Robin Hartmann
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Karolina Mueller
- Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany
| | - Magnus Baringer
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Daniel Schiltz
- Department of Plastic, Hand- and Reconstructive Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Invited Response on: Comments on 'A Prospective Study of Breast Morphological Changes and the Correlative Factors After Periareolar Dual-Plane Augmentation Mammaplasty with Anatomic Implant'. Aesthetic Plast Surg 2020; 44:1912-1913. [PMID: 32410201 DOI: 10.1007/s00266-020-01747-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 10/24/2022]
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Wilting FNH, Hameeteman M, Tielemans HJP, Ulrich DJO, Hummelink S. "Three-dimensional evaluation of breast volume changes following autologous free flap breast reconstruction over six months". Breast 2020; 50:85-94. [PMID: 32113147 PMCID: PMC7380344 DOI: 10.1016/j.breast.2020.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/07/2020] [Indexed: 01/11/2023] Open
Abstract
Objectives To date, little is known about postoperative changes in breast volume after autologous breast reconstruction. The purpose of this retrospective study was to investigate breast volume changes following autologous free flap reconstruction and the factors affecting flap volume. Materials and methods Patients who underwent deep inferior epigastric perforator, superficial inferior epigastric artery and profunda artery perforator flaps between December 2016 and January 2019 were included. Exclusion criteria were breast complications requiring surgical debridement, and the absence of at least two suitable three-dimensional images postoperatively. Three-dimensional stereophotogrammetry volume measurements were performed at the time of standard surgical check-ups. Changes in breast volume were modeled using a quartic polynomial curve function in a nested mixed effects model. Results 136 breasts in 101 patients were included. An average decrease of predicted breast volume was found from 637.8 cc (95%-CI [624.4, 651.1]) at two weeks to 566.6 cc (95%-CI [535.1, 598.0]) after three and 567.6 cc (95%-CI [515.9, 617.6]) after six months postoperatively. Reconstruction timing and first postoperatively measured breast volume showed a statistically significant difference in initial reconstructed breast volume and in the shape of the relationship between time and breast volume, whereas autologous technique and BMI only showed a statistically significant difference in initial reconstructed volume and mastectomy indication in the shape of the relationship. Conclusion The final overall flap volume decreased to 88.9% of its original volume after six months. Gaining more insight into the factors influencing flap volume is of crucial importance to facilitate predictable surgical outcomes.
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Affiliation(s)
- Floor N H Wilting
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Marijn Hameeteman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanneke J P Tielemans
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stefan Hummelink
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia. Aesthetic Plast Surg 2019; 43:616-624. [PMID: 30815735 DOI: 10.1007/s00266-019-01341-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume. OBJECTIVES To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume. METHODS Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System® before and 6 months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume. RESULTS When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4 mL) showed significant differences (p < 0.001) 6 months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5 mL) and after (120 ± 34.6 mL) centrifugation. CONCLUSION Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic gynecomastia. LEVEL OF EVIDENCE IV 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 .
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Effects of Silicone Implants on the Mammary Gland: Ultrasonographic and 3D Study. Aesthetic Plast Surg 2019; 43:354-365. [PMID: 30311034 DOI: 10.1007/s00266-018-1253-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Breast implants may be responsible for secondary deformities produced by parenchymal atrophy. However, few studies in the literature have reported changes in breast tissue after augmentation surgery. In this study, the breast thickness of patients undergoing breast augmentation was monitored by ultrasound, and correlations with surface, volume and projection measurements were examined. METHODS We studied the parenchymal thickness at the lower pole of the breast with ultrasound in 36 women (72 breasts). In another group of 33 patients (66 breasts), we studied the thickness at the upper and lower poles along the meridian of each breast by ultrasound and measured the anthropometric metrics, volume and projection of the breast with a 3D camera. RESULTS Midline measurements close to the areola showed reduced thickness at the lower pole, with 31.8% at the midpoint of the lower pole and 42% at the infra-areolar level (p < 0.0001). At the upper pole, there was a decrease of 14.6% (p < 0.001), but the thickness was increased by 6% and 38% at more cranial levels. No correlations with volume were found. Anatomical implants produced more atrophy at the lower pole, and round implants at the upper pole. More atrophy was found with subfascial than submuscular augmentation. Compared with the expected values, the final volume was very similar, but the projection was 29% less. Surface measurements changed significantly up to 4 months postoperatively and remained stable thereafter. CONCLUSIONS Implants affect significatively the thickness of the glandular tissue. All changes occur very soon postoperatively but stabilize after 4 months. LEVEL OF EVIDENCE IV 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 .
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Wang C, Luan J, Cheng H, Chen L, Li Z, Panayi AC, Liu C. Menstrual Cycle-Related Fluctuations in Breast Volume Measured Using Three-Dimensional Imaging: Implications for Volumetric Evaluation in Breast Augmentation. Aesthetic Plast Surg 2019; 43:1-6. [PMID: 30276455 DOI: 10.1007/s00266-018-1243-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 09/16/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Breast volume is a key parameter of breast measurement in breast augmentation. However, the correlation between menstrual cycle phases and variation in breast volume has not been well studied. METHODS Young female patients with regular menstrual cycles underwent eight three-dimensional imaging scans during a single menstrual cycle from November 2017 to January 2018. Breast volumetric difference at each timepoint and basic breast volume were measured for each subject. Preovulatory phase and postovulatory phase values were compared using an unpaired t test. A Pearson's linear correlated analysis was performed to identify the correlation between the basic breast volume and maximum range of breast volumetric difference during the menstrual cycle. RESULTS Thirteen patients (26 breasts) met the inclusion criteria. During the menstrual cycle, the breast volumetric difference showed first a rising trend followed by a fall. A significant difference in the breast volumetric difference between the preovulatory phase and postovulatory phase (- 19.6 ± 2.1 ml pre-ovulation vs. - 6.9 ± 3.3 ml post-ovulation, p = 0.002) was noted. There was a positive linear association between breast volume and maximum range of breast volumetric difference when a Pearson correlation was used (r = 0.45, p = 0.021). CONCLUSIONS The breast volume fluctuates during the menstrual cycle, and there is a significant difference between the preovulatory phase and postovulatory phase for breast volumetric change. The influence of the menstrual cycle on breast volume should be taken into consideration by plastic surgeons performing breast augmentation. LEVEL OF EVIDENCE IV 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 .
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Coltman CE, Steele JR, McGhee DE. Effects of age and body mass index on breast characteristics: a cluster analysis. ERGONOMICS 2018; 61:1232-1245. [PMID: 29792567 DOI: 10.1080/00140139.2018.1481229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 04/04/2018] [Accepted: 05/20/2018] [Indexed: 06/08/2023]
Abstract
UNLABELLED Limited research has quantified variation in the characteristics of the breasts among women and determined how these breast characteristics are influenced by age and body mass. The aim of this study was to classify the breasts of women in the community into different categories based on comprehensive and objective measurements of the characteristics of their breasts and torsos, and to determine the effect of age and body mass index on the prevalence of these breast categories. Four breast characteristic clusters were identified (X-Large, Very-ptotic & Splayed; Large, Ptotic & Splayed; Medium & Mildly-ptotic; and Small & Non-ptotic), with age and BMI shown to significantly affect the breast characteristic clusters. These results highlight the difference in breast characteristics exhibited among women and how these clusters are affected by age and BMI. The breast characteristic clusters identified in this study could be used as a basis for future bra designs and sizing systems in order to improve bra fit for women. Practitioner summary: This original research provides evidence for bra designers and manufacturers on the diverse breast characteristics exhibited by women within the population and the significant effect that both body mass index and age have on the breast characteristic clusters. Future bra designs should consider the variation in breast characteristics among women. ABBREVIATIONS BMI: Body Mass Index; UBCC: Under-bust chest circumference.
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Affiliation(s)
- Celeste E Coltman
- a Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health , University of Wollongong , Wollongong , Australia
| | - Julie R Steele
- a Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health , University of Wollongong , Wollongong , Australia
| | - Deirdre E McGhee
- a Biomechanics Research Laboratory, School of Medicine, Faculty of Science, Medicine & Health , University of Wollongong , Wollongong , Australia
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de Runz A, Boccara D, Bertheuil N, Claudot F, Brix M, Simon E. Three-dimensional imaging, an important factor of decision in breast augmentation. ANN CHIR PLAST ESTH 2018; 63:134-139. [DOI: 10.1016/j.anplas.2017.07.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 07/26/2017] [Indexed: 10/18/2022]
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Assessment of Breast Asymmetry in Adolescent Idiopathic Scoliosis Using an Automated 3D Body Surface Measurement Technique. Spine Deform 2017; 5:152-158. [PMID: 28449957 DOI: 10.1016/j.jspd.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 12/28/2016] [Accepted: 01/02/2017] [Indexed: 11/20/2022]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To assess breast asymmetry (BA) directly with 3D surface imaging and to validate it using MRI values from a cohort of 30 patients with significant adolescent idiopathic scoliosis (AIS). Also, to study the influence of posture (prone vs standing) on BA using the automated method on both modalities. SUMMARY OF BACKGROUND DATA BA is a common concern in young female patients with AIS. In a previous study using MRI, we found that the majority of patients with significant AIS experienced BA of up to 21% in addition to their chest wall deformity. MRI is costly and not always readily available. 3D surface topography, which offers fast and reliable breast acquisitions without radiation or distortion of the body surface, is an alternative method in the clinical setting. METHODS Thirty patients with AIS were enrolled in the study on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception of their BA. Each patient underwent two imaging studies of their torso: a 3D trunk surface topography and a breast MRI. An automated breast volume measuring method was proposed using a program developed with Matlab programming. RESULTS Strong correlations were obtained when comparing the proposed method to the MRI on the left breast volumes (LBV) (r = 0.747), the right breast volumes (RBV) (r = 0.805) and the BA (r = 0.614). Using the same method on both imaging modalities also yielded strong correlation coefficients on the LBV (r = 0.896), the RBV (r = 0.939) and the BA (r = 0.709). CONCLUSIONS The proposed 3D body surface automated measurement technique is feasible clinically and correlates very well with breast volumes measured using MRI. Additionally, breast volumes remain comparable despite being measured in different body positions (standing and prone) in a young cohort of AIS patients. LEVEL OF EVIDENCE Level IV.
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Costa CR, Small KH, Adams WP. Bra Sizing and the Plastic Surgery Herd Effect: Are Breast Augmentation Patients Getting Accurate Information? Aesthet Surg J 2017; 37:421-427. [PMID: 28096110 DOI: 10.1093/asj/sjw221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christopher R Costa
- Associate Clinical Professor, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kevin H Small
- Assistant Professor, Division of Plastic Surgery, Weill Cornell Medicine New York-Presbyterian Hospital, New York, USA
| | - William P Adams
- Associate Clinical Professor, Department of Plastic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Comparison of long-term changes in breast surface measurements after augmentation mammaplasty: silicone versus saline implants. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-016-1198-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zhao L, Cheong A, Reece GP, Fingeret MC, Shah SK, Merchant FA. Inferior Breast-Chest Contour Detection in 3-D Images of the Female Torso. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2016; 4:4300410. [PMID: 32519998 PMCID: PMC7228683 DOI: 10.1109/jtehm.2016.2614518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 08/15/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022]
Abstract
Stereophotogrammetry is finding increased use in clinical breast surgery, both for breast reconstruction after oncological procedures and cosmetic augmentation and reduction. The ability to visualize and quantify morphological features of the breast facilitates pre-operative planning and post-operative outcome assessment. The contour outlining the lower half of the breast is important for the quantitative assessment of breast aesthetics. Based on this inferior breast contour, relevant morphological measures, such as breast symmetry, volume, and ptosis, can be determined. In this paper, we present an approach for automatically detecting the inferior contour of the breast in 3D images. Our approach employs surface curvature analysis and is able to detect the breast contour with high accuracy, achieving an average error of 1.64 mm and a dice coefficient in the range of 0.72–0.87 when compared with the manually annotated contour (ground truth). In addition, the detected contour is used to facilitate the detection of the lowest visible point on the breast, which is an important landmark for breast morphometric analysis.
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Affiliation(s)
- Lijuan Zhao
- Department of Computer ScienceUniversity of HoustonHoustonTX77204USA
| | - Audrey Cheong
- Department of Electrical and Computer EngineeringUniversity of HoustonHoustonTX77204USA
| | - Gregory P Reece
- Department of Plastic SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Michelle C Fingeret
- Department of Behavioral ScienceThe University of Texas MD Anderson Cancer CenterHoustonTX77030USA
| | - Shishir K Shah
- Department of Computer ScienceUniversity of HoustonHoustonTX77204USA
| | - Fatima A Merchant
- Departments of Engineering TechnologyElectrical and Computer Engineering, and Computer ScienceUniversity of HoustonHoustonTX77204USA
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The Application of Three-Dimensional Surface Imaging System in Plastic and Reconstructive Surgery. Ann Plast Surg 2016; 77 Suppl 1:S76-83. [DOI: 10.1097/sap.0000000000000813] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chae MP, Rozen WM, Spychal RT, Hunter-Smith DJ. Breast volumetric analysis for aesthetic planning in breast reconstruction: a literature review of techniques. Gland Surg 2016; 5:212-26. [PMID: 27047788 DOI: 10.3978/j.issn.2227-684x.2015.10.03] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Accurate volumetric analysis is an essential component of preoperative planning in both reconstructive and aesthetic breast procedures towards achieving symmetrization and patient-satisfactory outcome. Numerous comparative studies and reviews of individual techniques have been reported. However, a unifying review of all techniques comparing their accuracy, reliability, and practicality has been lacking. METHODS A review of the published English literature dating from 1950 to 2015 using databases, such as PubMed, Medline, Web of Science, and EMBASE, was undertaken. RESULTS Since Bouman's first description of water displacement method, a range of volumetric assessment techniques have been described: thermoplastic casting, direct anthropomorphic measurement, two-dimensional (2D) imaging, and computed tomography (CT)/magnetic resonance imaging (MRI) scans. However, most have been unreliable, difficult to execute and demonstrate limited practicability. Introduction of 3D surface imaging has revolutionized the field due to its ease of use, fast speed, accuracy, and reliability. However, its widespread use has been limited by its high cost and lack of high level of evidence. Recent developments have unveiled the first web-based 3D surface imaging program, 4D imaging, and 3D printing. CONCLUSIONS Despite its importance, an accurate, reliable, and simple breast volumetric analysis tool has been elusive until the introduction of 3D surface imaging technology. However, its high cost has limited its wide usage. Novel adjunct technologies, such as web-based 3D surface imaging program, 4D imaging, and 3D printing, appear promising.
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Affiliation(s)
- Michael P Chae
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - Warren Matthew Rozen
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - Robert T Spychal
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
| | - David J Hunter-Smith
- 1 Monash University Plastic and Reconstructive Surgery Group (Peninsula Clinical School), Peninsula Health, Frankston, Victoria 3199, Australia ; 2 Department of Surgery, Frankston Hospital, Peninsula Health, Frankston, Victoria 3199, Australia
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Yang J, Zhang R, Shen J, Hu Y, Lv Q. The Three-Dimensional Techniques in the Objective Measurement of Breast Aesthetics. Aesthetic Plast Surg 2015; 39:910-5. [PMID: 26395095 DOI: 10.1007/s00266-015-0560-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 08/18/2015] [Indexed: 02/04/2023]
Abstract
UNLABELLED Breast symmetry, size, and shape are key components of aesthetic outcomes of augmentation mammoplasty, reduction, and reconstruction. Many have claimed that the 3D scanning technique, which measures breast volumes directly and assesses the asymmetry of the chest and breast on a 3D model, is superior to anthropometric measuring in accuracy, precision, and reproducibility. The documented methods of 3D body surface imaging include laser scanning, stereo photography and so on. To achieve ideal aesthetic results, individualized surgery planning based on a reliable virtual model of the prospective surgery outcome could be of considerable value in decision making and assisting in guidance for the surgery procedure. Additionally, the 3D scanning technique is applicable in postoperative monitoring of morphological change, notably, in a dynamic way. Another distinguishing feature is that it enables virtual division of breast volume, thus surgeons could virtually divide the breast volumes into portions using 3D scanning during the programming and evaluation of surgery plans. However, because 3D surface scanning cannot look through the breast substances and reach the interspace between the chest and posterior border of the breast/dorsal limit of the breast, the inframammary fold in larger breasts cannot be correctly imaged, leaving the preoperative inframammary fold reference lacking. Therefore, 3D scanning is thought to be inaccurate in large and/or ptotic breasts. Another fact that prevents 3D scanning from wide application is its high cost and lack of access. LEVEL OF EVIDENCE IV 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.
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Affiliation(s)
- Jiqiao Yang
- Department of Breast Surgery, West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Run Zhang
- West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Jiani Shen
- West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Yuanyuan Hu
- West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China
| | - Qing Lv
- Department of Breast Surgery, West China Hospital/West China School of Medicine, Sichuan University, Guoxuexiang 37, Chengdu, 610041, People's Republic of China.
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A simplified three-dimensional volume measurement technique in keloid scars: Validity and reliability. J Plast Reconstr Aesthet Surg 2015; 68:1574-80. [DOI: 10.1016/j.bjps.2015.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/06/2015] [Indexed: 11/23/2022]
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Roxo ACW, Nahas FX, Bazi F, de Castro CC, Aboudib JH, Marques RG. Evaluation of the effects of silicone implants on the breast parenchyma. Aesthet Surg J 2015; 35:929-35. [PMID: 26508645 DOI: 10.1093/asj/sjv120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite being the cosmetic procedure most performed worldwide, there are still few objective measurements of postoperative volumetric analysis of breast augmentation available in the literature. OBJECTIVE The aim of this study was to evaluate volumetric changes in the breast parenchyma after the placement of silicone implants in the subglandular plane. METHODS Thirty-four women were randomly allocated to the intervention group (n = 24), who underwent breast augmentation in the subglandular plane, or to the control group (n = 10), who received no intervention. Volumetric magnetic resonance imaging was performed at inclusion, and after 6 and 12 months in all participants. The non-parametric Friedman's test was used for statistical analysis. RESULTS There was a significant reduction in glandular volume (mean, 22%) at 12 months postoperatively in patients who underwent breast augmentation. CONCLUSIONS Breast augmentation caused reduction in the volume of the breast parenchyma. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Ana Claudia Weck Roxo
- Dr Roxo is a PhD Student, Graduate Program in Physiopathology and Surgical Sciences, and Drs Nahas, de Castro, and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, "Pedro Ernesto" University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Bazi is a Radiologist, Breast Division, Rio Imagem Center for Diagnostic Imaging of the State of Rio de Janeiro, Rio de Janeiro, Brazil. Dr Marques is an Assistant Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Fabio Xerfan Nahas
- Dr Roxo is a PhD Student, Graduate Program in Physiopathology and Surgical Sciences, and Drs Nahas, de Castro, and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, "Pedro Ernesto" University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Bazi is a Radiologist, Breast Division, Rio Imagem Center for Diagnostic Imaging of the State of Rio de Janeiro, Rio de Janeiro, Brazil. Dr Marques is an Assistant Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Fernanda Bazi
- Dr Roxo is a PhD Student, Graduate Program in Physiopathology and Surgical Sciences, and Drs Nahas, de Castro, and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, "Pedro Ernesto" University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Bazi is a Radiologist, Breast Division, Rio Imagem Center for Diagnostic Imaging of the State of Rio de Janeiro, Rio de Janeiro, Brazil. Dr Marques is an Assistant Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Claudio Cardoso de Castro
- Dr Roxo is a PhD Student, Graduate Program in Physiopathology and Surgical Sciences, and Drs Nahas, de Castro, and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, "Pedro Ernesto" University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Bazi is a Radiologist, Breast Division, Rio Imagem Center for Diagnostic Imaging of the State of Rio de Janeiro, Rio de Janeiro, Brazil. Dr Marques is an Assistant Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Jose Horacio Aboudib
- Dr Roxo is a PhD Student, Graduate Program in Physiopathology and Surgical Sciences, and Drs Nahas, de Castro, and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, "Pedro Ernesto" University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Bazi is a Radiologist, Breast Division, Rio Imagem Center for Diagnostic Imaging of the State of Rio de Janeiro, Rio de Janeiro, Brazil. Dr Marques is an Assistant Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - Ruy Garcia Marques
- Dr Roxo is a PhD Student, Graduate Program in Physiopathology and Surgical Sciences, and Drs Nahas, de Castro, and Aboudib are Associate Professors, Division of Plastic and Reconstructive Surgery, "Pedro Ernesto" University Hospital, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil. Dr Bazi is a Radiologist, Breast Division, Rio Imagem Center for Diagnostic Imaging of the State of Rio de Janeiro, Rio de Janeiro, Brazil. Dr Marques is an Assistant Professor, Graduate Program in Physiopathology and Surgical Sciences, Department of General Surgery, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
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Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery. Breast 2015; 24:331-42. [DOI: 10.1016/j.breast.2015.03.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/18/2015] [Accepted: 03/22/2015] [Indexed: 11/22/2022] Open
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3D surface imaging of the human female torso in upright to supine positions. Med Eng Phys 2015; 37:375-83. [PMID: 25703742 PMCID: PMC4380553 DOI: 10.1016/j.medengphy.2015.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 01/09/2015] [Accepted: 01/18/2015] [Indexed: 11/20/2022]
Abstract
Three-dimensional (3D) surface imaging of breasts is usually done with the patient in an upright position, which does not permit comparison of changes in breast morphology with changes in position of the torso. In theory, these limitations may be eliminated if the 3D camera system could remain fixed relative to the woman’s torso as she is tilted from 0 to 90 degrees. We mounted a 3dMDtorso imaging system onto a bariatric tilt table to image breasts at different tilt angles. The images were validated using a rigid plastic mannequin and the metrics compared to breast metrics obtained from 5 subjects with diverse morphology. The differences between distances between the same fiducial marks differed between the supine and upright positions by less than one percent for the mannequin, whereas the differences for distances between the same fiducial marks on the breasts of the 5 subjects differed significantly and could be correlated with body mass index and brassiere cup size for each position change. We show that a tilt table - 3D imaging system can be used to determine quantitative changes in the morphology of ptotic breasts when the subject is tilted to various angles.
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Objective breast volume, shape and surface area assessment: a systematic review of breast measurement methods. Aesthetic Plast Surg 2014; 38:1116-30. [PMID: 25338712 DOI: 10.1007/s00266-014-0412-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 09/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There are many methods of measuring the breast and their clinical applications are well described in the literature. However, there has been no attempt to compare these various methods to allow the user to have a broad overview of the subject. The authors have attempted to summarise all the available methods to measure the breast in this article to provide a useful reference for all. METHODS A comprehensive literature search of PubMed was performed, and the resulting articles were screened and reviewed. The data regarding the methods' mechanism, reliability, time and cost were evaluated and compared. RESULTS A total of 74 articles dating from 1970 to 2013 were included in this study. All of the methods can be classified into those that measure (1) volume, (2) shape and (3) surface area. Each category consists of several methods that work through different mechanisms and they vary in their reliability and feasibility. Based on their mechanism, the volume measurement methods were further grouped into the natural shape methods, the stereological method, the geometrical methods and the mathematical modelling method. CONCLUSIONS More objective breast evaluation can be achieved if all three dimensions (volume, shape and surface area) are considered. In the volume measurements, 3D modelling and the MRI are the most reliable tools. Linear measurement (geometry) and mathematical modelling are less accurate but are more economical. In the shape measurements, besides the traditional linear measurement, 3D methods that can deliver colour-coded maps and Swanson's 2D photographic measurement system are capable of depicting and tracking breast shape changes after surgery. Although the surface area metric has not been used extensively, it has potential in clinical and research applications. LEVEL OF EVIDENCE IV 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.
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Ramsay J, Joncas J, Gilbert G, Trop I, Cheriet F, Labelle H, Parent S. Is Breast Asymmetry Present in Girls with Adolescent Idiopathic Scoliosis? Spine Deform 2014; 2:374-379. [PMID: 27927335 DOI: 10.1016/j.jspd.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 05/11/2014] [Accepted: 05/24/2014] [Indexed: 11/29/2022]
Abstract
STUDY DESIGN Cross-sectional descriptive study. OBJECTIVES To characterize breast asymmetry (BA), as defined by breast volume difference, in girls with significant adolescent idiopathic scoliosis (AIS), using magnetic resonance imaging (MRI). SUMMARY AND BACKGROUND BA is a frequent concern among girls with AIS. It is commonly believed that this results from chest wall deformity. Although many women exhibit physiological BA, the prevalence is not known in adolescents and it remains unclear if it is more frequent in AIS. Breasts vary in shape and size and many ways of measuring them have been explored. MRI shows the highest precision at defining breast tissue. METHODS Thirty patients were enrolled on the basis of their thoracic curvature, skeletal and breast maturity, without regard to their perception on their BA. MRI acquisitions were performed in prone with a 1.5-Tesla system using a 16-channel breast coil. Segmentation was achieved using the ITK-SNAP 2.4.0 software and subsequently manually refined. RESULTS The mean left breast volume (528.32 ± 205.96 cc) was greater compared with the mean right breast volume (495.18 ± 170.16 cc) with a significant difference between them. The mean BA was found to be 8.32% ± 6.43% (p < .0001). A weak positive correlation was observed between BA and thoracic Cobb angle (0.177, p = .349) as well as thoracic gibbosity angle (0.289, p = .122). The left breast was consistently larger in 65.5% of the patients. Twenty patients (66.7%) displayed BA ≥5%. CONCLUSIONS We have described BA in patients with significant AIS using MRI. This method is feasible, objective, and very precise. The majority of patients had a larger left breast, which could compound the apparent BA secondary to trunk rotation. In many cases, BA is present independently of thoracic deformity. This knowledge will assist in counseling AIS patients in regards to their concerns with BA.
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Affiliation(s)
- Joyce Ramsay
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; University of Montreal, 2910 Edouard-Montpetit Blvd, Montreal, Quebec H3C 3J7, Canada
| | - Julie Joncas
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Guillaume Gilbert
- MR Clinical Science, Philips Healthcare, 281 Hillmount Road, Markham, Ontario L6C 2S3, Canada; Hôtel-Dieu University of Montreal Hospital Center, 3840 Saint Urbain Street, Montreal, Quebec H2W 1T8 Canada
| | - Isabelle Trop
- Hôtel-Dieu University of Montreal Hospital Center, 3840 Saint Urbain Street, Montreal, Quebec H2W 1T8 Canada
| | - Farida Cheriet
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec, H3T 1J4 Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Stefan Parent
- Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada; University of Montreal, 2910 Edouard-Montpetit Blvd, Montreal, Quebec H3C 3J7, Canada.
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Roostaeian J, Adams WP. Three-Dimensional Imaging for Breast Augmentation: Is This Technology Providing Accurate Simulations? Aesthet Surg J 2014; 34:857-75. [PMID: 24970274 DOI: 10.1177/1090820x14538805] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For patients considering breast augmentation, 3-dimensional (3D) imaging provides a preoperative simulation of the postoperative result. However, the clinical accuracy of these simulations has not been assessed. OBJECTIVE The authors compared preoperative simulations with postoperative results of breast augmentation to permit more informed decisions about breast augmentation. METHODS To determine differences between simulations and actual results, volumetric and contour analyses were performed for patients who underwent 3D imaging both preoperatively and 3 months after breast augmentation. All patients received round smooth silicone implants or anatomically shaped cohesive silicone gel implants; the mean volume was 295 cc. RESULTS Twenty patients (40 breasts) underwent 3D imaging both pre- and postoperatively. There were no procedural complications or revisions. The mean difference between preoperative simulation and postoperative breast volume was 27.2 cc (range, 1.4-99.5 cc), representing a 9.2% mean difference in volume and an accuracy of 90.8%. The mean absolute difference (root mean square) of all surface points along the breast in aggregate was 4.0 mm (range, 1.8-8.3 mm). No specific location along the surface contour of the breast could be identified as having the greatest differences. CONCLUSIONS The preoperative simulation provided by 3D imaging is >90% accurate in predicting postoperative breast volume. The mean absolute differential for surface contour in this study was 4 mm, representing 98.4% accuracy based on average surface area. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jason Roostaeian
- Dr Roostaeian is an assistant clinical instructor in the Division of Plastic Surgery at the University of California-Los Angeles
| | - William P Adams
- Dr Adams is an Associate Clinical Professor of Plastic Surgery at the University of Texas Southwestern Medical School, Dallas
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Georgii J, Eder M, Burger K, Klotz S, Ferstl F, Kovacs L, Westermann R. A Computational Tool for Preoperative Breast Augmentation Planning in Aesthetic Plastic Surgery. IEEE J Biomed Health Inform 2014; 18:907-19. [DOI: 10.1109/jbhi.2013.2285308] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Ji K, Luan J, Liu C, Mu D, Mu L, Xin M, Sun J, Yin S, Chen L. A prospective study of breast dynamic morphological changes after dual-plane augmentation mammaplasty with 3D scanning technique. PLoS One 2014; 9:e93010. [PMID: 24671190 PMCID: PMC3966867 DOI: 10.1371/journal.pone.0093010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 02/28/2014] [Indexed: 12/02/2022] Open
Abstract
Background The dual-plane technique has been widely used in augmentation mammaplasty procedures. However, there are some concerns about aesthetic contour maintenance for long time after muscle releasing. This study aims to track and analyze breast dynamic morphological changes after dual-plane breast augmentation with three-dimensional (3D) scanning technique. Methods Thirteen dual-plane anatomic implant augmentation patients underwent 3D scanning preoperatively (pre-OP) and postoperatively in four time points (1 month: post-1M, 3 months: post-3M, 6 months: post-6M and 12 months: post-12M). The linear distance, breast projection, nipple position, breast volume and breast surface area were measured and analyzed on the 3D models over time. Results Compared with post-12M, no significant differences were found in distances of nipple to midline, nipple to inframammary fold and sternal notch to the level of inframammary fold after 6 months in both straight-line distance and its projection on surface. The distances between sternal notch and nipple had no significant difference after post-1M. Breast volume changes had no significant difference after post-3M. The volume and area percentage of upper pole decreased while the lower pole’s increased gradually. The surface showed no significant changes after post-1M. The changes of breast projection had no significance after post-1M either. The nipple moved 1.0±0.6 cm laterally(X axis), 0.6±0.7 cm upward(Y axis) and 2.3±1.1 cm anteriorly (Z axis) at post-12M, and the differences were not significant after post-1M. Conclusions 3D scanning technique provides an objective and effective way to evaluate breast morphological changes after augmentation mammaplasty over time. Dual-plane augmentation optimizes breast shape especially in the lower pole and maintains stable aesthetic outcome during the 12 months follow-up. Most of the contour changes and the interadaptation with the implant have completed 6 months after operation. Therefore, 6 months could be chosen as a relatively stable observing period in the assessment of postoperative outcomes of dual-plane breast augmentation.
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Affiliation(s)
- Kai Ji
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Jie Luan
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
- * E-mail:
| | - Chunjun Liu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Dali Mu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Lanhua Mu
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Minqiang Xin
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Jingjing Sun
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Shilu Yin
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Lin Chen
- Breast Plastic and Reconstructive Surgery Center, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, P. R. China
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Liu C, Ji K, Sun J, Luan J. Does respiration influence breast volumetric change measurement with the three-dimensional scanning technique? Aesthetic Plast Surg 2014; 38:115-119. [PMID: 24337147 DOI: 10.1007/s00266-013-0247-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/13/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Measurement of volumetric change after aesthetic and reconstructive breast surgery is of great significance to plastic surgeons. This study aimed to investigate the influence of respiration on measurement of breast volumetric change via a three-dimensional (3D) scanning technique. METHODS In this study, ten augmentation mammaplasty patients received preoperative 3D scanning in different respiration states at three time points: the end of normal exhalation (ENE1), the end of normal inhalation (ENI), and the end of normal exhalation again (ENE2). Using Geomagic Studio 12 software, breast volumetric change error (BVCE) was measured between the ENE1 scan and the ENI scan (R1) and between the ENE1 scan and ENE2 scan (R2). Three-dimensional deviation, defined as the shortest distance from one scan to any point on the other scan, was measured in R1 and R2. A paired-sample t test was used to compare the means of BVCE and the 3D deviation between R1 and R2. Pearson's correlation coefficient was calculated between 3D deviation and BVCE. For the analysis, SPSS program version 16 was used. Differences were considered statistically significant at P values lower than 0.05. RESULTS The mean breast volume was 352.3 ± 52.7 ml, and BVCE was significantly lower in R1 than in R2 (9.7 vs. 21.3 ml; P = 0.000). The 3D deviation was significantly higher in R2 than in R1 (1.600 vs. 0.887; P = 0.000). In the analysis, BVCE was not correlated significantly with 3D deviation in R1 (P = 0.157) but was significantly correlated with 3D deviation in R2 (correlation coefficient = 0.766; P = 0.000). CONCLUSIONS Keeping patients in the same respiration state is crucial for accurate measurement of breast volumetric change via the 3D scanning technique. LEVEL OF EVIDENCE I 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 .
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Three-dimensional simulated images in breast augmentation surgery: an investigation of patients' satisfaction and the correlation between prediction and actual outcome. Plast Reconstr Surg 2013; 132:810-822. [PMID: 24076673 DOI: 10.1097/prs.0b013e3182a014cb] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breast augmentation is one of the most commonly performed operations. Three-dimensional outcome simulation can be used to predict and demonstrate for the patient what the planned operation aims to achieve in terms of size and shape. However, there are still few studies in the literature that look at how close the simulation is to the actual postoperative result and how patients perceive the accuracy and usefulness of the simulation. METHODS A prospective series of 150 patients underwent breast augmentation following consultation with the aid of three-dimensional simulation images. These patients were evaluated with a questionnaire 6 months postoperatively. A retrospective chart review of 52 patients whose three-dimensional simulations were compared with the postoperative photographs were evaluated and graded by an independent panel of investigators. RESULTS The independent panel graded the overall similarity of the three-dimensional simulations to the actual breasts with a total average score ± SD of 7.5 ± 0.80 (range, 4.5 to 8.9) using a visual analogue scale ranging from 1 to 10. The highest average score was given to projection, breast width, and height (7.8); the lowest average score was given to intermammary distance (7.0). Eighty-six percent of patients felt the simulated image was very accurate in predicting the actual result of their breasts. CONCLUSIONS Patients prefer a center that offers three-dimensional imaging technology; they feel that the simulation is very accurate and helps them very much in choosing the implant; if they could go back in time, they would choose the same implant again. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Eisenhardt SU, Nienhueser H, Braig D, Penna V, Bannasch H, Torio-Padron N. Comparison of the Rubin dermal suspension sutures and total parenchymal reshaping technique with a traditional inverted T-scar reduction mammaplasty technique using a superior pedicle. Aesthetic Plast Surg 2013; 37:1153-60. [PMID: 24122070 DOI: 10.1007/s00266-013-0223-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/06/2013] [Indexed: 11/29/2022]
Abstract
UNLABELLED Adipose patients, especially after massive weight loss, pose a challenge to the breast surgeon due to the major loss of volume and the inelasticity of the skin. Rubin described a suitable mammaplasty technique for these patients involving dermal suspension sutures and total parenchymal reshaping. With this technique, the tissue of the prominent axillary skin fold typically found in patients with massive weight loss is used to increase the upper pole volume of the breast. To prove the effectiveness of this technique, the current study compared it with a traditional inverted T-scar technique using a superior pedicle, as described by Höhler. This technique usually is used for a different patient clientele that requires reduction mammaplasty. However, because none of the difficult aforementioned preconditions are found in this clientele, it leads to the best possible outcome and represents the authors’ internal “gold standard” for mammaplasty against which all other techniques must be compared. This study retrospectively analyzed the complication rate, lift effect, and upper pole fullness by chart analysis and photometric analysis of 21 Höhler and 24 Rubin mammaplasties. Despite the more challenging patient clientele in the Rubin groups, both therapies achieved a similar lift effect without significant differences (Höhler 4.8 ± 3.3 cm vs Rubin 6 ± 4 cm). In both groups, the upper pole area increased significantly. The ratio of upper pole-to-lower pole area increased from 1.31 preoperatively to 2.1 postoperatively in the Rubin group, suggesting a redistribution of tissue in favor of the upper pole, and it increased from 1.18 to 1.69 in the Höhler group, indicating an even greater increase in upper pole volume in the Rubin group. In conclusion, the technique described by Rubin, despite the dramatically more difficult soft tissue condition of the patients with massive weight loss, results in an outcome similar to that of a traditional reduction mammaplasty technique in terms of increased upper pole volume. It is suitable and preferable for patients who have a lateral axillary roll deformity and can be applied safely for these patients without increasing the complication rate. LEVEL OF EVIDENCE IV 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.
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Eder M, Raith S, Jalali J, Müller D, Harder Y, Dobritz M, Papadopulos NA, Machens HG, Kovacs L. Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging. Int J Comput Assist Radiol Surg 2013; 9:541-9. [PMID: 24091852 DOI: 10.1007/s11548-013-0941-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/03/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The diagnostic use of computer tomography angiography (CTA) to identify perforating blood vessels for abdominal free-flap breast reconstruction was extended to estimate the three-dimensional (3D) preoperative flap volume and to compare it with the real intraoperative flap weights in order to (1) evaluate the accuracy of CTA-based 3D flap volume prediction, and (2) to analyze abdominal tissue estimation for required breast volume reconstruction. METHODS Preoperative CTA was performed in 54 patients undergoing unilateral breast reconstruction with a free, deep, inferior epigastric artery perforator flap. 3D flap volumes ([Formula: see text]) based on CTA data were calculated and compared with the actual intraoperative flap weight (g). In addition, a breast volume to flap volume ratio was calculated to analyze whether the estimated 3D abdominal flap volume would match that of the breast to be removed. RESULTS 40 CTA data sets (74.1 %) fulfilled the technical requirements for a reliable determination of flap volume. 3D CTA flap volume prediction showed no relevant differences to the actual flap weight (p = 0.44) and high correlations (r = 0.998, [Formula: see text]), allowing a prediction accuracy within 0.29 [Formula: see text] 3.0 % (range: from [Formula: see text]8.77 to 5.67 %) of the real flap weight. Significantly larger flap volumes were harvested compared with the actually required breast volumes ([Formula: see text]), leading to an average of 21 % of the remnant flap tissue potentially being discarded. CONCLUSIONS CTA-based 3D flap volume prediction provides accurate preoperative guidelines concerning the needed amount of abdominal tissue that can be harvested to achieve acceptable symmetry.
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Affiliation(s)
- Maximilian Eder
- Research Group-Computer Aided Plastic Surgery (CAPS), Department of Plastic Surgery and Hand Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675 , Munich, Germany,
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Evaluation of precision and accuracy assessment of different 3-D surface imaging systems for biomedical purposes. J Digit Imaging 2013; 26:163-72. [PMID: 22584773 DOI: 10.1007/s10278-012-9487-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Three-dimensional (3-D) surface imaging has gained clinical acceptance, especially in the field of cranio-maxillo-facial and plastic, reconstructive, and aesthetic surgery. Six scanners based on different scanning principles (Minolta Vivid 910®, Polhemus FastSCAN™, GFM PRIMOS®, GFM TopoCAM®, Steinbichler Comet® Vario Zoom 250, 3dMD DSP 400®) were used to measure five sheep skulls of different sizes. In three areas with varying anatomical complexity (areas, 1 = high; 2 = moderate; 3 = low), 56 distances between 20 landmarks are defined on each skull. Manual measurement (MM), coordinate machine measurements (CMM) and computer tomography (CT) measurements were used to define a reference method for further precision and accuracy evaluation of different 3-D scanning systems. MM showed high correlation to CMM and CT measurements (both r = 0.987; p < 0.001) and served as the reference method. TopoCAM®, Comet® and Vivid 910® showed highest measurement precision over all areas of complexity; Vivid 910®, the Comet® and the DSP 400® demonstrated highest accuracy over all areas with Vivid 910® being most accurate in areas 1 and 3, and the DSP 400® most accurate in area 2. In accordance to the measured distance length, most 3-D devices present higher measurement precision and accuracy for large distances and lower degrees of precision and accuracy for short distances. In general, higher degrees of complexity are associated with lower 3-D assessment accuracy, suggesting that for optimal results, different types of scanners should be applied to specific clinical applications and medical problems according to their special construction designs and characteristics.
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Eder M, Klöppel M, Müller D, Papadopulos NA, Machens HG, Kovacs L. 3-D analysis of breast morphology changes after inverted T-scar and vertical-scar reduction mammaplasty over 12 months. J Plast Reconstr Aesthet Surg 2013; 66:776-86. [DOI: 10.1016/j.bjps.2013.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/19/2012] [Accepted: 02/12/2013] [Indexed: 11/28/2022]
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Patete P, Eder M, Raith S, Volf A, Kovacs L, Baroni G. Comparative assessment of 3D surface scanning systems in breast plastic and reconstructive surgery. Surg Innov 2012; 20:509-15. [PMID: 23075528 DOI: 10.1177/1553350612463443] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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