A Novel Approach For Quantifying Skin Growth In Patients Undergoing Expander-based Breast Reconstruction
Sofia Aronson, MD1,2, Sarah A. Applebaum, MD1, Joanna K. Ledwon, PhD1,2, Tianhong Han, BS3, Adrian Buganza Tepole, PhD3, Arun K. Gosain, MD1,2.
1Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA, 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA, 3Purdue University, West Lafayette, IN, USA.
PURPOSE: Tissue expansion protocols for breast reconstruction are highly variable among surgeons and institutions. Animal studies in a porcine model of tissue expansion have relied on skin tattooing to standardize and predict expansion-induced skin growth, as estimated by the amount of total in-vivo deformation calculated by multi-view stereo and isogeometric analysis (IGA). However, an investigation of expansion-induced skin growth has not been performed in humans, and studies are limited by absence of a standardized methodology. Here, we will utilize our knowledge of IGA in the porcine model to develop a standardized approach for tracking skin growth in human patients undergoing expander-based breast reconstruction without the use of invasive tattoo-based methodology.
METHODS: Female Yucatan minipigs underwent tattooing of 10-by-10 cm grids and placement of subcutaneous tissue expanders below the grids. Female human patients were marked at several fixed bony anatomic landmarks that remain unchanged throughout reconstruction, including the clavicle, sternal notch, xyphoid, and midline connecting the notch and xyphoid. Four additional marks were made between the nipple and base of the breast in each quadrant to further orient the 3D camera (VECTRA®H2 from Canfield Scientific, Parsippany, NJ, USA) to the breast topography. All markings were made with patients lying flat to avoid variation due to skin draping. In both models, 3D images were generated based on the fixed markings and compared across a consistent coordinate system to allow for direct calculation of skin growth from pre- to post-expansion.
RESULTS: Expanded swine skin demonstrates spatial differences of skin growth within each grid, with highest growth experienced at the point of maximal stretch (Fig. 1). Similarly, total deformation in female patients is determined by superimposing pre- and post-operative 3D photographs standardized to markings of fixed landmarks (Fig. 2).
CONCLUSION: We demonstrate clinical translation of our prior work and proof of concept of a new approach to study human skin growth in response to tissue expansion. Further patient enrollment is needed to validate this framework in clinical settings; however, our novel breast model has the potential to optimize reconstructive efforts with respect to expansion variables such as fill volumes and frequency of expansion. This new standardized methodology for the study of breast tissue expansion can be modified and applied to other areas where tissue expansion reconstruction is used and understand variable responses of human skin to different expansion protocols, as well as the mechanics of skin in different anatomic sites subjected to expansion.
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