The Application Of Three Dimensional Scanning Technique In Evaluation And Measurement Of Breast

Objectives1. Establish a method to create three dimensional coordinate system for evaluation and measurement of breast using three dimensional scanning technnique2. Study the incidence and profile of breast asymmetry3. Establish an innovative method to measure breast volumetric change after mammaplasty using three dimensional scanning technique4. Study the influence of respiratory state on the measurement of breast volumetric change after mammaplasty using three dimensional scanning techniqueMethods1. Twenty mammaplasty candidates were enrolled. Three different methods were used to create3D coordinate system for evaluation of breast. Agreement between3D image and real patient was assessed. Repeatability of the three different methods were assessed.2. One hundred and sixty-seven augmentation mammaplasty candidates received3D scanning. Parameters related to augmentation mammaplasty were measured in the software. Breast asymmetry were evaluated to study the incidence and profile of asymmetry.3. Five augmentation mammaplasty candidates’pre-operative3D scans (ten breasts) were enrolled. Virtual post-operative scans were created in the software. Accuracy and precision of measurement of breast volumetric change were assessed between the traditional method and the new method.4. Ten augmentation mammaplasty patients received3D scanning post-operatively in different respiratory states. The measurement of breast volumetric change in the different respiratory state was assessed.Results1. The agreement between3D image and real patient was highest in method C with total score as40, which was significantly higher than the score of7in method A and the score of6in method B; The3D Deviation SD was1.38+0.27mm in method C, which was significantly lower than5.23+1.62mm in method A but not significantly different from1.64+0.38mm in method B.2. The mean discrepancy of nipple level, the distance between nipple to midline, IMF level, breast width, breast projection and anterior chest wall projection were4.8±3.9mm,4.5±3.4mm,4.6±3.7mm,4.8±2.9mm,5.4±3.9mm and4.8±3.3mm, respectively. The mean difference of breast volume was (51±44) ml. The incidence of significant asymmetry was73%in nipple position,95%in breast contour,38%in anterior chest wall projection. Nine percent of patients had one parameter of significant asymmetry,19%had two,32%had three,21%had four,14%had five,3%had six,2%had seven. None of patients was completely free of asymmetry.3. The mean breast volumetric change was256.1±61. lml for the new method,281.9±73.7ml for the traditional method and256.0±61.0ml for true value, respectively. The difference from true value for traditional method was significantly higher than for new method. ICC was0.9999for new method and0.993for traditional method. Bland Altman analysis showed the95%Confidence Interval was-40.9ml to92.7ml for traditional method and-0.9ml to1.2ml for new method, respectively. Comparison of agreement between Investigator1and Investigator2showed the95%Confidence Interval was-0.9ml to1.0ml; the limits of agreement were±1.0ml.4. Mean breast volume was352.3±52.7ml. Breast volumetric change error (BVCE) was significantly lower in the same respiratory state (R1) than in the different respiratory state (R2)(9.7ml V.S.21.3ml, P=0.000).3D Deviation SD was significantly higher in R2than in R1(1.60V.S.0.89, P=0.000). BVCE was not correlated with3D Deviation SD in R1significantly (P=0.157) while was correlated with3D Deviation SD in R2significantly with the correlation coefficient as0.77 (P=0.000).Conclusions1. Our proposed new standardized protocol to establish3D coordinate system for breast scanning has shown excellent agreement with real patient and repeatability.2. Thorough3D measurement and analysis of breast asymmetry can be accomplished by3D scanning technique. Augmenatation mammaplasty candidates have high incidence of breast asymmetry, the knowledge of which is of great significance to pre-operative planning, consulting and post-operative evaluation.3. Our proposed new method to measure breast volumetric change after mammaplasty has been proved to have excellent accuracy and precision.4. The measurement of breast volumetric change using3D scanning technique can be significantly influenced by respiratory state. Keeping patients in the same respiration state is crucial to accurate measurement of breast volumetric change.