Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road, Haidian District, Beijing, 100191, People's Republic of China.
Department of General Surgery, Peking University Third Hospital, Beijing, China.
Aesthetic Plast Surg. 2020 Feb;44(1):60-69. doi: 10.1007/s00266-019-01513-3. Epub 2019 Oct 9.
In China, traditional preoperative planning of unilateral breast reconstruction mainly depends on anthropometric measurement and visual assessment. Thus, the lack of objective assessment of breast volume and shape would likely result in suboptimal reconstruction outcomes. Three-dimensional surface imaging (3D-SI), which could provide objective measurement data of the breast, may be a promising solution to this problem.
A retrospective review of patients undergoing tissue expander (TE)/implant breast reconstruction without any mammoplasty surgery on the contralateral sides in our hospital from August 2013 to May 2018 was performed. All the patients underwent unilateral mastectomy with immediate or delayed insertion of TE, followed by an exchange of a silicone gel implant without contralateral procedures. 3D images were obtained at the time of preoperation, the routine expansion visit, and post-exchange of implant. The breast volume measured by 3D-SI served as a guide to conduct the surgery management, such as in deciding the total volume of expansion and guiding the final implant size selection. 3D-SI also provided objective data to evaluate the final outcomes of the reconstruction.
Fifty-one patients were included in this study, in which eighteen patients underwent immediate TE insertion and thirty-three patients underwent delayed TE insertion. The ptosis degree of contralateral breasts was assessed as follows: forty-four were normal, and seven showed mild ptosis. The average expansion degree was controlled at 161.6% ± 14.1% compared to the contralateral breasts. The volume of implants exchanged had a strong linear correlation with the 3D volume of the contralateral breasts at the end of expansion (P < 0.01). The mean time of follow-up was 9.1 ± 6.6 months. There was only one patient who experienced TE leakage with secondary infection and received TE exchange. For the immediate reconstruction group, the overall breast symmetry improved at the completion of implant exchange (P < 0.01), with an average asymmetry of 5.3% ± 4.0% compared with 10.6% ± 6.1% initially. For the delayed reconstruction group, the reconstructed side achieved good volume symmetry to the contralateral side (P > 0.05). There was no significant difference in breast basal width between bilateral breasts post-reconstruction (P > 0.05).
3D-SI serves as a valuable adjunct by providing accurate 3D volume of breasts within TE/implant breast reconstruction in Chinese patients without obvious breast ptosis, which could facilitate surgeons to achieve good reconstructive outcomes.
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在中国，单侧乳房重建的传统术前规划主要依赖于人体测量和视觉评估。因此，缺乏对乳房体积和形状的客观评估可能会导致重建效果不佳。三维表面成像（3D-SI）可以提供乳房的客观测量数据，可能是解决这个问题的一种有前途的方法。
对 2013 年 8 月至 2018 年 5 月期间在我院接受组织扩张器（TE）/植入物乳房重建且对侧乳房无任何乳房成形术的患者进行回顾性分析。所有患者均行单侧乳房切除术，即刻或延迟置入 TE，随后行硅胶凝胶植入物置换，对侧乳房不手术。在术前、常规扩张期和植入物置换后均行 3D 图像采集。3D-SI 测量的乳房体积可用于指导手术管理，如决定总扩张量和指导最终植入物大小选择。3D-SI 还提供了客观数据来评估重建的最终结果。
本研究共纳入 51 例患者，其中 18 例即刻行 TE 置入，33 例延迟行 TE 置入。对侧乳房下垂程度评估如下：44 例为正常，7 例为轻度下垂。与对侧乳房相比，扩张后的平均扩张度控制在 161.6%±14.1%。扩张结束时，植入物的交换体积与 3D 体积之间具有很强的线性相关性（P<0.01）。平均随访时间为 9.1±6.6 个月。仅 1 例患者发生 TE 渗漏伴继发感染，行 TE 置换。对于即刻重建组，在植入物置换完成时整体乳房对称性得到改善（P<0.01），与初始时的 10.6%±6.1%相比，平均不对称性为 5.3%±4.0%。对于延迟重建组，重建侧与对侧乳房达到良好的体积对称性（P>0.05）。重建后双侧乳房的乳房基底宽度无显著差异（P>0.05）。
3D-SI 作为一种有价值的辅助手段，可提供中国无明显乳房下垂的 TE/植入物乳房重建患者的准确 3D 乳房体积，有助于外科医生获得良好的重建效果。
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