New software and breast boundary landmarks to calculate breast volumes from 3D surface images

• Published in: European journal of plastic surgery Vol. 41; no. 6; pp. 663 - 670
• Main Authors: Wesselius, T. S., Vreeken, R. D., Verhulst, A. C., Xi, T., Maal, T. J. J., Ulrich, D. J. O.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2018
• Subjects: Medicine; Medicine & Public Health; Original Paper; Plastic Surgery; Breast landmarks; 3D analysis; 3D stereophotogrammetry; 3D surface imaging; Breast volume
• ISSN: 0930-343X; 1435-0130
• DOI: 10.1007/s00238-018-1431-2

Background
A method to accurately calculate breast volumes helps achieving a better breast surgery outcome. 3D surface imaging potentially allows these calculations in a harmless, quick, and practicable way. The calculated volume from a 3D surface image is dependent on the determined breast boundary and the method of chest wall simulation by software. Currently, there is no consensus on a robust set of breast boundary landmarks and validation studies on breast volume calculation software are scarce. The purposes of this study were to determine the robustness of newly introduced breast boundary landmarks and introduce and validate a new method to simulate a chest wall.
Methods
Sixteen subjects who underwent a unilateral simple mastectomy were included. In addition to the natural skin fold of the breast, the sternomanubrial joint, the transition of the pectoral muscle curve into the breast curvature, and the midaxillary line were used as landmarks to indicate the breast boundary. The intra- and interrater variability of these landmarks was tested. Furthermore, new chest wall simulation software was validated on the breastless chest side of the subjects.
Results
The intra- and interrater variability of the three breast boundary markers was small (mean 3.5–6.7 mm), and no significant difference was found between the intra- and interrater variability (
p
 = 0.08,
p
 = 0.06, and
p
 = 0.10). The mean volume error of the most accurately simulated chest wall was 4.6 ± 37 ml.
Conclusion
The newly introduced landmarks showed to be robust and our new chest wall simulation algorithm showed accurate results.
Level of Evidence: Level IV, diagnostic study.