Breast volume estimation from systematic series of CT scans using the Cavalieri principle and 3D reconstruction

A Machine Learning-Based Model for Breast Volume Prediction Using Preoperative Anthropometric Measurements

BACKGROUND

Accurate assessment of breast volume is helpful in preoperative planning and intraoperative judgment in both cosmetic and reconstructive breast surgery. In this prospective study, a formula was derived using machine learning algorithm (Gradient Boosted Model).

METHOD

A prospective study was performed on 39 female-to-male transgender patients. Bilateral mastectomy was done for all patients. Preoperative anthropometric measurements were performed on 78 breasts of these patients. Weight of breasts was calculated postoperatively with digital scale (weight), and then volume of breasts was calculated with the calibrated container (water displacement technique). Authors built a model based on Python CatBoostClassifier. Finally, an android application was built for ease of real-time utilization.

RESULTS

Eight anthropometric measurements were collected preoperatively as independent variables. Breast vertical perimeter at lower half, upper pole, sternal notch to nipple and nipple to IMF had most correlation with volume and weight. Based on machine learning model, the following formula established: Breast volume = (breast width) × 24.69 + (nipple to IMF) × 49.03 - (sternal notch to nipple) × 1.34 + (anterior axillary line to medial border) × 6.57 - (upper pole) × 1.27 - (chest perimeter IMF) × 5.63 + (chest perimeter nipple) × 10.40 + (breast vertical perimeter at lower half) × 9.20 - 1133.74. The R2 of the model is 0.93, and RMSE is 62.4.

CONCLUSION

Our formula is an accurate method for preoperative breast volume assessment. We built an android App (Breast Volume Predictor) for the real-time utilization of resulting formula. It is available at Google Play Store for free download.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Volume changes in the reconstructed breast over two years after free abdominal tissue transfer: Comparison of unipedicled versus bipedicled flaps

BACKGROUND

Volume changes in reconstructed flaps, particularly regarding symmetry, are an important consideration to improve long-term esthetic results in patients who undergo breast reconstruction. Asian patients with thin abdominal tissues tend to require bipedicled flaps, which provide a greater volume of abdominal tissue. We investigated volume changes in free abdominal flaps and the factors that may affect flap volume, particularly the number of pedicles.

METHODS

The study included all consecutive patients who underwent immediate unilateral breast reconstruction using free abdominal flaps between January 2016 and December 2018. The initial flap volume was calculated intraoperatively, and the postoperative flap volume was calculated using computed tomography or magnetic resonance imaging based on the Cavalieri principle.

RESULTS

The study included 131 of 249 patients. Compared with the initial inset volume, the mean flap volumes at 1 and 2 years postoperatively decreased to 80.11% and 73.80%, respectively. The multivariable analysis of factors that affect flap volume showed a significant association with the flap inset ratio, radiation (P = .019,.040, respectively). Stratification based on the number of pedicles showed that the flap inset ratio was significantly negatively correlated with the postoperative flap volume change in unipedicled (P < .05) but not in bipedicled flaps.

CONCLUSIONS

The flap volume decreased over time, and its change had a negative correlation with the flap inset ratio in the unipedicled group. Therefore, prediction of postoperative volume changes in various clinical situations is important before breast reconstruction.

Applications of various stereological tools for estimation of biological tissues

To provide concise and brief important stereological application methods and techniques for estimating biological tissues. Stereology studies the quantity of biological tissue using little practice and the low price of counting and preparing tissue slices to obtain direct and accurate results. Since their establishment, the stereological techniques underwent much improvement, thus allowing more precise analysis of target structures using various approaches. Using stereological tools, advances in stereological techniques made the target tissues or organs represented by 2D instead of 3D dimensions. Process tools estimate volume, area and length. According to the exciting tissue and aims, the stereological tools perform differently. This review summarizes various stereological tools and techniques, providing brief information about the orientation method, slicer probe method, Delesse's principle, Cavalieri principle, disector, fractionator, nucleator, virtual cycloids and saucer, which are described in detail.

Reduction of neuroinflammation alleviated mouse post bone fracture and stroke memory dysfunction

Tibia fracture (BF) enhances stroke injury and post-stroke memory dysfunction in mouse. Reduction of neuroinflammation by activation of α-7 nicotinic acetylcholine receptor (α-7 nAchR) reduced acute neuronal injury and sensorimotor dysfunction in mice with BF 1-day after stroke. We hypothesize that reduction of neuroinflammation by activation of α-7 nAchR improves long-term memory function of mice with BF 6-h before stroke. The mice were randomly assigned to saline, PHA-568487 (α-7 nAchR agonist) and methyllycaconitine (antagonist) treatment groups. The sensorimotor function was tested by adhesive removal and corner tests at 3 days, the memory function was tested by Y-maze test weekly for 8 weeks and novel objective recognition test at 8 weeks post-injuries. We found PHA-568487 treatment reduced, methyllycaconitine increased the number of CD68⁺ cells in the peri-infarct and hippocampal regions, neuronal injury in the infarct region, sensorimotor and long-term memory dysfunctions. PHA-568487 treatment also reduced, while methyllycaconitine treatment increased atrophy of hippocampal granule cell layer and white matter damage in the striatum. In addition, PHA-568487 treatment increased neuron proliferation in granule cell layer. Our data indicated that reduction of neuroinflammation through activation of α-7 nAchR decreased neuronal damage, sensorimotor and long-term memory dysfunction of mice with BF shortly before stroke.

Correlation analysis of resected breast tissue and implant volume after mastectomy and its association with breast density

BACKGROUND

The current methods for calculating the ideal implant volume for breast reconstruction are based on pre- or intraoperative volume measurements of the existing breast volume and do not take into account the individual breast density of the woman. This study aims is to identify objective parameters that can help to improve the optimal implant selection.

MATERIALS AND METHODS

This retrospective analysis includes 198 breast cancer patients who underwent mastectomy. Breast densities (ACR) measured in mammography and MRI were compared with the removed breast tissue weight and volume of the implants used. In addition, the resected weight was compared directly with the implant volume to calculate a mathematical function.

RESULTS

There was no significant correlation between the ACR values and the resected weights [correlation coefficient: mammography:- 0.117 (p = 0.176), MRI - 0.033 (p = 0.756)]. A negative correlation between the implant volumes and both imaging methods could be demonstrated [correlation coefficient: mammography - 0.268; p = 0.002; MRI was - 0.200 (p = 0.055)]. A highly significant correlation between the resected weights and the implant volumes (correlation coefficient 0.744; p < 0.001) was observed. This correlation corresponds to a power function (y = 34.71 x^0.39), in which any resected weight can be used for the variable x to calculate the implant volume.

CONCLUSION

We were able to show that there is a significant correlation between the resected breast tissue and the implant volume. With our novel potency function, the appropriate implant volume can be calculated for any resected weight making it easier for the surgeon to choose a fitting implant in a simple and more objective manner.

A multicentre study of the relationship between abdominal flap and mastectomy weights in immediate unilateral free flap breast reconstruction and the effect of adjuvant radiotherapy

Abdominal free flaps are considered the gold standard for post-mastectomy autologous breast reconstruction. A key element of outcome assessment is breast symmetry often achieved by approximating the reconstructed breast dimensions such as weight (wt) to those of the mastectomy. However, the ideal relationship between these two entities remains unclear. 525 immediate unilateral abdominal free flap breast reconstruction (FFBR) patients were enrolled in a multicentre study (UK 141; Italy 384) and subdivided into Group A (flap wt < mastectomy wt, n = 163), Group B (flap wt > mastectomy wt, n = 260) and Group C (flap wt = mastectomy wt, n = 102). Their rates of contralateral balancing and ipsilateral revision surgeries were compared using Chi-Square tests. Radiotherapy influence on these adjustment procedures was also assessed. More contralateral balancing procedures (17%) were performed than ipsilateral revisions (10%). Group A rates of contralateral balancing procedures were three times higher than Group B's with a ratio of 37 to 1 versus Group C (37% vs 11% vs 1% respectively, p < 0.001). Similarly, the ipsilateral breast revision surgery rate in Group A was double that of Group B and almost three times that of Group C (17% vs 8% vs 6% respectively, p = 0.01). Adjuvant radiotherapy disproportionately increased ipsilateral revisions versus contralateral balancing surgeries (p = 0.028). A flap-to-mastectomy weight ratio of less than 1 (Group A) significantly increases subsequent adjustments on both contralateral and reconstructed breasts whilst irradiation predisposes to ipsilateral revisions. This is important in patient counselling and intraoperative flap contouring. Flap weight should ideally approximate or exceed mastectomy weight in unilateral FFBR.

3D Breast Volume Estimation

INTRODUCTION

Breast volume estimation is considered crucial for breast cancer surgery planning. A single, easy, and reproducible method to estimate breast volume is not available. This study aims to evaluate, in patients proposed for mastectomy, the accuracy of the calculation of breast volume from a low-cost 3D surface scan (Microsoft Kinect) compared to the breast MRI and water displacement technique.

MATERIAL AND METHODS

Patients with a Tis/T1-T3 breast cancer proposed for mastectomy between July 2015 and March 2017 were assessed for inclusion in the study. Breast volume calculations were performed using a 3D surface scan and the breast MRI and water displacement technique. Agreement between volumes obtained with both methods was assessed with the Spearman and Pearson correlation coefficients.

RESULTS

Eighteen patients with invasive breast cancer were included in the study and submitted to mastectomy. The level of agreement of the 3D breast volume compared to surgical specimens and breast MRI volumes was evaluated. For mastectomy specimen volume, an average (standard deviation) of 0.823 (0.027) and 0.875 (0.026) was obtained for the Pearson and Spearman correlations, respectively. With respect to MRI annotation, we obtained 0.828 (0.038) and 0.715 (0.018).

DISCUSSION

Although values obtained by both methodologies still differ, the strong linear correlation coefficient suggests that 3D breast volume measurement using a low-cost surface scan device is feasible and can approximate both the MRI breast volume and mastectomy specimen with sufficient accuracy.

CONCLUSION

3D breast volume measurement using a depth-sensor low-cost surface scan device is feasible and can parallel MRI breast and mastectomy specimen volumes with enough accuracy. Differences between methods need further development to reach clinical applicability. A possible approach could be the fusion of breast MRI and the 3D surface scan to harmonize anatomic limits and improve volume delimitation.

Relationship between formulaic breast volume and risk of breast cancer based on linear measurements

BACKGROUND

Whether breast volume is a risk factor for breast cancer is controversial. This study aimed to evaluate whether a significant association between breast volume and risk of breast cancer, based on linear measurements, was present by applying propensity score matching (PSM).

METHODS

The study was designed as a hospital-based case-control study. Between March 2018 and May 2019, 208 cases and 340 controls were retrospectively reviewed. Information on menarche, smoking, feeding mode, oral contraceptives, reproductive history and family history was obtained through a structured questionnaire. Breast volume was calculated using a formula based on linear measurements of breast parameters. Cox regression and PSM were used to estimate odds ratios and 95% confidence intervals for breast cancer using risk factors adjusted for potential confounders.

RESULTS

There was a significant difference in breast volume between the two groups before propensity score matching (P = 0.014). Binary logistic regression showed that the risk of breast cancer was slightly higher in the case group with larger breast volumes than in the control group(P = 0.009, OR = 1.002, 95%CI:1.000 ~ 1.003). However, there was no significant statistical difference between the two groups using an independent sample Mann-Whitney U test (P = 0.438) or conditional logistic regression (P = 0.446).

CONCLUSIONS

After PSM for potential confounding factors, there is no significant difference in breast volume estimated by BREAST-V formula between the case group and the control group. The risk of breast cancer may not be related to breast volume in Chinese women.

Prediction of the Ideal Implant Size Using 3-Dimensional Healthy Breast Volume in Unilateral Direct-to-Implant Breast Reconstruction

Background and objectives: There is no consensus regarding accurate methods for assessing the size of the implant required for achieving symmetry in direct-to-implant (DTI) breast reconstruction. The purpose of this study was to determine whether the ideal implant size could be estimated using 3D breast volume or mastectomy specimen weight, and to compare prediction performances between the two variables. Materials and Methods: Patients who underwent immediate DTI breast reconstruction from August 2017 to April 2020 were included in this study. Breast volumes were measured using 3D surface imaging preoperatively and at postoperative three months. Ideal implant size was calculated by correcting the used implant volume by the observed postoperative asymmetry in 3D surface imaging. Prediction models using mastectomy weight or 3D volume were made to predict the ideal implant volume. The prediction performance was compared between the models. Results: A total of 56 patients were included in the analysis. In correlation analysis, the volume of the implant used was significantly correlated with the mastectomy specimen weight (R2 = 0.810) and the healthy breast volume (R2 = 0.880). The mean ideal implant volume was 278 ± 123 cc. The prediction model was developed using the healthy breast volume: Implant volume (cc) = healthy breast volume × 0.78 + 26 cc (R2 = 0.900). The prediction model for the ideal implant size using the 3D volume showed better prediction performance than that of using the mastectomy specimen weight (R2 = 0.900 vs 0.759, p < 0.001). Conclusions: The 3D volume of the healthy breast is a more reliable predictor than mastectomy specimen weight to estimate the ideal implant size. The estimation formula obtained in this study may assist in the selection of the ideal implant size in unilateral DTI breast reconstruction.

Organ-based tube current modulation in chest CT. A comparison of three vendors

INTRODUCTION

Organ-based tube current modulation (OBTCM) is designed for anterior dose reduction in Computed Tomography (CT). The purpose was to assess dose reduction capability in chest CT using three organ dose modulation systems at different kVp settings. Furthermore, noise, diagnostic image quality and tumour detection was assessed.

METHODS

A Lungman phantom was scanned with and without OBTCM at 80-135/140 kVp using three CT scanners; Canon Aquillion Prime, GE Revolution CT and Siemens Somatom Flash. Thermo-luminescent dosimeters were attached to the phantom surface and all scans were repeated five times. Image noise was measured in three ROIs at the level of the carina. Three observers visually scored the images using a fivestep scale. A Wilcoxon Signed-Rank test was used for statistical analysis of differences.

RESULTS

Using the GE revolution CT scanner, dose reductions between 1.10 mSv (12%) and 1.56 mSv (24%) (p < 0.01) were found in the anterior segment and no differences posteriorly and laterally. Total dose reductions between 0.64 (8%) and 0.91 mSv (13%) were found across kVp levels (p < 0.00001). Maximum noise increase with OBTCM was 0.8 HU. With the Canon system, anterior dose reductions of 6-10% and total dose reduction of 0.74-0.76 mSv across kVp levels (p < 0.001) were found with a maximum noise increase of 1.1 HU. For the Siemens system, dose increased by 22-51% anteriorly; except at 100 kVp where no dose difference was found. Noise decreased by 1 to 1.5 HU.

CONCLUSION

Organ based tube current modulation is capable of anterior and total dose reduction with minimal loss of image quality in vendors that do not increase posterior dose.

IMPLICATIONS FOR PRACTICE

This research highlights the importance of being familiar with dose reduction technologies.

Fracture shortly before stroke in mice leads to hippocampus inflammation and long-lasting memory dysfunction

Cognitive impairment occurs in stroke and hip fracture patients. In mice, bone fracture (BF) exacerbates stroke-related neuronal damage and sensorimotor dysfunction. We hypothesize that BF exacerbates post-stroke cognitive impairment. Adult mice were randomly assigned into BF, stroke, BF+stroke (BF 6 h before stroke), and control (sham operated) groups. Memory function was evaluated weekly for eight weeks by Y maze test and at eight weeks post-surgeries by novel object recognition (NOR) test. The neuronal damage and inflammation in hippocampus were analyzed three days and eight weeks after the surgeries. In Y maze test, BF+stroke mice started making fewer alternations than controls two weeks after the surgeries. Significant difference between BF+stroke and stroke groups started at five weeks post-injury and continued to the end of the experiment. In NOR test, BF+stroke group spent less time on novel objective than that of other groups. Cx3cr1⁺ cells and CD68⁺ cells accumulated in the stratum lacunosum moleculare (SLM) on the ipsilateral side of stroke injury in stroke and BF+stroke mice. BF+stroke mice had a higher ratio of ipsilateral/contralateral Cx3cr1⁺ cell-density than that of stroke mice. Therefore, BF shortly before stroke exacerbates hippocampal inflammation and causes long-lasting memory dysfunction.

The current gold standard breast volumetry technique seems to overestimate fat graft volume retention in the breast: A validation study

BACKGROUND

MRI is generally considered as the gold standard for measuring breast volume because of its high accuracy of the modality. Many techniques used to measure total breast volume have been validated, but none of these techniques have been validated for their ability to measure the volume retention of fat grafts in the breast. In this study, the authors investigated the accuracy of the most common MRI technique used to measure fat graft retention in the breast by measuring the volume changes after breast augmentation.

METHODS

Patients undergoing breast augmentation with either breast implants or fat grafting underwent MRI scans before and after surgery. Blinded observers measured the change in breast volume from the MRI scans. The difference between the measured change in breast volume and the volume of the breast augmentation was used to determine the accuracy of the MRI technique.

RESULTS

Twenty-eight patients with a total of 56 breasts were included. In total, 168 measurements of change in breast volume were performed by the observers. The MRI measurements of change in breast volume overestimated the true volumes of the breast augmentations by an average of 50.8%, and only 8 of the 168 individual measurements had measurement errors below 50 mL.

CONCLUSION

The MRI technique, which is considered as the gold standard for the quantification of fat graft volume retention, was associated with a significant measurement error. These findings have potential implications for the interpretation of previously published results of studies based on this technique.

Breast cancer research and treatment reconstruction of unilateral breast structure using three-dimensional ultrasound imaging to assess breast neoplasm

Purpose

To develop and evaluate the accuracy of a three-dimensional (3D) US method for assessing unilateral breast reconstruction and discuss the feasibility of breast ultrasound 3D reconstruction of the unilateral breast compared with 3D MRI.

Methods

Sixty-four breast lesions were collected for surgical resection. (1) MRI and US imaging were used to reconstruct the 3D models of the breast neoplasm. The diameters for maximum length, width, and depth of the negative tumor margins were used as the primary standards for comparison. (2) The measurement direction was determined by the largest gravity change between the two body positions. (3) The vertical distance from the midpoint of breast neoplasm to the ipsilateral nipple was calculated via MRI and US reconstruction.

Results

(1) Comparison of the measured size and histopathology of the breast neoplasm showed that US, MRI, and histopathology were highly correlated (p < 0.001). (2) When compared with the other two vertical directions, the direction with the largest gravity change had the greatest difference between MRI and US measurements. (3) The vertical distance from the breast neoplasm to the ipsilateral nipple and skin junction was significantly different (p > 0.05).

Conclusions

We have presented a novel US 3D reconstruction method for evaluating tumor size, which can provide a basis for investigated advanced visualization techniques for assessing breast tissue such as holographic presentation of 3D image data. These methods can provide physicians with a novel approach for making accurate surgical plans, for better communication with patients, and for more effective navigating throughout the operation.

Three-dimensional visualization technique in endoscopic breast-conserving surgery and pedicled omentum for immediate breast reconstruction

PURPOSE

To evaluate the three-dimensional visualization technique (3DVT) in endoscopic breast-conserving surgery (EBCS) and pedicled omentum for immediate breast reconstruction.

METHODS

Clinical data of 256-slice multi-detector CT scanning from 52 patients (group A) were introduced into self-developed Medical Imaging 3D Visualization Systems (MI-3DVS) for individualized segmentation, 3D reconstruction and volume calculation. The surgical process was designed according to the 3D model. Next, the EBCS and pedicled omentum breast reconstruction were performed according to the preoperative design. Finally, the operating time, blood loss, length of postoperative hospital stay, complications and cosmetic outcomes in group A were compared to 44 patients in group B, who underwent the same operation without 3DVT.

RESULTS

The 3DVT can be used to analyze the location of the breast tumors and determine the excision extension of the breast precisely. Compared to group B, group A had the advantage of less bleeding, shortened operating time and earlier discharge (p < 0.05). The cosmetic results of group A were more satisfactory than those of group B (p < 0.05). After a postoperative follow-up of 6-30 months, none of the patients in either group showed any signs of recurrence.

CONCLUSIONS

3DVT can be used to design the surgical process preoperatively and results in positive therapeutic and cosmetic outcomes in EBCS and pedicled omentum for immediate breast reconstruction.

Evaluation of Volume of Nasopharyngeal Cancers by the Cavalieri Principle

Prediction of tumor volume using the Cavalieri method may be helpful in management of therapy and evaluation of treatment results. The aim of this study was to adapt the Cavalieri stereological method to magnetic resonance imaging for determining volume of nasopharyngeal cancers and assess changes after treatment using the Cavalieri method. Serial MRI images in the sagittal plane were obtained from a total of 33 patients with nasopharyngeal carcinomas (11 with stage T2, 11 with stage T3, and 11 with stage T4 lesions). The images were analyzed retrospectively before and two months following the cessation of radiochemotherapy for comparison. Average tumor volumes before and after treatment in patients with stage T2 were 21. 5±10.5 cm3 and 2.82±3.43 cm³, respectively (p=0.000). The respective figures were 35.1±19.0 cm3 and 6.27±7.82 cm³ (p=0.000) for stage T3 cases, and 62.8±27.8 cm3 and 11. 6±11.9 cm3 (p=0.000) for stage T4. Post-treatment tumor volumes were statistically reduced when compared to pre-treatment volumes in all stages.

Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction

BACKGROUND

The use of immediate breast reconstruction and adjuvant radiation therapy is increasing in breast cancer patients. This study aimed to analyze the aesthetic outcome and changes in flap volume in patients with breast cancer undergoing radiation therapy of the surgical site after immediate autologous tissue reconstruction.

METHODS

Immediate abdominal free flap breast reconstruction following unilateral mastectomy was performed in 42 patients; 21 patients received adjuvant radiation (study group) and 21 patients did not (control group). To compare flap volume, three-dimensional computed tomography (CT) was performed before and after radiation. Also, aesthetic analysis was performed in both groups to evaluate shape changes.

RESULTS

There was a 12.3% flap volume reduction after the completion of radiation in the experimental group that was significantly greater than the 2.6% volume reduction observed in the non-radiation group (P<0.01). There was no significant difference in the short- and long-term aesthetic results between the groups.

CONCLUSIONS

When performing immediate autologous breast reconstruction, 14% volume overcorrection is recommended for patients in whom adjuvant radiation therapy is anticipated to improve aesthetic outcomes.

Salvianolic acid B promotes microglial M2-polarization and rescues neurogenesis in stress-exposed mice

Although accumulating evidence suggests that activated microglia are associated with deficits in neurogenesis and contribute to the physiopathology of major depressive disorder, the role of microglia in treating depression remains poorly understood. Our previous study showed that salvianolic acid (SalB) has the regulation of neuroinflammatory responses and antidepressant-like effects. Here, we hypothesized that SalB's therapeutic effects occur because it modulates microglial phenotypes that are associated with neurogenesis. To test this hypothesis, we treated CMS-exposed C57BL/6 mice with SalB (20mg/kg, intraperitoneally, once daily) for 3weeks and investigated microglial phenotypic profiles and hippocampal neurogenesis. The results showed that the SalB treatment skewed M1 microglial polarization toward M2 activation in the hippocampus and cortex and remedied CMS-induced deficits in hippocampal neurogenesis. SalB (40µM) inhibited LPS-stimulated microglial M1 activation as well as induced M2 activation in vitro, and the cultured microglia with the SalB treatment showed enhanced neural precursor cell proliferation, differentiation, and survival. SalB treatment also ameliorated the depressive-like behaviors of the CMS-treated mice in sucrose preference, forced swimming, and tail suspension tests. These findings suggest a possible antidepressive mechanism for anti-inflammatory agents that is correlated with microglial polarization and hippocampal neurogenesis and which may provide a new microglia-targeted strategy for depression therapy.

DIEP Flap Breast Reconstruction in Patients with Breast Ptosis: 2-Stage Reconstruction Using 3-Dimensional Surface Imaging and a Printed Mold

Background:

Autologous breast reconstruction can be performed for breasts with ptosis to a certain extent, but if patients desire to correct ptosis, mastopexy of the contralateral breast is indicated. However, accurate prediction of post-mastopexy breast shape is difficult to make, and symmetrical breast reconstruction requires certain experience. We have previously reported the use of three-dimensional (3D) imaging and printing technologies in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction. In the present study, these technologies were applied to the reconstruction of breasts with ptosis.

Methods:

Eight breast cancer patients with ptotic breasts underwent two-stage unilateral DIEP flap breast reconstruction. In the initial surgery, tissue expander (TE) placement and contralateral mastopexy are performed simultaneously. Four to six months later, 3D bilateral breast imaging is performed after confirming that the shape of the contralateral breast (post-mastopexy) is somewhat stabilized, and a 3D-printed breast mold is created based on the mirror image of the shape of the contralateral breast acquired using analytical software. Then, DIEP flap surgery is performed, where the breast mold is used to determine the required flap volume and to shape the breast mound.

Results:

All flaps were engrafted without any major perioperative complications during both the initial and DIEP flap surgeries. Objective assessment of cosmetic outcome revealed that good breast symmetry was achieved in all cases.

Conclusions:

The method described here may allow even inexperienced surgeons to achieve reconstruction of symmetrical, non-ptotic breasts with ease and in a short time. While the requirement of two surgeries is a potential disadvantage, our method will be particularly useful in cases involving TEs, i.e., delayed reconstruction or immediate reconstruction involving significant skin resection.

The effect of gigantomasty on vertebral degeneration: A computed tomography study

The main reason for waist and back pain in patients with gigantomasty is increased thoracic kyphosis and lumber lordosis. These symptoms and abnormal spinal angulations regress after reduction mammoplasty operations. However, the effect of chronic mechanical stress caused by gigantomasty on the spinal degenerative process is not clear yet. In this study with computed tomography it is shown that degenerative spondylosis is more widespread and severe in patients with large breasts.

Volumetric Planning Using Computed Tomographic Angiography Improves Clinical Outcomes in DIEP Flap Breast Reconstruction

BACKGROUND

The present study evaluated outcomes of deep inferior epigastric perforator (DIEP) flap breast reconstruction using volumetric planning-which is preoperative planning based on volumetric data of the breast and flap estimated from computed tomographic angiography.

METHODS

A prospective review of three patient cohorts undergoing DIEP flap breast reconstruction from June of 2009 to February of 2015 was performed. Cohort 1 comprised 48 cases in which no volumetric planning was used. Cohort 2 included the next 101 consecutive cases undergoing breast reconstruction according to an algorithm based on volumetric planning. Cohort 3 consisted of the next 109 consecutive cases using a modified algorithm. The inset rate (weight ratio of the inset flap to harvested flap) was estimated during volumetric planning, and specific surgical strategies, such as incorporating multiple perforators, conducting venous augmentation (cohort 2), or harvesting bipedicled flaps (cohort 3), were used with reference to it. Rates of perfusion-related complications were compared.

RESULTS

All but one flap survived completely. Fat necrosis occurred in 9.7 percent. Overall, the perfusion-related complication rate was 22.9 percent of cohort 1, 10.9 percent in cohort 2, and 5.6 percent in cohort 3 (p = 0.006). The fat necrosis rates were 19.1, 9.9, and 5.6 percent in cohorts 1, 2, and 3, respectively (p = 0.032). A multivariate analysis demonstrated that volumetric planning had independent benefits for preventing perfusion-related complications (p = 0.003).

CONCLUSION

The authors' results suggest that volumetric planning can facilitate elaborate planning and reduce perfusion-related complications, enabling reliable breast reconstruction using DIEP flaps.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, III.