Plastic Surgery Research Council
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PSRC 60th Annual Meeting

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Evaluation of 3D Photographic Imaging as a Method to Measure Differential Volumes in Reconstructed Breast Tissue
Priya G. Lewis, BA, Gennaya L. Mattison, BS, Hahns Y. Kim, MD, Subhas C. Gupta, MD, CM, PhD, FRCSC, FACS.
Loma Linda University, Loma Linda, CA, USA.

PURPOSE: Incremental tissue expansion is commonly used for mastectomy patients in the delayed breast reconstruction process. After mastectomy, an inflatable tissue expander is placed in the subpectoral pocket and filled with saline periodically; fixed volumes, determined qualitatively by the surgeon, are added over the course of weeks until an adequate pocket is available to accommodate a permanent implant. This method relies on the physician's subjective opinions of aesthetic targets and 2D measurements. 3D photographic technology has the potential to quantitatively improve the process by measuring patients' natural breast volume thereby setting a target for fill volumes during reconstruction. METHODS: We compared the known tissue expander fill volumes with measured breast volumes using the 3dMD® imaging system in 17 breasts. Patients were imaged before and after saline expansion at outpatient clinic appointments. Data collection for each patient was complete after permanent implant placement. The differential volumes were then measured and compared. Volume measurements were calculated with the 3dMD® software by one analyst using the same physical landmarks for each patient to standardize the process. A linear regression analysis was conducted of the measured to known volume. Also, known fill volumes were compared to the measured/filled ratio.
RESULTS: A total of 17 reconstructed breasts from 10 patients were analyzed. The ratio of measured volume to known fill volume was found to have a mean of 1.265 with a standard deviation of 1.429 and SEM of 0.215 (p=5.07E-14) and a 95% CI of 0.843 - 1.688. The measured/fill ratio was closer to 1:1 at higher fill volumes; the fill volume correlating to exactly 1 was 91.72cc. The difference between known and measured volumes was found to have a mean of 38.336 with a standard deviation of 43.605 and SEM of 6.574 (p=0.012) and a 95% CI of 25.451 - 51.220.
CONCLUSION: 3D imaging for quantitative breast volumetry has a great deal of potential for use in reconstructive procedures. In this preliminary study, there appears to be a quantifiable relationship between the volume added and the volume achieved when measured using 3D imaging. Further data collection may elucidate a stronger relationship. 3D imaging as a clinical tool has the potential to be a powerful adjunct in the astute clinician's decision-making process for breast reconstruction.

Figure 1: Example of 3D photo extrapolated by 3dMD®
software (texturized).

Table 1: Linear regression of measured to fill volumes.

Table 2: Difference between measured and fill volumes showing the general trend of consistently elevated measured volumes by the 3dMD® software.

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