Magnetic Resonance Imaging Versus 3-Dimensional Laser Scanning for Breast Volume Assessment After Breast Reconstruction.

BACKGROUND: There are several methods available for measuring breast volume in the clinical setting, but the comparability and accuracy of different methods is not well described. The ideal breast volume measurement technique should be low cost, comfortable for the patient, have no ionizing radiation and be non-invasive. METHODS: Prospective cohort study comparing a 3-dimensional (3D) laser scanner versus noncontrast magnetic resonance imaging (MRI) for breast volume assessment. Subjects were women undergoing breast reconstruction with autologous fat graft. Both types of scan were performed the day before fat grafting and at 6 months postoperatively. Pearson correlations and Bland-Altman tests were performed to compare the assessment methods. RESULTS: Eighteen patients underwent preoperative breast MRI and 3D laser scanning. Eighteen patients also underwent assessment 6 months after surgery. The total number of breasts scanned for comparison was 36, with a total of 72 comparisons for analysis. There was a strong linear association between the 2 methods using a Pearson correlation (r = 0.79; P <0.001), and Bland-Altman showed a high level of agreement between the 2 methods. CONCLUSIONS: The 3D laser scanning, with an established protocol, was found to be equivalent to non-contrast MRI for the assessment of breast volume. Given the convenience of laser scanning and potential for lower cost compared with MRI, this technique should be considered for quantifying outcomes after complex breast reconstruction when the equipment is available.

A comparison of reconstructive outcomes following rotation flap approach (RoFA) versus standard mastectomy: a randomized controlled trial.

BACKGROUND: The rotation flap approach (RoFA) mastectomy is a skin-sparing technique that actively imports skin to the centre of the skin envelope and therefore aids in achieving natural ptosis to the reconstructed breast. The objective of this study was to compare clinical outcomes, aesthetics, patient satisfaction and health-related quality of life between the ROFA mastectomy and standard mastectomy approach. METHODS: This study is a prospective randomised controlled trial of participants undergoing mastectomy using either the RoFA technique or standard technique with breast reconstruction. The BREAST-Q was administered pre-operatively and at 3-, 6-, 9- and 12-months following mastectomy. A panel assessment of clinical photographs was conducted to score aesthetics and outcomes of reconstruction. RESULTS: A total of 100 participants were enrolled in the study; of these, 51 underwent RoFA incision, 47 underwent standard incision and 2 were lost to follow up. There were no statistically significant differences in BREAST-Q scores or panellist assessment between the mastectomy groups following breast reconstruction. The post-operative incidence of mastectomy skin flap tip necrosis was high in the RoFA incision group, with rates of other complications such as seroma being similar. CONCLUSION: The RoFA skin-sparing mastectomy incision showed no significant difference in results across patient-reported outcomes or aesthetics when compared to the standard approach, however, did rate higher for skin flap tip necrosis.

Accurate assessment of breast volume: a study comparing the volumetric gold standard (direct water displacement measurement of mastectomy specimen) with a 3D laser scanning technique.

Preoperative assessment of breast volume could contribute significantly to the planning of breast-related procedures. The availability of 3D scanning technology provides us with an innovative method for doing this. We performed this study to compare measurements by this technology with breast volume measurement by water displacement. A total of 30 patients undergoing 39 mastectomies were recruited from our center. The volume of each patient's breast(s) was determined with a preoperative 3D laser scan. The volume of the mastectomy specimen was then measured in the operating theater by water displacement. There was a strong linear association between breast volumes measured using the 2 different methods when using a Pearson correlation (r = 0.95, P < 0.001). The mastectomy mean volume was defined by the equation: mastectomy mean volume = (scan mean volume × 1.03) -70.6. This close correlation validates the Cyberware WBX Scanner as a tool for assessment of breast volume.

Determinants of breast reconstruction outcome: How important is volume symmetry?

Breast reconstruction has established psychosocial benefit compared to mastectomy alone. Evaluation of determinants of breast reconstruction outcome has previously been limited by lack of high quality, condition-specific, patient-reported outcomes measures. The BREAST-Q is such a measure and is well suited to comparison against objective measurements of reconstructed breasts such as volume and volume symmetry. A cohort of patients who had undergone breast reconstruction over a 14 year period underwent assessment of their breast reconstructions using a 3D laser scanning technique and at the same time completed the BREAST-Q patient reported outcomes measure. The objective data derived from the 3D laser scans were then compared to the quantitative data from the patient-reported outcomes measure. Internal comparisons between domains of the BREAST-Q were also examined. 119 patients completed the study. No correlation was found between objectively measured post-operative volume symmetry and patient reported satisfaction with breasts. Examination of a specific question of the BREAST-Q established that patients did notice if they had breast asymmetry but that this did not translate into dissatisfaction with the breasts overall. Patients who had second stage surgery to correct asymmetry, however, did have a statistically significant increase in satisfaction with breasts between pre and post-symmetrization measures. The strongest correlation for a high level of satisfaction with the reconstructed breast(s) was high level of satisfaction with pre-operative information given. Although symmetrization procedures are valuable for increasing satisfaction with breasts, breast volume symmetry is not a major determinant of outcome in breast reconstruction. The breast reconstruction 'process' is more important in determining patients' post-operative well-being and satisfaction with their overall outcome than the actual final 'product' of their reconstruction.

Autologous fat grafting for whole breast reconstruction.

SUMMARY: This is the first reported case of a patient who had a single-stage large-volume breast reconstruction with autologous fat grafting, following rotation flap approach (RoFA) mastectomy. The purpose of this case study was to evaluate the viability of reconstruction of the breast by autologous fat grafting alone, in the context of RoFA mastectomy. The hypothesis was that there would be minimal interval loss of autologous fat on the whole breast reconstruction side. Right RoFA mastectomy was used for resection of an invasive primary breast cancer and resulted in the right breast skin envelope. Eleven months later, the patient underwent grafting of 400 ml of autologous fat into the skin envelope and underlying pectoralis major muscle. Outcome was assessed by using a validated 3D laser scan technique for quantitative breast volume measurement. Other outcome measures included the BREAST-Q questionnaire and 2D clinical photography. At 12-month follow-up, the patient was observed to have maintenance of volume of the reconstructed breast. Her BREAST-Q scores were markedly improved compared with before fat grafting, and there was observable improvement in shape, contour, and symmetry on 2D clinical photography. The 2 new techniques, RoFA mastectomy and large-volume single-stage autologous fat grafting, were used in combination to achieve a satisfactory postmastectomy breast reconstruction. Novel tools for measurement of outcome were the 3D whole-body laser scanner and BREAST-Q questionnaire. This case demonstrates the potential for the use of fat grafting for reconstruction. Outcomes in a larger patient populations are needed to confirm these findings.

Rotation flap approach mastectomy.

BACKGROUND: The authors present a technique for mastectomy with greater versatility for reconstruction. METHODS: The areola is marked and a vertical line is dropped medial to the breast axis, down towards the inframammary fold and laterally to the anterior axillary line. In large ptotic breasts, the markings are modified to reduce the skin envelope. The rotation flap is raised over the lateral half of the breast, and the remainder of the skin envelope is then separated from the breast tissue as per any other mastectomy. Skin closure is by rotation of the flap and incremental gathering of skin. An audit of 37 cases of rotation flap approach (RoFA) mastectomy has been performed, evaluating complications and post-reconstruction outcome using the BREAST Q. RESULTS: RoFA has been found to offer good access for mastectomy and lymphadenectomy. A total of 7 of 37 patients had delay in healing, and 2 patients developed haematoma. Post-reconstruction outcome was scored as comparable with other published series. DISCUSSION: The RoFA mastectomy has the potential to facilitate reconstructive results equivalent to skin-sparing mastectomy and immediate reconstruction.