Investigating the effects of Argireline in a skin serum containing hyaluronic acids on skin surface wrinkles using the Visia® Complexion Analysis camera system for objective skin analysis.

Objective: To analyze the effects of Argireline on skin surface wrinkles using the Visia® camera system developed by Canfield Scientific Inc., U.S.A., for facial image capture. Method: Nineteen female participants were recruited from a plastic surgery clinic. Initial facial images captured the left, front, and right sides of the participants' faces, which were documented as timepoint one. Following this, the participants immediately began to apply a facial skin serum containing triple hyaluronic acids produced by CNC cosmetic GmbH, Philippsburg, Germany. The serum was applied once in the morning and once in the evening. Participants received two identical containers labeled L for left and R for right, with each container to be used on the corresponding facial side, particularly around the eye area. One container contained Argireline, a synthetic hexapeptide, which previously was deemed to be a biosafe alternative to botulinum neurotoxin. The study was conducted as double-blind; neither the participants nor researchers knew which of the two containers contained Argireline. Participants were allowed to use their own cosmetic products throughout the study. After four weeks, the participants returned to have their faces recaptured using the Visia® camera, which was documented as timepoint two. The absolute scores of the wrinkles were noted, and results on both sides of the face were calculated and compared. The "TruSkinAge®" measurement provided by the Visia® camera was reviewed for each face side. Results between both time points and both sides of the face were compared. After the data analysis was complete, the company was contacted to determine which container contained Argireline. Results: Nineteen participants returned for facial image capture. There were no significant adverse events, allergic reactions, or skin irritations. The investigation revealed that the wrinkle score slightly decreased for the right and left side of the face following four weeks of serum application. However, this decrease was not significant (p>0.05) based on the Wilcoxon matched pairs tests for the wrinkle scores (right side p=0.060 and left side p=0.176) and Truskin Ages® results (right side p=0.096 and left side p=0.489).Comparing the data from the right side with that from the left side of the face revealed that neither demonstrated a significant reduction in wrinkle score (p=0.829) or Truskin Ages® results (p=0.804). Argireline was included in the serum applied to the right side of the face. However, no statistical significance was seen in the results on this side of the face indicating any possible effects. Conclusion: Wrinkle scores and Truskin Ages® results were observed to decrease non-significantly following the application of a skin serum involving hyaluronic acid. The Visia® imaging method was used to analyze the data objectively. Differences between both sides of the face that were treated with and without Argireline were not statistically significant. Therefore, the effect of Argireline was not proven. While Argireline presented with low toxicity, its efficacy was found not to be significant. Therefore, it is not deemed to be an alternative treatment to botulinum toxin.

Assessment of the reproducibility and accuracy of the Visia® Complexion Analysis Camera System for objective skin analysis of facial wrinkles and skin age.

Objective: This study aimed to investigate the reproducibility and accuracy of the Visia® Complexion Analysis Camera System by Canfield Scientific for objective skin analysis. Methods: Nineteen participants underwent facial capture with the Visia® camera following a standardised protocol. During the first session, the participants sat down and positioned their faces in a capture rig, closed their eyes and had their faces captured from the left, front and right sides, with threefold repetition of the captures from the front side. After 4 weeks, the participants underwent recapture in a similar manner. Based on the frontal views, data for two measurement methods of the Visia® camera system, the absolute scores and the percentiles, were obtained with regard to the skin criterion wrinkles via automated software calculation. Means and standard deviations were evaluated. Based on the side views, the data for the Truskin Ages® were calculated by the Visia® camera system and compared with the calendrical ages, which served as the gold standard for comparison. Results: In the assessment of the reproducibility of the data of the capture system the standard deviation from the frontal captures among all participants was about 3% when the absolute scores of the wrinkles were compared with each other; specifically, the average deviation was 3.36% during the first capture session and 3.4% during the second capture session. Meanwhile, the standard deviation of the measurements was about 9% when the percentiles were compared; specifically, the average deviation was 8.2% during the first capture session and 10.7% during the second capture session. In the assessment of the accuracy the correlation between the calendrical age and the calculated Truskin Age® for both facial sides was very high at a correlation coefficient rho value of >0.8 (right side: r=0.896; left side: r=0.827) and statistically significant at a p-value of <0.001. The average calendrical age and Truskin Age® deviated only slightly from each other and did not differ significantly (right side: p=0.174; left side: p=0.190). The Truskin Age® was slightly higher than the calendrical age by a mean value of 1.37 years for both facial sides. The analysis of the absolute differences revealed that in 50% of the cases, there was a maximum difference of 3 years, and in 75% of the cases, there were maximum differences of 4.5 years for the right side and 5.5 years for the left side. Conclusion: The assessment of the reproducibility and accuracy of the objective measurement method, the Visia® camera system, contributed to the validation of the system. The evaluation of the reproducibility revealed a satisfactory precision of the repeated captures when investigating facial wrinkles. Absolute scores should be preferred over percentiles owing to their better precision. The calculation of the accuracy of the Truskin Age® data from the Visia® camera system revealed only a slight deviation from the true calendrical ages. The correlation between both data groups was highly significant.

Exploring natural breast symmetry in the female plastic surgical patient population.

Background: Breast symmetry remains a challenging quality to measure. The question arises of how much baseline breast symmetry exists in the female plastic surgical patient population. Material and methods: Several linear dimensional assessments were collected based on a retrospective analysis of objective data of women with natural breasts, who presented for an initial consultation in a plastic surgical clinic and were measured with the 3D Vectra Camera by the company Canfield Scientific Inc., U.S.A. The first 100 cases were extracted from the large database in alphabetical order. The nipple positions were examined, including the following linear dimensions: distances from the jugulum to the nipple, from the nipple to the inframammary fold, and from the nipple to midline. Furthermore, the under-breast widths were obtained. Results: The objective three-dimensional imaging method determined that all patients had some degree of asymmetry. The linear distances from the jugulum and midline to the nipple revealed that the measurements were larger on the left side. However, the nipple to the inframammary fold measurements were roughly the same. In the sample of plastic surgical patients, the average distance between the jugulum and nipple was around 20 cm, the distance between the nipple and inframammary fold was around 6.5 cm, the distance between the nipple and midline was around 10 cm, and the under-breast width was around 13 cm. On average, the jugulum-nipple distance on the right side was 19.9±2.3 cm and 20.1±2.4 cm on the left side. The distance between the nipple and the inframammary fold was 6.4±1.1 cm, revealing a similar distribution on both sides. The mean distance from the nipple to the midline was much larger on the left side of the body at 10.0±1.2 cm than on the right side at 9.4±1.3 cm. The under-breast width on the right side was slightly larger than the left side, with measurements of 13.4±1.8 cm versus 13.2±1.7 cm. Conclusion: Breast dimensions can be described comprehensively by an objective three-dimensional imaging process, which can detect asymmetry in all patients. The differences related to the nipple position were larger on the left side than the right regarding the distances from the jugulum and particularly the midline to the nipple, which seems to be of special importance, but not from the nipple to the inframammary fold. The linear measurements for the distances from the jugulum and the midline to the nipple are essential to accurate symmetry assessments and form an aesthetic triangle of the breast, which is a new term and the key to a simplified shape analysis.

Investigation of the precision of the Visia® complexion analysis camera system in the assessment of skin surface features.

Background: The aim of this study was to independently investigate the precision of the high resolution Visia® camera, from Canfield Scientific, to capture several skin surface features. Method: Facial images of eight volunteers were taken with closed eyes and a relaxed face. The capture was conducted in a resting position within a positioning rig. Frontal view images were taken. In the first capture session, the images were captured three times in a row with the head steadily resting in the capture rig. Each volunteer then left the capture rig and returned to it one week later repositioning the face, and the capture was repeated three times. On the basis of this study, it was additionally investigated which number of study participants would be required in order to make a claim as to the reproducibility of the captures. As a possible approach to making this determination, a power analysis was considered. In order to conduct this analysis, it was necessary to determine which differences between individual image captures would be clinically acceptable. To answer this question, a subjective assessment of the repeated image captures for all study participants and for all skin surface features was conducted in order to identify any differences that were visible with the human eye. Results: Differences in skin criteria of the eight volunteers in terms of means and standard deviations were collected for weeks one and two. For the criteria skin texture, UV spots, brown spots and porphyrins, these differences were less than 2% and for pores and red areas they were between 2% and 4%. The results for spots and wrinkles were around 6%. Looking at the differences between the data from week one and two as well as the standard deviations, these differences turned out to be relatively small. This finding also pointed to a quite good precision of the measurement technique. The subjective assessment of the images of the eight participants on each of the eight skin criteria revealed that no differences were detectable in the recaptured versions of the images of the participants' faces in their native digital forms solely with the human eye. There was an exception for only one participant, in whom a distinction between two image captures appeared to be subjectively visible with the human eye, but only for the criterion of red areas. As the subjective assessment revealed that no clinically relevant differences could be identified, a power analysis involving a test for significant differences between the recaptured images was discarded. As a consequence, the number of participants recruited for the study on the reproducibility of the system presented herein was deemed to be sufficient. Conclusion: The precision of the Visia® camera system was found to be satisfactory in this study. The Visia® camera helped to visualise skin features beyond what is visible to the human eye. Thus, the Visia® camera system provides new objective information on skin surface characteristics beyond what can be acquired through purely subjective assessments.

Measurement of the effects of the IMAGE MD® skin care regimen on skin surface features via modern imaging technology with the Visia® complexion analysis camera system.

Objective: Objective analysis of the effects of a series of skin care products by application of modern imaging technology. Method: A study was conducted in 25 volunteers who attended a plastic surgical clinic. The cosmeceuticals chosen for investigation were from the IMAGE MD® series provided by the company IMAGE Skincare. Facial images were taken with the Visia® camera system by the company Canfield Scientific. The volunteers stopped their own skin care regimen after the initial facial captures and applied a series of the products for three months. 19 volunteers returned and underwent again facial capture. Eight different skin aspects - spots, wrinkles, skin texture, pores, UV spots, brown spots, red marks and porphyrins - as well as the skin age were determined and analysed. Results: Overall, the volunteers turned out to appear younger by 1.4 years, however not at a significant level. There was a spread in the results and a tendency for a stronger reduction of the measured skin age in women under 55 years old by 3.2 years. Best effects of the studied product line were obtained for the skin aspects red areas and brown spots. For the criteria spots, texture, pores and UV spots at least two thirds of the comparisons between the two time points, before and after treatment, were positive. In wrinkles and porphyrins, results did not improve. Altogether the majority of the examined skin criteria improved. Conclusion: The IMAGE MD® product series caused the volunteer testers overall to appear slightly younger. An objective measurement of skin changes over time by application of the Visia® imaging technology was found to be possible.

Validation of the Visia® Camera System for skin analysis through assessment of the correlations among the three offered measurements - the percentile, feature count and absolute score - as well as the three capture perspectives, from the left, front and right.

Objective: Validation of the Visia® Camera System in terms of providing data on various skin aspects via the establishment of the correlations among the obtained measurements - the percentile, feature count and absolute score. Method: A large data cloud was analysed statistically following a clinical study. In the study, facial images of nineteen women were obtained at two different time points, before and three months after following a skin care routine. Objective analysis was provided by the Visia® Camera System, which provided measurements firstly as percentiles, secondly as feature counts and thirdly as absolute scores on eight different skin aspects. The eight skin criteria were spots, wrinkles, skin texture, pores, UV spots, brown spots, red marks and porphyrins. Data on the facial skin were gathered from three different perspectives, namely the left, front and right views. The correlations between pairs of the three obtained measurements, i.e., the percentile, the feature count and the absolute score, were calculated. Further, the correlation coefficients for the three capture perspectives, from the left, front and right, were calculated. Data from the two time points, i.e., before and after application of the skin care cosmetic line were analysed. The statistical analyses were conducted using R (R Core Team 2016). Results: There was a high level of correlation among the three offered measurement methods. From 144 calculations of the correlations 128 (88.9%) were statistically significant (p<0.05). The correlation coefficients in the vast majority of cases pointed to very clear correlations between the two examined variables. In particular, 50% of the absolute values of these correlations were above 0.945. The few insignificant results were in UV spots and wrinkles. All three methods used to measure the data on skin aspects, i.e., the percentiles, the feature count and the absolute score, served equally well when making comparisons between the two time points. When examining the correlation coefficients for the three capture perspectives, i.e., left, front and right views, their percentages of significant results were found to be only marginally different. Of the 144 examined correlations, 121 were found to be statistically significant (84%). The average correlation coefficient was r=0.74, which pointed to a very clear correlation between the data. The few insignificant results were in wrinkles, UV spots and spots. The Visia® Camera System was found to be an objective tool with which to examine the effects of a cosmeceutical skin care regime. However, there was a learning curve associated with the application of this system. Conclusion: The Visia® Camera System was successfully validated by investigation of the correlations between measurement methods and capture perspectives. The camera system can not only serve as a tool with which to visualise, provide communications concerning or sell a skin care product, but it can also provide objective data for clinical follow-up studies. Thus, investigations into which skin aspect can be improved the most by a cosmetic product line are possible.

Multisegmental Lumbar Corporectomy and Transcorporal Fixation for Correction of Extreme Thoracolumbar Kyphosis in Myelomeningocele with Chronic Decubitus.

We introduce a novel technique for the treatment of severe kyphosis in myelomeningocele. A 5-year-old paraplegic boy with myelomeningocele presented with severe thoracolumbar kyphosis and a chronic ulcus at the site of the gibbus. The myelomeningocele had been treated during his first week of life, and an accompanying Chiari type II malformation had been treated by ventriculoperitoneal shunting. He subsequently developed a rapidly progressive thoracolumbar kyphosis with an angle of 180° between T10 and L5. He also suffered from a chronic superinfected skin ulcus at the site of the gibbus. Since the skin ulcus required plastic surgery reconstruction, we deemed classical posterior fixation after kyphectomy unfeasible. The subsequent operative steps of our novel surgical approach were performed in a single-stage surgery. First, a three-level lumbar corporectomy from L1 to L3 was performed. Subsequently, the body of the removed L2 vertebra was isolated and configured as an autologous graft to bridge the gap between the thoracic and the caudal lumbar spine. The graft was fixed via a transcorporal interbody fusion technique with titanium screws, and chopped autologous bone was added for fusion. The skin was closed using rotation flaps. At the 3-year follow-up, the patient and his family reported marked improvement of quality of life, imaging showed solid fusion and the wound was unremarkable. Our novel technique with transcorporal fixation provides new perspectives in the treatment of severe kyphosis and skin ulceration in myelomeningocele.

Optimal Positioning of the Nipple-Areola Complex in Men Using the Mohrenheim-Estimated-Tangential-Tracking-Line (METT-Line): An Intuitive Approach.

INTRODUCTION: The reconstruction of the body shape after post-bariatric surgery or high-grade gynecomastia involves, besides skin tightening, the repositioning of anatomical, apparent landmarks. The surgeon usually defines these during the preoperative planning. In particular, the positions of the nipple-areola complexes (NAC) should contribute to the gender-appropriate appearance. While in the female breast numerous methods have been developed to determine the optimal position of the NACs, there are only a few, metric and often impractical algorithms for positioning the nipples and areoles in the male. With this study, we show the accuracy of the intuitive positioning of the nipple-areola complex in men. MATERIAL AND METHODS: From a pre-examined and measured quantity of 10 young and healthy men, six subjects were selected, which corresponded, on the basis of their chest and trunk dimensions, to the average of known data from the literature. The photographed frontal views were retouched in two steps. Initially, only the NACs were removed and the chest contours were left. In a second step, all contours and the navel were blurred. These pictures were submitted to resident and consultant plastic surgeons, who were asked to draw the missing NACs without any tools. The original positions of the nipples were compared with the inscriptions. Furthermore, the results were compared between the contoured and completely retouched pictures and between the residents and consultants. RESULTS: A total of 8 consultants and 7 residents were included. In the contoured and completely retouched images, a significant deviation of the marked positions of the missing features was found. The height of the NAC was determined somewhat more precisely than the vertical position. There was no significant difference between the contoured and completely retouched images, with a discretely more accurate tendency on the contoured images. In comparison with the professional experience, the consultants were tangentially more precise, but without a statistically significant impact. DISCUSSION: The intuitive determination of the NACs is a challenge for the plastic surgeon. In this study, a statistically significant deviation was seen in almost all dimensions, although the clinical relevance cannot be conclusively assessed. We found a positional relationship of the NAC to the infraclavicular groove ("Mohrenheim pit") in the vertical and 4-4.5 cm above the submammary fold. The position of the NAC can be satisfactorily determined by a combination of plastic surgical intuition, patient wishes and practical metric methods using the Mohrenheim-Estimated-Tangential-Tracking-Line (METT-Line). LEVEL OF EVIDENCE V: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Kinect Recording System for objective three- and four-dimensional breast assessment with image overlays.

INTRODUCTION: We investigated the application of the validated portable Kinect camera for three- and four-dimensional breast assessment in female life models. METHOD: Breast images from six life models were captured using the Kinect camera. Capture was conducted with taking three different arm positions while standing upright: with the arms straight down, straight up to the side at 90° and straight all the way up. Images of the volunteers were superimposed on each other. Digital linear distances between sternal notch and nipple-areola complexes were obtained and compared. The views of plastic and breast surgeons to arm positions were questioned. An example for clinical application was provided. RESULTS: Successful capture of images of the female life breast models was achieved. Digital breast measurements at the three different arm positions revealed considerable variation in linear distances measured on the images obtained with the Kinect camera. The dynamic of breast movements could be demonstrated by image overlay and the first ever four-dimensional breast assessment was demonstrated. Fourteen plastic and breast surgeons were found to have nine different opinions regarding their favoured arm positions for breast capture. Even though precision of image sharpness still needs improvement, the images were satisfactory for clinical patient use. The Kinect data were shown to be applicable to surgery planning by designing a planar flap from the 3D mesh. CONCLUSION: The portable and low-cost Kinect camera proved to be easy to use for the first application in life models for three- and four-dimensional breast assessment.

Multi-view stereophotogrammetry for post-mastectomy breast reconstruction.

A multi-view three-dimensional stereophotogrammetry system was developed to capture 3D shape of breasts for breast cancer patients. The patients had received immediate unilateral breast reconstruction after mastectomy by the extended latissimus dorsi flap and without contralateral surgery. In order to capture the whole breast shape including the inframammary fold, the patients were introduced to the imaging room and leaned over the imaging rig to open up the inframammary fold and to expose the entire area of each breast. The imaging system consisted of eight high-resolution ([Formula: see text] pixels) digital cameras and four flash units. The cameras were arranged in four stereo pairs from four different view angles to cover the whole surface of the breasts. The system calibration was carried out ahead of every capture session, and the stereo images were matched to generate four range images to be integrated using an elastic model proposed. A watertight breast mesh model was reconstructed to measure the volume of the breast captured. The accuracy of using the developed multi-view stereophotogrammetry system for breast volume measurement was 11.12cc with SEM 7.74cc, comparing to the measurements of the water displacement method. It was concluded that the 3D stereophotogrammetry image system developed was more reliable than the method of water displacement.

Dermoglandular rotation flaps for breast-conserving therapy: aesthetic results, patient satisfaction, and morbidity in comparison to standard segmentectomy.

We compared a dermoglandular rotation flap (DGR) in the upper inner, lower inner, and upper outer quadrant regarding similar aesthetic results, patient satisfaction, and comfort after breast-conserving therapy with standard segmentectomy (SE). Between 2003 and 2011, 69 patients were treated with breast-conserving surgery using DGR for cancers with high tumor-to-breast volume ratios or skin resection in the three above mentioned quadrants; 161 patients with tumors in the same quadrants were treated with SE. The outcome of the procedures was assessed at least 7 months after completed radiation therapy using a patient and breast surgeon questionnaire and the BCCT.core software. Symmetry, visibility of the scars, the position of the nipple-areola complex, and the appearance of the treated breast were each assessed on a scale from 1 to 4 by an expert panel and by the patients. Univariate and multivariate analysis were used to evaluate the relationship between patient-, tumor-, and treatment-dependent factors and patient satisfaction. 94.2% of the patients with rotation flaps and 83.5% of the patients with lumpectomy were very satisfied with the cosmetic appearance of their breast. Younger patient age was significantly associated with a lower degree of satisfaction. DGR provides good cosmetic results compared with SE and shows high patient satisfaction despite longer scarring and higher median resection volume.

Validation of the Kinect device as a new portable imaging system for three-dimensional breast assessment.

AIM: The aim of this study was the evaluation of a new, simple, touchless, low-cost and portable three-dimensional (3D) measurement system for objective breast assessment. METHOD: The Kinect Recording System by Microsoft was used. Coloured and depth images were captured of nine silicone breast implants of known volumes. The data were processed using Matlab(®) software. Volume measurements were obtained in a blinded calculation on the 3D images. For further comparison, implant volumes were assessed with the Arthur Morris device, a manual measurement tool. RESULTS: Four tests revealed that the true breast implant volumes were calculated within an error margin of 10%. Reproducibility of measurements was satisfactory. Overall, the accuracy and reproducibility of the measurements of the Kinect System were better than those of the Arthur Morris device. Accuracy of volume assessments with the Kinect System was satisfactory for clinical application. Our new portable 3D imaging system was successfully validated. DISCUSSION: The portable and easy-to-use system has several advantages against the currently available commercial systems. Despite a slight overestimation of the volume data, we felt that these results were very promising due to the repeatability of the measurements. After validating the measurement accuracy of the system in a simpler case, we aim to conduct further studies on 3D breast assessment. CONCLUSION: The results obtained with the Kinect System were sufficiently accurate and reproducible for application in 3D breast capture. We successfully validated the portable 3D imaging system for the first ever use in 3D breast assessment.

The importance of the pose in three-dimensional imaging of the ptotic breast.

INTRODUCTION: 3D imaging of the breast has recently emerged as a new method for objective breast assessment. However in the ptotic breast shape, which is seen in the majority of cases, the sub-mammary fold remains obscured when the breast is captured in an upright body posture. METHOD: A self-designed positioning frame for 3D breast capture was utilized as a safe positioning aide. Six volunteers stood on an adjustable standing step, leaning with the hips against a soft-coated hip roll while stretching forward with the upper body extending to a nearly horizontal position and reaching with the arms forward resting on arm pads. 3D breast capture was conducted simultaneously with eight digital cameras that were positioned to capture the right, left, anterior and inferior views of the breast. Capture was repeated three times at different time intervals. The reproducibility of the pose, captures and 3D measurements were investigated. RESULTS: The custom-made positioning frame allowed the complete capture of the breast, even in the ptotic shapes. The investigation of the reproducibility revealed a 6.25% standard deviation of the pose; this being the variable with the smallest variation compared with the variations obtained for reproducibility of captures and 3D measurements. The difference between the first and second pose was not significant at 95% CI (-77.3; 11.9), p = 0.119. CONCLUSION: The presented system used a self-designed positioning frame, by which the complete capture of the ptotic breast in near horizontal upper body posture was achieved. Reproducibility of the pose for 3D capture was satisfactory.

Subjective versus objective assessment of breast reconstruction.

BACKGROUND: To date breast assessment has been conducted mainly subjectively. However lately validated objective three-dimensional (3D) imaging was developed. The study aimed to assess breast reconstruction subjectively and objectively and conduct a comparison. METHODS: In forty-four patients after immediate unilateral breast reconstruction with solely the extended latissimus dorsi flap the breast was captured by validated 3D imaging method and standardized 2D photography. Breast symmetry was subjectively evaluated by six experts who applied the Harris score giving a mark of 1-4 for a poor to excellent result. An error study was conducted by examination of the intra and inter-observer agreement and agreement on controls. By Procrustes analysis an objective asymmetry score was obtained and compared to the subjective assessment. RESULTS: The subjective assessment showed that the inter-observer agreement was good or substantial (p-value: <0.0001). There was moderate agreement on the controls (p-value: <0.0001) and fair (p-values: 0.159, 0.134, 0.099) to substantial (p-value: 0.005) intra-observer agreement. The objective assessment revealed that the reconstructed breast showed a significantly smaller volume compared to the opposite side and that the average asymmetry score was 0.052, ranging from 0.019 to 0.136. When comparing the subjective and objective method the relationship between the two scores was highly significant. CONCLUSION: Subjective breast assessment lacked accuracy and reproducibility. This was the first error study of subjective breast assessment versus an objective validated 3D imaging method based on true 3D parameters. The substantial agreement between established subjective breast assessment and new validated objective method supported the value of the later and we expect its future role to expand.

Investigation into variation and errors of a three-dimensional breast imaging system using multiple stereo cameras.

BACKGROUND: Errors derive from the variability seen in the repeat volume measurements for a particular individual. The aim of this study was to evaluate the variation and errors of a three-dimensional (3D) multiple stereo camera system for objective breast assessment. It was also investigated whether there was any correlation between these errors and the size of the breast. METHODS: A prototype eight camera multiple stereophotogrammetry system was utilized. The volumes of nine plaster breast models were determined by 3D imaging and the correlation between the size of the models and the variability of the measurements was investigated after ten repeats. The breasts of six live volunteers were examined following a specific protocol. The breasts were captured six times, three times each on two different occasions; from each breast capture a three-dimensional model was built and the breast volume was measured three times with breast analysis tool (BAT) software. This allowed for an assessment of the variability introduced at each stage of the measurement procedure. The correlation between the size of the breast and the variability of the measurements was investigated. Results of volume measurements by water displacement method, repeated ten times with the plaster models and six times with the live models, were used for comparison. RESULTS: The correlation between the size of the plaster models and the variability of the measurements revealed a significant correlation (p = 0.033), indicating that the larger the model, the more variable were the results. The correlation between the size of the breasts in the live models and the variability of the results revealed a non-significant correlation (p = 0.342), but there was a visible trend that the larger breasts showed more variable results. The average variation in the repeated measurements on each individual was found to be 32.95 cc across the two different poses, 19.43 cc across the various captures, and 28.32 across the different volume calculations with the BAT software. The error is less than what is clinically visible with the human eye, which is about 50 cc variation in volume by subjective assessment. As a proportion of the mean volume, namely 6.9%, 4.0% and 5.9% respectably, the values are small and indicate that the reproducibility of the system is good. CONCLUSION: The 3D imaging system using multiple stereo cameras revealed a positive correlation between the size of plaster models and the breasts of live models and the reproducibility of the measurements, indicating that the variation was higher for the larger sizes. The relationship was significant in the plaster models but not in the live models, although a trend was observed. The assessment of the variation and errors of the system was part of the necessary procedure that should be considered for the validation of any new measurement technology for breast assessment.

Objective evaluation of the latissimus dorsi flap for breast reconstruction using three-dimensional imaging.

BACKGROUND: The latissimus dorsi muscle flap is a common method for the reconstruction of the breast following mastectomy. The study aimed to assess the quality of this reconstruction using a three-dimensional (3D) imaging method. The null hypothesis was that there was no difference in volume between the reconstructed breast and the opposite side. METHODS: This study was conducted in forty-four patients who had had immediate unilateral breast reconstruction by latissimus dorsi muscle flap. The breast was captured using the 3D imaging system. Ten landmarks were digitised on the 3D images. The volume of each breast was measured by the application of Breast Analysis Tool software. The symmetry of the breast was measured using Procrustes analysis. The impact of breast position, orientation, size and intrinsic shape on the overall breast asymmetry was investigated. RESULTS: The null hypothesis was rejected. The reconstructed breast showed a significantly smaller volume when compared to the opposite side, p < 0.0001, a mean difference of 176.8 cc and 95% CI (103.5, 250.0). The shape and the position of the reconstructed breast were the main contributing factors to the measured asymmetry score. CONCLUSIONS: 3D imaging was efficient in evaluating the outcome of breast surgery. The latissimus dorsi muscle flap on its own for breast reconstruction did not restore the volume and shape of the breast fully lost due to complete mastectomy. The modification of this method and the selection of other or additional surgical techniques for breast reconstruction should be considered. The asymmetry analysis through reflection and Procrustes matching was a useful method for the objective shape analysis of the female breast and presented a new approach for breast shape assessment. The intrinsic breast shape and the positioning of the breast were major components of postoperative breast asymmetry. The reconstructed breast was smaller overall than the un-operated breast at a significant level when assessing the breast volume using the surface area. 3D imaging by multiple stereophotogrammetry was a useful tool for volume measurements, shape analysis and the evaluation of symmetry.

Investigation into accuracy and reproducibility of a 3D breast imaging system using multiple stereo cameras.

BACKGROUND: The aim of this study was to evaluate the validity of a three-dimensional (3D) multiple stereo camera system for objective breast assessment. METHODS: A multiple stereo camera system, which consisted of four pods and eight cameras, two cameras on each pod, developed by Glasgow University, was used. Nine specially shaped plaster breast models were captured once, 3Dmodels were constructed and the volume of each plaster model was measured 10 times by the breast analysis tool (BAT) software. A comparison was conducted with water displacement method, and measurements were repeated 10 times. The breast of six live volunteers was captured six times; from each breast capture, a 3D model was constructed and the volume was measured with BAT software. Breast volume assessment by the water displacement method was repeated six times. RESULTS: In all plaster casts, the discrepancies in volume measurements between 3D imaging and water displacement methods did not exceed 40 cc. The overall mean relative difference was 5%. The differences of the two methods were not significant at p = 0.189, overall mean difference: 11.1 cc and 95% confidence interval (CI) was (-6.732, 28.976). In the live models, the differences in breast volume measurements between the 3D imaging and water displacement methods were significant at p ≤ 0.017, overall mean difference: 207.05 cc and 95% CI (56.12, 357.98). Measurements by 3D imaging were consistently smaller. In the live models, 3D imaging overall was a more reproducible method for measuring breast volume than the water displacement method with a standard deviation of 36 units cc(-1) and 62.6 units cc(-1), respectively. CONCLUSIONS: The 3D breast imaging system using multiple stereo cameras was accurate for measuring the volumes of breast-shaped plaster models, and it was more reproducible than the water displacement method in live models. 3D imaging is a reliable method for the comparative assessment of breast volume.