Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2019 Sep;82(9):732-739. doi: 10.1097/JCMA.0000000000000155.
Accurate assessment of breast volume is an essential component of preoperative planning in one-stage immediate breast reconstruction (IBR) for achieving breast symmetry and a satisfactory cosmetic outcome. In this study, we compared breast volume estimation using three-dimensional (3D) surface imaging with magnetic resonance imaging (MRI) to determine the accuracy of breast volume measurements. Further, a 3D printing mold for facilitating autologous breast reconstruction intraoperatively is described.
Patients scheduled to therapeutic or prophylactic mastectomy with one-stage IBR, either by autologous tissue transfer or direct implant, from 2016 to 2019, were enrolled in this study. 3D surface image and MRI were performed to evaluate breast volume and shape. The results were validated by the water displacement volume of the mastectomy specimen. Finally, a 3D printing mold was designed for breast reconstruction with autologous tissue.
Nineteen women who were scheduled to have 20 mastectomies (18 unilateral and one bilateral) were included. There was a strong linear association between breast volume measured using the two different methods and water displacement of mastectomy specimens when a Pearson correlation was used (3D surface image: r = 0.925, p < 0.001; MRI: r = 0.915, p < 0.001). Bland-Altman plots demonstrated no proportional bias between the assessment methods. The coefficient of variation was 52.7% for 3D surface imaging and 59.9% for MRI. The volume of six breasts was evaluated by both measurements and the intraclass correlation coefficient was 0.689 for 3D surface image (p = 0.043) and 0.743 for MRI (p = 0.028).
Using 3D surface image to evaluate breast shape and volume is a quick, effective, and convenient method. The accuracy, reproducibility, and reliability of 3D surface imaging were comparable with MRI in our study. In addition, 3D-printed molds can achieve better symmetry and aesthetic outcomes in immediate autologous breast reconstructions.
准确评估乳房体积是一期即刻乳房重建（IBR）术前规划的重要组成部分，对于实现乳房对称性和满意的美容效果至关重要。本研究比较了三维（3D）表面成像与磁共振成像（MRI）在评估乳房体积中的准确性，并描述了一种用于术中辅助自体乳房重建的 3D 打印模具。
本研究纳入了 2016 年至 2019 年间因治疗性或预防性乳房切除术而行一期 IBR 的患者，包括自体组织转移或直接植入。通过 3D 表面成像和 MRI 评估乳房体积和形状。通过测量乳房切除术标本的排水量来验证结果。最后，设计了一种用于自体组织乳房重建的 3D 打印模具。
本研究共纳入了 19 名女性的 20 例乳房切除术（18 例单侧，1 例双侧）。当使用 Pearson 相关系数时，两种不同方法测量的乳房体积与乳房切除术标本排水量之间存在很强的线性相关性（3D 表面成像：r=0.925，p<0.001；MRI：r=0.915，p<0.001）。Bland-Altman 图显示两种评估方法之间没有比例偏差。3D 表面成像的变异系数为 52.7%，MRI 的变异系数为 59.9%。对 6 例乳房进行了两种方法的测量，3D 表面成像的组内相关系数为 0.689（p=0.043），MRI 的组内相关系数为 0.743（p=0.028）。
使用 3D 表面成像评估乳房形状和体积是一种快速、有效、方便的方法。在本研究中，3D 表面成像的准确性、可重复性和可靠性与 MRI 相当。此外，3D 打印模具可在即刻自体乳房重建中实现更好的对称性和美学效果。
