Contralateral breast volume measurement during chest CT for postmastectomy breast reconstruction

A study on the correlation between MRI-assessed breast volume asymmetry and patient satisfaction after immediate breast reconstruction in breast cancer patients

Immediate breast reconstruction provides breast cancer patients with a valuable opportunity to restore breast shape. However, post-reconstruction breast asymmetry remains a common issue that affects patient satisfaction. This study aims to quantify breast asymmetry after surgery using magnetic resonance imaging (MRI) and assess its impact on both breast satisfaction and overall outcome satisfaction, offering scientific evidence to guide improvements in preoperative evaluation. We retrospectively collected MRI images and demographic characteristics from 98 patients who underwent unilateral immediate breast reconstruction. All patients underwent breast MRI scans post-reconstruction, and the MRI images were converted into 3D models using 3D Slicer software. The implant volumes were measured and compared with the actual implant volumes inserted during surgery to assess the accuracy of the MRI measurements. Breast symmetry after surgery was quantified using MRI-measured breast volumes, and patient satisfaction was analyzed through BREAST-Q questionnaires to explore the relationship between breast symmetry, post-reconstruction breast satisfaction, and overall outcome satisfaction. The implant volumes measured in the 3D reconstructed MRI images exhibited high concordance with the volumes recorded during surgery (r = 0.980, p < 0.001). Breast asymmetry values were significantly higher in the high BMI group compared to the low BMI group (P = 0.013), while the asymmetry ratio was significantly lower in the high weight group compared to the low weight group (P = 0.006). The asymmetry ratio showed a weak correlation with breast satisfaction (r = - 0.341, P = 0.002) and outcome satisfaction (r = - 0.371, P = 0.004). When grouped by low asymmetry (asymmetry > 10%), there was no significant difference in breast satisfaction (P = 0.054) or outcome satisfaction scores (P = 0.23) between the groups. However, in cases of high asymmetry (asymmetry ratio > 40%), breast satisfaction (P = 0.003) and outcome satisfaction scores (P = 0.005) were significantly lower in the asymmetry group compared to the symmetry group. Breast volume asymmetry after immediate breast reconstruction is associated with patient satisfaction, with a significant decrease in satisfaction when asymmetry exceeds 40%. This suggests that preoperative evaluation should focus on breast symmetry to improve post-reconstruction patient satisfaction and surgical outcomes.

Quantitative assessment of breast volume changes after whole-breast irradiation for breast cancer using breast auto-segmentation

PURPOSE

This study aimed to quantitatively estimate the changes in breast volume associated with radiotherapy in patients undergoing breast-conserving surgery and whole-breast irradiation (WBI).

METHODS

Pre-WBI simulation computed tomography (CT) scans and post-WBI follow-up chest CT scans from a total of 1,151 breast cancer patients were analyzed using a deep-learning-driven auto-segmentation approach. The CT-based asymmetry index (CTAI) was calculated by dividing the volume of the irradiated breast by the volume of the contralateral breast. Significant breast shrinkage was defined as a CTAI < 0.85. To quantify changes in CTAI over the follow-up period, the CTAI ratio was determined as the post-WBI CTAI divided by the pre-WBI CTAI. A multivariate logistic regression analysis was conducted to identify potential variables associated with post-WBI significant breast shrinkage.

RESULTS

The median CTAI values for pre- and post-WBI CT scans were 0.973 (interquartile range: 0.887-1.069) and 0.866 (interquartile range: 0.773-0.967), respectively. The difference between them was statistically significant (p < 0.001). Following WBI, there was an increase in the rate of significant breast shrinkage from 16.3 to 44.8%. The CTAI ratio showed a negative association with the time interval (p < 0.001, Pearson r = - 0.310). In the multivariate logistic regression analysis, lower pre-WBI CTAI, younger age, and longer interval between CT scans were found to be significantly associated with a higher occurrence of post-WBI significant breast shrinkage.

CONCLUSION

Breast volume decreases following WBI, and this decrease is correlated with an increased duration after WBI. These findings highlight the long-term consequences of WBI on breast asymmetry.

Breast Anthropometry-Results of a Prospective Study Among Indian Breast Cancer Patients

Breast anthropometry plays an important role in surgical decision-making in the era of breast conservation therapy, oncoplasty and reconstruction. Majority of the currently available breast anthropometry data is from Western countries, and there is a need to evaluate anthropometric data among Indian women to tailor our surgical decision-making and achieve optimum surgical results. Two hundred and thirty-one breast cancer patients were included in this prospective study, and different anthropometric parameters were evaluated to assess and describe the nipple-areola complex, breast shape, size, volume and ptosis. Breast volume was calculated using formula developed by Qiao et al. Outcomes were compared with data available from different countries. Mean breast volume among Indian women was 515 ml. Nearly, 81% of patients had ptosis and up to 40% had grade 3 ptosis. Breast volume among Indian patients can be grouped into three categories based on quartiles (category I-≤ 220 ml, category II-> 220 to ≤ 730 ml, category III-> 730 ml). Overall breast anthropometry data among Indian women was different from the data reported from western studies. Breast anthropometry plays an important role in the surgical decision-making, and results of the study indicate that the anthropometry of Indian women is different from western counterparts.

Breast reconstruction with breast implants

BACKGROUND

Breast cancer is the most common noncutaneous malignancy among women worldwide. After a breast cancer removal procedure, women are asked to decide about breast reconstruction, mainly to improve their life quality, and they can choose from among many options. Broadly, there are two different types of breast reconstruction procedures: prosthetic implant-based reconstruction and autologous tissue-based reconstruction.

METHODS

Implant-breast reconstruction is a minimally invasive procedure compared with autologous breast reconstruction. It is associated with fewer short- and long-term complications.

RESULTS

The ideal candidates for implant-based reconstruction are patients with non-redundant soft tissue coverage, who desire a moderate sized non-ptotic breast and have not been previously irradiated.

CONCLUSION

The state of the art for implant-breast reconstruction is briefly described in this article.