Accuracy of the method for estimating breast volume on three-dimensional simulated magnetic resonance imaging scans in breast reconstruction

Volume changes in the reconstructed breast over two years after free abdominal tissue transfer: Comparison of unipedicled versus bipedicled flaps

BACKGROUND

Volume changes in reconstructed flaps, particularly regarding symmetry, are an important consideration to improve long-term esthetic results in patients who undergo breast reconstruction. Asian patients with thin abdominal tissues tend to require bipedicled flaps, which provide a greater volume of abdominal tissue. We investigated volume changes in free abdominal flaps and the factors that may affect flap volume, particularly the number of pedicles.

METHODS

The study included all consecutive patients who underwent immediate unilateral breast reconstruction using free abdominal flaps between January 2016 and December 2018. The initial flap volume was calculated intraoperatively, and the postoperative flap volume was calculated using computed tomography or magnetic resonance imaging based on the Cavalieri principle.

RESULTS

The study included 131 of 249 patients. Compared with the initial inset volume, the mean flap volumes at 1 and 2 years postoperatively decreased to 80.11% and 73.80%, respectively. The multivariable analysis of factors that affect flap volume showed a significant association with the flap inset ratio, radiation (P = .019,.040, respectively). Stratification based on the number of pedicles showed that the flap inset ratio was significantly negatively correlated with the postoperative flap volume change in unipedicled (P < .05) but not in bipedicled flaps.

CONCLUSIONS

The flap volume decreased over time, and its change had a negative correlation with the flap inset ratio in the unipedicled group. Therefore, prediction of postoperative volume changes in various clinical situations is important before breast reconstruction.

The triangular prism approximation method for volume estimation of deep inferior epigastric artery perforator flap in breast reconstruction

BACKGROUND

Many methods to predict the amount of tissue needed for breast reconstruction have been reported, but some require complicated software and special systems. The purpose of this report was to present a simpler method for predicting the volume required for deep inferior epigastric artery perforator (DIEP) flaps. The accuracy of this method was evaluated based on both actual flap design and computed tomography.

METHODS

The weight and horizontal (x cm) and vertical (y cm) lengths of the DIEP flap were recorded, and the maximum thickness of subcutaneous tissue (z cm) was measured from computed tomography in 36 cases of breast reconstruction using DIEP flap in our hospital performed between January 2019 and December 2020. Flap volume was calculated using three methods of approximation: triangular prisms using physical and CT measurements (1/2xyz cm³ ); quadrangular and triangular prisms using physical and CT measurements (3/4xyz cm³ ); and a previously reported method using measurements from CT angiography alone and calculation with a standard mathematical formula. These three groups were compared using Bland-Altman plots and intraclass correlation coefficients (ICCs) to assess consistency between predicted and measured values.

RESULTS

On Bland-Altman plots, values were distributed almost randomly around the average value of the difference, and no proportional error was evident in the methods. The ICC between predicted and actual values of triangular prisms using physical and CT measurements was largest: ICC (1, 2) = 0.978 (0.825-0.981; 95% confidence interval for ICC). A sufficient flap volume was able to be transplanted in all cases.

CONCLUSION

The methods presented appear useful to calculate flap volume closer to the measured value without complicated software systems. These results suggest that the method using two symmetric triangular prisms could predict volume more easily than previously reported methods and may facilitate good breast reconstruction.

Clinical use of perioperative magnetic resonance imaging-based breast volumetric analysis in final implant volume prediction for two-stage breast reconstruction

Purpose

Breast volume is an important factor in breast reconstruction; however, the surgeon is expected to deliver the volume expectation with his aesthetic inspiration. Therefore, objective volumetry must be developed. This study aimed to conduct an MRI-based breast volumetric analysis. With periodic analysis of 2-stage breast reconstruction, we suggest the possibility of clinical use of breast volumetry in implant volume prediction.

Methods

This retrospective study included 140 patients who underwent unilateral 2-stage breast reconstruction (tissue expander followed by implant insertion) between January 1, 2017 and December 31, 2019. The MRI image was converted into a 3-dimensional image with a reconstruction program (A-VIEW, Coreline Soft). MRI image was obtained before the surgery and then at 1, 3, 6, 12, and 24 months postoperatively. The volume was automatically calculated.

Results

Compared with the preoperative volume, maximized volume and differences were noted at 1 month and minimized at 1 year. The correlation between MRI-based preoperative breast volumetry and the mastectomy specimen volume was 0.611. Volume difference between the MRI-based preoperative state and the implant volume showed a minimal difference at 1 year. The final implant size prediction formula was calculated using the 1-year postoperative volume (P < 0.001, R² = 0.594).

Conclusion

To avoid breast reconstruction based solely on the surgeon’s subjective assessment, MRI-based breast volumetry could be a useful method to develop more scientific and objective breast reconstruction planning. We suggest a volume prediction formula that describes the relationship between the postoperative breast volume and the final breast implant size.

A New Automated AI-Assisted System to Assess Cervical Disc Herniation

STUDY DESIGN

An algorithm was developed with MATLAB platform to automatically quantify the volume of cervical disc herniation (CDH) based on the sagittal magnetic resonance images. This automated program was used for CDH data set, and then compared with manual measurement results confirming its reliability.

OBJECTIVE

The aim was to develop a new software for automated CDH volume measurement.

SUMMARY OF BACKGROUND DATA

CDH compresses the spinal cord, regarding as the leading cause of cervical myelopathy. However, the CDH volume, of great value to clinical symptoms, can be only manually measured with no-excellent but acceptable interobserver reliability. This was due to the manual error of outlining CDH area and inclusion of structure posterior vertebra. No studies has proposed such an automated algorithm of CDH volume quantification which is standardised to quantify the accurate volume of CDH thus helping doctors easily evaluate CDH progressing.

METHODS

The algorithm of CDH volume measurement was proposed. This program was then tested for 490 CDHs data set, from 185 patients with two repeated magnetic resonance imaging detections. Three individual observers manually measured the volumes of these CDHs, to justify the accuracy of this software. CDH volume was either in the classic way or the revised way excluding the influence of structure posterior vertebra.

RESULTS

The automated software was successfully developed on MATLAB platform, with no difference found with manual measurements (average level) in CDH volume measurement. The change ratios in CDH volumes were profoundly consistent with manual observation, showing the error of 5.8% in median. The revised method elevated the absolute value of ratio by amplifying the percentage change.

CONCLUSION

Our developed automated volumetry system was an standardized and accurate way, with selective removal module of structure posterior vertebra, replaceable for manual volume measurement of CDH, which was useful for spinal surgeons diagnosing and treating CDH disease.

Nonsubjective Assessment of Shape, Volume and Symmetry during Breast Augmentation with Handheld 3D Device

Three-dimensional Surface Imaging (3DSI) has become a valuable tool for planning and documenting surgical procedures. Although surface scanners have allowed for a better understanding of breast shape, size, and asymmetry during patient consultation, its use has not been included in intraoperative assessment so far. Validation of the reliability of the intraoperative use of a portable handheld 3DSI equipment as a tool to evaluate morphological changes during breast augmentation surgery. The patients who underwent bilateral subpectoral breast augmentation through an inframammary incision were included in this study. Intraoperative 3DSI was performed with the Artec Eva device, allowing for visualization of the surgical area before incision, after use of breast sizers and implant, and after wound closure. Intraoperatively manual measurements of breast distances and volume changes due to known sizer and implant volumes were in comparison with digital measurements calculated from 3DSI of the surgical area. Bilateral breasts of 40 patients were 3D photographed before incision and after suture successfully. A further 108 implant sizer uses were digitally documented. There was no significant difference between manual tape measurement and digital breast distance measurement. Pre- to postoperative 3D volume change showed no significant difference to the known sizer and implant volume.

Morphometric study of post menarcheal nulliparous breasts, their clinical relevance and relationship with body size indicators in a Nigerian population

Background

The female breast is a symbol of femininity and aesthetics having a great psychosocial impact on the woman's sense of wellbeing and self-esteem. To optimize satisfaction of patients in cosmetic and reconstructive breast surgeries, there is a need to define the dominant breast size and shape that connotes feminine attractiveness. This necessitates the knowledge of ideal data for normal nulliparous female breast parameters and volume for various body sizes in the particular population, nationality, and race.

Aim

To establish reference data for normal breast parameters and volumes for the various body sizes amongst the Nigerian population and to determine their relationships with other body parameters.

Patients and Methods

A total of 528 breasts from 264 Nigerian undergraduate post-menarcheal nulliparous students of the University of Nigeria Enugu Campus aged between 17 and 29 years were measured. Thirty-one (31) anthropomorphic parameters and five body size anthropometric indicators were measured. Data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 21(IBM) and were summarized using various descriptive statistics tools.

Results

The mean nipple-nipple distance is 23.37 ± 3.10. The mean left Midclavicle-nipple Length (22.17 ± 3.5 cm) is significantly (P = 0.04) higher than the right (21.79 ± 3.3 cm) just as the mean left (12.60 ± 2.5) medial radius is significantly (P = 0.0001) longer than the right (12.45 ± 2.4 cm). The mean left nipple projection (0.37 ±0.2 cm) and left vertical surface dimension (32.27 ± 5.7 cm) are significantly (P > 0.05) longer than the right (0.33 ±0.2) and (31.76 ± 5.2 cm). Also the mean volume for the left breast (605.26 ± 280.52 cm) is significantly (0.0001) higher than that of the right breast (592.53 ± 278.69). Breast volume correlated well with most of the breast parameters, BMI, and other anthropometric variables. Most breasts were ptotic (51%, 55%), especially the left breasts. Breast dimensions were asymmetrical in >50% of subjects, where the left breasts were seen to have slightly greater breast dimensions than right.

Conclusion

Breast values and related body size parameters were noted to be comparatively higher than earlier reported values mostly for the Asian population.

Mammography with a fully automated breast volumetric software as a novel method for estimating the preoperative breast volume prior to mastectomy

Purpose

Increasing interest in maintaining a positive body image following breast cancer surgery has become an important aspect of reconstruction surgery. Volume matching of the reconstructed breast to natural breasts is the most important consideration. This study aimed to explore the feasibility of using mammography with a fully automated breast volumetric software to measure the preoperative breast volume in patients with breast cancer.

Methods

We evaluated patients who underwent a total mastectomy between July 2016 and February 2021. The specimen volume following total mastectomy was compared with breast volume estimates using a fully automated volumetric software (Quantra ver. 2.1.1) and 4 other previously described mammography-based prediction methods. The association between the estimates and mastectomy specimen volume was assessed using Pearson correlation and Bland-Altman analysis.

Results

Sixty-six patients were included. Compared with previously described mammography-based methods, Quantra estimates were more strongly correlated with mastectomy specimen volume in the entire, fatty, and dense breast groups (r = 0.920, 0.921, and 0.915, respectively; P < 0.001). In applying Quantra estimates for measuring preoperative breast volume, we adjusted a simple equation: mastectomy specimen volume = Quantra estimate × 0.8.

Conclusion

Mammography with a fully automated breast volumetric software can be useful for measuring preoperative breast volume in patients with breast cancer who undergo reconstruction surgery.

Breast Biomechanics: What Do We Really Know?

Although half the world's population will develop breasts, there is limited research documenting breast structure or motion. Understanding breast structure and motion, however, is imperative for numerous applications, such as breast reconstruction, breast modeling to better diagnose and treat breast pathologies, and designing effective sports bras. To be impactful, future breast biomechanics research needs to fill gaps in our knowledge, particularly related to breast composition and density, and to improve methods to accurately measure the complexities of three-dimensional breast motion. These methods should then be used to investigate breast biomechanics while individuals, who represent the full spectrum of women in the population, participate in a broad range of activities of daily living and recreation.

Alternative flaps in autologous breast reconstruction

The gold standard for autologous reconstruction in the post-mastectomy patient remains the deep inferior epigastric artery perforator flap, although many women may not be candidates for abdominally based free tissue transfer. In this scenario, there are several other donor site options based from the thigh (transverse and diagonal upper gracilis flaps, profunda artery perforator flap, lateral thigh flap) and trunk (lumbar artery perforator flap, superior and inferior gluteal artery perforator flaps). This study will review the history, relevant anatomy, surgical technique and outcomes for alternative flaps in autologous reconstruction. Additionally, preoperative imaging (CTA, MRA) and novel applications (stacking flaps, neurotization) in breast reconstructive microsurgery will be discussed.

Breast and tumor volumes on 3D-MRI and their impact on the performance of a breast conservative surgery (BCS)

Breast conservation rate is being increasingly used nowadays as a marker of breast cancer care among hospitals. Searching for the ideal technique to predict the feasibility of BCS is ongoing. For this matter, the preoperative MRIs of 169 patients operated with radical or conservative surgery were reviewed. We estimated the tumor volume (TV) and breast volume (BV) on enhanced 3D-MRI and compared the tumor-to-breast volume ratio (TV/BV) in both groups. The mean ratio was 9.5% in the mastectomy group and 1.7% in the BCS group. A tumor-to-breast volume ratio less than 4% seemed to favor the adoption of a conservative option. Our data suggest that preoperative 3D-MRI can orient the surgical approach by assessing the TV/BV ratio, increasing lumpectomy rates with clear margins and good cosmetic outcome.

The current gold standard breast volumetry technique seems to overestimate fat graft volume retention in the breast: A validation study

BACKGROUND

MRI is generally considered as the gold standard for measuring breast volume because of its high accuracy of the modality. Many techniques used to measure total breast volume have been validated, but none of these techniques have been validated for their ability to measure the volume retention of fat grafts in the breast. In this study, the authors investigated the accuracy of the most common MRI technique used to measure fat graft retention in the breast by measuring the volume changes after breast augmentation.

METHODS

Patients undergoing breast augmentation with either breast implants or fat grafting underwent MRI scans before and after surgery. Blinded observers measured the change in breast volume from the MRI scans. The difference between the measured change in breast volume and the volume of the breast augmentation was used to determine the accuracy of the MRI technique.

RESULTS

Twenty-eight patients with a total of 56 breasts were included. In total, 168 measurements of change in breast volume were performed by the observers. The MRI measurements of change in breast volume overestimated the true volumes of the breast augmentations by an average of 50.8%, and only 8 of the 168 individual measurements had measurement errors below 50 mL.

CONCLUSION

The MRI technique, which is considered as the gold standard for the quantification of fat graft volume retention, was associated with a significant measurement error. These findings have potential implications for the interpretation of previously published results of studies based on this technique.

Breast cancer research and treatment reconstruction of unilateral breast structure using three-dimensional ultrasound imaging to assess breast neoplasm

Purpose

To develop and evaluate the accuracy of a three-dimensional (3D) US method for assessing unilateral breast reconstruction and discuss the feasibility of breast ultrasound 3D reconstruction of the unilateral breast compared with 3D MRI.

Methods

Sixty-four breast lesions were collected for surgical resection. (1) MRI and US imaging were used to reconstruct the 3D models of the breast neoplasm. The diameters for maximum length, width, and depth of the negative tumor margins were used as the primary standards for comparison. (2) The measurement direction was determined by the largest gravity change between the two body positions. (3) The vertical distance from the midpoint of breast neoplasm to the ipsilateral nipple was calculated via MRI and US reconstruction.

Results

(1) Comparison of the measured size and histopathology of the breast neoplasm showed that US, MRI, and histopathology were highly correlated (p < 0.001). (2) When compared with the other two vertical directions, the direction with the largest gravity change had the greatest difference between MRI and US measurements. (3) The vertical distance from the breast neoplasm to the ipsilateral nipple and skin junction was significantly different (p > 0.05).

Conclusions

We have presented a novel US 3D reconstruction method for evaluating tumor size, which can provide a basis for investigated advanced visualization techniques for assessing breast tissue such as holographic presentation of 3D image data. These methods can provide physicians with a novel approach for making accurate surgical plans, for better communication with patients, and for more effective navigating throughout the operation.

Chances and limitations of a low-cost mobile 3D scanner for breast imaging in comparison to an established 3D photogrammetric system

BACKGROUND

In search of new possibilities in 3D surface imaging, several nonmedical scanning systems have been assessed for their implementation in plastic surgery. The aim of this study was to compare a new affordable 3D imaging consumer product with an established medical 3D imaging system for objective 3D breast imaging.

METHOD

We compared a low-cost mobile, handheld scanner against an established medical 3D surface imaging system. Forty-two female patients who underwent different types of breast surgery were captured in a 3D view with both devices. Digital breast measurement, volume measurement, and breast surface-to-surface analysis were done using Mirror software. Repeatability was assessed by repeated 3D scans of the torso and surface-to-surface analysis.

RESULTS

Digital breast measurement showed low differences with good-to-excellent correlation between both devices. Mean breast volume difference was small (-5.11 ± 32.10 mL) within the 95% limits of agreement. Surface-to-surface analysis yielded a higher surface deviation in the lower breast quadrants (1.62 ± 0.80 mm root mean square [RMS] error and 1.81 ± 0.88 mm RMS error) than in the upper breast quadrants. Repeatability was satisfactory with a mean of 0.636 ± 0.279 mm RMS error.

CONCLUSION

Affordable mobile surface scanners may offer new perspectives in the future for 3D breast imaging. Although surface acquisition was sufficient for breast measurements in comparison to an established system, the lack of appropriate medical software for patient consultation next to moderate texture quality needs to be improved for wider acceptance in plastic surgery.

Volumetric Planning Using Computed Tomographic Angiography Improves Clinical Outcomes in DIEP Flap Breast Reconstruction

BACKGROUND

The present study evaluated outcomes of deep inferior epigastric perforator (DIEP) flap breast reconstruction using volumetric planning-which is preoperative planning based on volumetric data of the breast and flap estimated from computed tomographic angiography.

METHODS

A prospective review of three patient cohorts undergoing DIEP flap breast reconstruction from June of 2009 to February of 2015 was performed. Cohort 1 comprised 48 cases in which no volumetric planning was used. Cohort 2 included the next 101 consecutive cases undergoing breast reconstruction according to an algorithm based on volumetric planning. Cohort 3 consisted of the next 109 consecutive cases using a modified algorithm. The inset rate (weight ratio of the inset flap to harvested flap) was estimated during volumetric planning, and specific surgical strategies, such as incorporating multiple perforators, conducting venous augmentation (cohort 2), or harvesting bipedicled flaps (cohort 3), were used with reference to it. Rates of perfusion-related complications were compared.

RESULTS

All but one flap survived completely. Fat necrosis occurred in 9.7 percent. Overall, the perfusion-related complication rate was 22.9 percent of cohort 1, 10.9 percent in cohort 2, and 5.6 percent in cohort 3 (p = 0.006). The fat necrosis rates were 19.1, 9.9, and 5.6 percent in cohorts 1, 2, and 3, respectively (p = 0.032). A multivariate analysis demonstrated that volumetric planning had independent benefits for preventing perfusion-related complications (p = 0.003).

CONCLUSION

The authors' results suggest that volumetric planning can facilitate elaborate planning and reduce perfusion-related complications, enabling reliable breast reconstruction using DIEP flaps.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.

Three-Dimensional Surface Imaging is an Effective Tool for Measuring Breast Volume: A Validation Study

Background

Accurate breast volume assessment is a prerequisite to preoperative planning, as well as intraoperative decision making in breast reconstruction surgery. The use of three-dimensional surface imaging (3D scanning) to assess breast volume has many advantages. However, before employing 3D scanning in the field, the tool's validity should be demonstrated. The purpose of this study was to confirm the validity of 3D-scanning technology for evaluating breast volume.

Methods

We reviewed the charts of 25 patients who underwent breast reconstruction surgery immediately after total mastectomy. Breast volumes using the Axis Three 3D scanner, water-displacement technique, and magnetic resonance imaging (MRI) were obtained bilaterally in the preoperative period. During the operation, the tissue removed during total mastectomy was weighed and the specimen volume was calculated from the weight. Then, we compared the volume obtained from 3D scanning with those obtained using the water-displacement technique, MRI, and the calculated volume of the tissue removed.

Results

The intraclass correlation coefficient (ICC) of breast volumes obtained from 3D scanning, as compared to the volumes obtained using the water-displacement technique and specimen weight, demonstrated excellent reliability. The ICC of breast volumes obtained using 3D scanning, as compared to those obtained by MRI, demonstrated substantial reliability. Passing-Bablok regression showed agreement between 3D scanning and the water-displacement technique, and showed a linear association of 3D scanning with MRI and specimen volume, respectively.

Conclusions

When compared with the classical water-displacement technique and MRI-based volumetry, 3D scanning showed significant reliability and a linear association with the other two methods.

Avoiding a Systematic Error in Assessing Fat Graft Survival in the Breast with Repeated Magnetic Resonance Imaging

Several techniques for measuring breast volume (BV) are based on examining the breast on magnetic resonance imaging. However, when techniques designed to measure total BV are used to quantify BV changes, for example, after fat grafting, a systematic error is introduced because BV changes lead to contour alterations of the breast. The volume of the altered breast includes not only the injected volume but also tissue previously surrounding the breast. Therefore, the quantitative difference in BV before and after augmentation will differ from the injected volume. Here, we present a new technique to measure BV changes that compensates for this systematic error by defining the boundaries of the breast to immovable osseous pointers. This approach avoids the misinterpretation of tissue included within the expanded boundaries as graft tissue. This new method of analysis may be a reliable tool for assessing BV changes to determine fat graft retention and may be useful for evaluating and comparing available surgical techniques for breast augmentation and reconstruction using fat grafting.

The accuracy of breast volume measurement methods: A systematic review

Breast volume is a key metric in breast surgery and there are a number of different methods which measure it. However, a lack of knowledge regarding a method's accuracy and comparability has made it difficult to establish a clinical standard. We have performed a systematic review of the literature to examine the various techniques for measurement of breast volume and to assess their accuracy and usefulness in clinical practice. Each of the fifteen studies we identified had more than ten live participants and assessed volume measurement accuracy using a gold-standard based on the volume, or mass, of a mastectomy specimen. Many of the studies from this review report large (>200 ml) uncertainty in breast volume and many fail to assess measurement accuracy using appropriate statistical tools. Of the methods assessed, MRI scanning consistently demonstrated the highest accuracy with three studies reporting errors lower than 10% for small (250 ml), medium (500 ml) and large (1000 ml) breasts. However, as a high-cost, non-routine assessment other methods may be more appropriate.

Evaluation of the effects of silicone implants on the breast parenchyma

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.

The impact of breast mass on outcomes of total skin-sparing mastectomy and immediate tissue expander-based breast reconstruction

BACKGROUND

Larger breast size has been viewed as a relative contraindication for nipple/areola preservation with mastectomy. Few studies have directly evaluated the effect of quantified breast size on postoperative outcomes.

METHODS

The authors reviewed and assessed 325 total skin-sparing mastectomy cases performed in 224 patients with immediate tissue expander placement that had documented mastectomy specimen mass. Cases were divided into two groups based on having larger (>352 grams) or smaller (≤352 grams) breast mass.

RESULTS

Patients in the larger group had a mean body mass index that was 3.6 kg/m2 greater (p < 0.001). Overall, the larger group had an 8.1 percent increase in risk of superficial nipple necrosis (adjusted relative risk 4.0; 95 percent CI, 1.5 to 10.3). There were non-significant trends toward a 4.3 percent increase in risk of minor skin necrosis (adjusted relative risk 2.0; 95 percent CI, 0.7 to 6.4) and a 4.4 percent increase in risk of wound breakdown (adjusted relative risk 1.8; 95 percent CI, 0.8 to 3.7) with larger breast mass. Stratifying by radiation exposure, there was a non-significant trend toward a 5.4 percent increase in risk of wound breakdown (adjusted relative risk 2.9; 95 percent CI, 0.9 to 8.8) with larger breast mass in the stratum without radiation exposure.

CONCLUSIONS

Larger breast mass was associated with an increased risk of superficial nipple necrosis and trends toward increased risks of minor skin necrosis and wound breakdown. Larger breast mass was not associated with an increased risk of nipple or skin flap necrosis requiring operative management.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Risk, II.

3D volumetric analysis for planning breast reconstructive surgery

Breast reconstruction plays an integral role in the holistic management of breast cancer, with assessment of breast volume, shape, and projection vital in planning breast reconstruction surgery. Current practice includes two-dimensional (2D) photography and visual estimation in selecting ideal volume and shape of breast implants or soft-tissue flaps. Other objective quantitative means of calculating breast volume have been reported, such as direct anthropomorphic measurements or three-dimensional (3D) photography, but none have proven reliably accurate. We describe a novel approach to volumetric analysis of the breast, through the creation of a haptic, tactile model, or 3D print of scan data. This approach comprises use of a single computed tomography (CT) or magnetic resonance imaging (MRI) scan for volumetric analysis, which we use to compare to simpler estimation techniques, create software-generated 3D reconstructions, calculate, and visualize volume differences, and produce biomodels of the breasts using a 3D printer for tactile appreciation of volume differential. Using the technique described, parenchymal volume was assessed and calculated using CT data. A case report was utilized in a pictorial account of the technique, in which a volume difference of 116 cm(3) was calculated, aiding reconstructive planning. Preoperative planning, including volumetric analysis can be used as a tool to aid esthetic outcomes and attempt to reduce operative times in post-mastectomy breast reconstruction surgery. The combination of accurate volume calculations and the production of 3D-printed haptic models for tactile feedback and operative guidance are evolving techniques in volumetric analysis and preoperative planning in breast reconstruction.