Background: Plastic surgeons aim to achieve breast symmetry during cosmetic and reconstructive breast surgery. They rely on measures of breast size, position, and projection to determine and achieve breast symmetry, but normative data on symmetry in preoperative breast reconstruction patients are scarce. Methods: A statistical evaluation was performed to examine the relationship of breast symmetry to demographic and clinical factors such as age, body mass index (BMI), race, and cancer status in a sample population of 87 patients who were scheduled to undergo mastectomy and breast reconstruction. The sternal notch to nipple (SN-N) distance and breast volume were measured on three-dimensional images, and distance and volume ratios across the left and right breasts were compared to determine symmetry. Ptosis grades were recorded and grade agreement (match) across the left and right breasts was assessed to determine shape symmetry. Results: A substantial portion of women (41.4%) showed SN-N distance differences >5 mm and 50.6% exhibited a volume difference >50 mL between their right and left breasts. Multiple linear regression modeling did not show any association between age, BMI, and cancer status and the SN-N and volume ratios. Race showed an association with volume symmetry but not with SN-N symmetry. A higher BMI increased the likelihood of ptosis disagreement. Additionally, tumor size did not impact overall breast symmetry. Conclusion: This study provides normative data on the extent of breast asymmetry in preoperative patients that can guide physicians in setting realistic goals for reconstruction procedures and manage patients’ expectations related to outcomes.

Stereophotography is now finding a niche in clinical breast surgery, and several methods for quantitatively measuring breast morphology from 3D surface images have been developed. Breast ptosis (sagging of the breast), which refers to the extent by which the nipple is lower than the inframammary fold (the contour along which the inferior part of the breast attaches to the chest wall), is an important morphological parameter that is frequently used for assessing the outcome of breast surgery. This study presents a novel algorithm that utilizes three-dimensional (3D) features such as surface curvature and orientation for the assessment of breast ptosis from 3D scans of the female torso. The performance of the computational approach proposed was compared against the consensus of manual ptosis ratings by nine plastic surgeons, and that of current 2D photogrammetric methods. Compared to the 2D methods, the average accuracy for 3D features was ~13% higher, with an increase in precision, recall, and F-score of 37%, 29%, and 33%, respectively. The computational approach proposed provides an improved and unbiased objective method for rating ptosis when compared to qualitative visualization by observers, and distance based 2D photogrammetry approaches.

Background: Although pre- and postoperative three-dimensional (3D) photography are well-established in breast reconstruction, intraoperative 3D photography is not. We demonstrate the process of intraoperative acquisition and visualization of 3D photographs for breast reconstruction and present clinicians’ opinions about intraoperative visualization tools. Methods: Mastectomy specimens were scanned with a handheld 3D scanner during breast surgery. The 3D photographs were processed to compute morphological measurements of the specimen. Three visualization modalities (screen-based viewing, augmented reality viewing, and 3D printed models) were created to show different representations of the 3D photographs to plastic surgeons. We interviewed seven surgeons about the usefulness of the visualization methods. Results: The average time for intraoperative acquisition of 3D photographs of the mastectomy specimen was 4 minutes, 8 seconds ± 44 seconds. The average time for image processing to compute morphological measurements of the specimen was 54.26 ± 40.39 seconds. All of the interviewed surgeons would be more inclined to use intraoperative visualization if it displayed information that they are currently missing (eg, the target shape of the reconstructed breast mound). Additionally, the surgeons preferred high-fidelity visualization tools (such as 3D printing) that are easy-to-use and have minimal disruption to their current workflow. Conclusions: This study demonstrates that 3D photographs can be collected intraoperatively within acceptable time limits, and quantitative measurements can be computed timely to be utilized within the same procedure. We also report surgeons’ comments on usability of visualization methods and of measurements of the mastectomy specimen, which can be used to guide future surgical practice.

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Breast reconstruction surgery is an integral part of breast cancer treatment for many patients and has been shown to positively influence patients' psychosocial adjustment and quality of life. Threedimensional (3D) visualization and quantification of the breast for different types of reconstruction procedures during the reconstruction process can allow for a better understanding of the changes in breast shape. The reconstruction process, which involves multiple procedures, can take as long as 18-24 months, and the breasts can change shape throughout this period. In this study, we present a novel approach for monitoring and quantifying changes in breast shape using 3D surface images of the torso in conjunction with surface normal measurements. The results of this study can help provide information to physicians and patients about the dynamic changes in breast morphology occurring at different stages of the reconstruction process. Additionally, this information may assist in pre-treatment surgical planning and training. In our approach, we compare the surface normal values of different regions of the breasts at different time-points using the Bhattacharyya distance, which measures histogram similarity. Results are shown for 17 patients who underwent autologous reconstruction, 14 patients who underwent implant-based reconstruction, and one patient who underwent a mixed reconstruction. Using the proposed method, we were able to evaluate changes in the 3D surface images of reconstructed breasts relative to the 3D images of preoperative breasts.