A comparative study of breast surface reconstruction for aesthetic outcome assessment

Breast cancer is the most prevalent cancer type in women, and while its survival rate is generally high the aesthetic outcome is an increasingly important factor when evaluating different treatment alternatives. 3D scanning and reconstruction techniques offer a flexible tool for building detailed and accurate 3D breast models that can be used both pre-operatively for surgical planning and post-operatively for aesthetic evaluation. This paper aims at comparing the accuracy of low-cost 3D scanning technologies with the significantly more expensive state-of-the-art 3D commercial scanners in the context of breast 3D reconstruction. We present results from 28 synthetic and clinical RGBD sequences, including 12 unique patients and an anthropomorphic phantom demonstrating the applicability of low-cost RGBD sensors to real clinical cases. Body deformation and homogeneous skin texture pose challenges to the studied reconstruction systems. Although these should be addressed appropriately if higher model quality is warranted, we observe that low-cost sensors are able to obtain valuable reconstructions comparable to the state-of-the-art within an error margin of 3 mm.Comment: This paper has been accepted to MICCAI201

Nonrigid reconstruction of 3D breast surfaces with a low-cost RGBD camera for surgical planning and aesthetic evaluation

Accounting for 26% of all new cancer cases worldwide, breast cancer remains the most common form of cancer in women. Although early breast cancer has a favourable long-term prognosis, roughly a third of patients suffer from a suboptimal aesthetic outcome despite breast conserving cancer treatment. Clinical-quality 3D modelling of the breast surface therefore assumes an increasingly important role in advancing treatment planning, prediction and evaluation of breast cosmesis. Yet, existing 3D torso scanners are expensive and either infrastructure-heavy or subject to motion artefacts. In this paper we employ a single consumer-grade RGBD camera with an ICP-based registration approach to jointly align all points from a sequence of depth images non-rigidly. Subtle body deformation due to postural sway and respiration is successfully mitigated leading to a higher geometric accuracy through regularised locally affine transformations. We present results from 6 clinical cases where our method compares well with the gold standard and outperforms a previous approach. We show that our method produces better reconstructions qualitatively by visual assessment and quantitatively by consistently obtaining lower landmark error scores and yielding more accurate breast volume estimates

Kinect based system applied to breast cancer conservative treatment

Tese de Mestrado Integrado. Engenharia Electrotécnica e de Computadores. Faculdade de Engenharia. Universidade do Porto. 201

Enhancement of autologous fat graft survival by recipient site preparation

Fat grafting has emerged as a very powerful tool, largely used in plastic surgery for a multitude of indications, including correction of contour abnormalities, breast reconstruction, and cosmetic procedures. However, the variability in terms of volumetric stability of the grafted fat and the lack of methods to measure outcomes in a reliable, easy and reproducible manner represent relevant limitations. To improve outcomes, the majority of the investigations has focused on three of the four steps of the fat grafting process, namely harvesting, processing, and re-injection. The preparation of the recipient site has instead received less attention, despite several reports suggesting an ability of determining higher fat survival rates, mainly through induction of cell proliferation, neo-vascularization and neo-adipogenesis. It is therefore of utmost clinical relevance to determine whether the preparation of the recipient site prior to fat grafting leads to more favorable results. The aim of the present work is to collect and review all existing pre-clinical and clinical evidence regarding all methods to prepare the recipient site, to introduce a new preparation technique and to validate a new three-dimensional method to assess outcomes objectively. Four publications are included. The first manuscript provides a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in pre-clinical studies, including external volume expansion, implantation of alloplastic material, administration of cell-proliferation factors, ischemia, and microneedling. The resulting outcomes are analyzed and the underlying mechanisms of action clarified. The second paper reviews all clinical studies investigating the most used preparation technique, external volume expansion, examining different indications, treatment protocols, outcomes, and complications. The third article presents an innovative and simple intraoperative external expansion system which applies a strong cycling negative pressure of -550 mmHg to enhance small-volume autologous fat grafting (40–80 mL) and discusses its background and its mechanism of action. In particular, this article examines our experience with recipient sites in the breast characterized by restrictive cicatrix or pre-irradiated tissues. Finally, the fourth study validates the use of a novel, inexpensive and handheld three-dimensional scanning process to perform an easy and precise measurement of breast volumes and surfaces, extremely useful to evaluate fat grafting outcomes, especially in case of small volume transplantation

The current progress and critical analysis of three-dimensional scanning and three-dimensional printing applications in breast surgery.

BACKGROUND: Several attempts have been made to develop a tool capable of evaluating breast shape and volume to aid surgical planning and outcome assessment. More recently, newer technologies such as three-dimensional (3D) scanning and 3D printing have been applied in breast assessment. The aim of this study was to review the literature to assess the applicability of 3D scanning and 3D printing in breast surgery. METHODS: A literature search was carried on PubMed, Google Scholar and OVID from January 2000 to December 2019 using the keywords '3D', 'Three-dimensional', 'Three/four dimensions' and 'Breast'. RESULTS: A total of 6564 articles were identified initially; the abstracts of 1846 articles were scanned, and 81 articles met the inclusion criteria and were included in this review. Articles were reviewed and classified according to their aims, study subjects, the software and hardware used, main outcomes and major limitations. CONCLUSIONS: These technologies are fast and easy to use, however, high costs, long processing times and the need for training might limit their application. To incorporate these technologies into standard healthcare, their efficacy and effectiveness must be demonstrated through multiple and rigorous clinical trials

The value of 3D images in the aesthetic evaluation of breast cancer conservative treatment. Results from a prospective multicentric clinical trial

PURPOSE: BCCT.core (Breast Cancer Conservative Treatment. cosmetic results) is a software created for the objective evaluation of aesthetic result of breast cancer conservative treatment using a single patient frontal photography. The lack of volume information has been one criticism, as the use of 3D information might improve accuracy in aesthetic evaluation. In this study, we have evaluated the added value of 3D information to two methods of aesthetic evaluation: a panel of experts; and an augmented version of the computational model - BCCT.core3d. MATERIAL AND METHODS: Within the scope of EU Seventh Framework Programme Project PICTURE, 2D and 3D images from 106 patients from three clinical centres were evaluated by a panel of 17 experts and the BCCT.core. Agreement between all methods was calculated using the kappa (K) and weighted kappa (wK) statistics. RESULTS: Subjective agreement between 2D and 3D individual evaluation was fair to moderate. The agreement between the expert classification and the BCCT.core software with both 2D and 3D features was also fair to moderate. CONCLUSIONS: The inclusion of 3D images did not add significant information to the aesthetic evaluation either by the panel or the software. Evaluation of aesthetic outcome can be performed using of the BCCT.core software, with a single frontal image

Optimising breast reconstruction. A clinical study on autologous breast reconstruction

Denne avhandlingen omhandler metoder for å optimalisere utfallet av brystrekonstruksjon ved bruk av kroppseget vev. Det første delarbeidet beskriver en kirurgisk teknikk som kombinerer to lapper fra henholdsvis buken (DIEP og TRAM lapper) og ytre deler av brystkassen (LICAP lapp) for å oppnå større volum og penere fasong på det rekonstruerte brystet hos kvinner med lite overskuddsvev på buken. LICAP lapp til brystrekonstruksjon er tidligere beskrevet, men en ny design på lappen resulterte i et bedre estetisk resultat enn med tidligere brukt teknikk. Det andre delarbeidet beskriver verdien termografi for å kartlegge lokalisasjonen av blodkar under huden (perforanter) til i planlegging av brystrekonstruksjon ved bruk av lapper fra øvre del av ryggen (TDAP lapp). Samme visualiseringsteknikk ble også funnet nyttig under og etter kirurgisk behandling for å overvåke blodforsyningen i det rekonstruerte brystet. Termografi er gunstig ved at en unngår potensielt farlige og mer arbeidskrevende teknikker som baseres på røntgenstråling eller intravenøse kontrastmidler, som ellers er hyppig brukt. Tidligere studier av intravenøs væskebehandling ved større kirurgi har vist at altfor liberal væsketilførsel kan øke risikoen for komplikasjoner og forlenge sykehusoppholdet. I det tredje delarbeidet ble to forskjellige strategier for intraoperativ væskebehandling sammenlignet, i forbindelse med mikrokirurgisk brystrekonstruksjon ved abdominale lapper. Resultatene viste at en restriktiv intravenøs væskebehandling i kombinasjon med bruk av noradrenalin og propofol, for å motvirke blodtrykksfall og gi økt blodforsyning til det transplantert vevet, var forenlig med færre komplikasjoner og kortere sykeleie. Spesielt forekom komplikasjoner relatert til det transplanterte vevet i betydelig mindre grad i pasientgruppen med lavere total intraoperativ væskevolum. Kombinasjon av lappeplastikker ved mikrokirurgisk brystrekonstruksjon, termografi for å sikre adekvat blodforsyning og en restriktiv intraoperativ væsketerapi er faktorer som kan bidra til er bedre resultat og mindre risiko ved avansert rekonstruktiv brystkirurgi.Breast reconstruction using the patient’s own tissue is common, but the surgical procedures can be complex. This project evaluated new methods to reduce the risks for complications and improve overall outcome after such surgery. In patients with limited surplus tissue on the lower abdomen, larger breast volume and improved aesthetic outcome was achieved when an abdominal free tissue transplant was combined with a local flap from the axillary area. Registration of heat radiation from the skin surface proved a valuable and safe technique to ensure proper flap design before tissue transplantation and to monitor flap blood perfusion during and after surgery, enabling swift correction of compromised flap perfusion. On assessment of intraoperative fluid management, a restricted fluid infusion combined with vasoactive drugs to ensure adequate blood pressure was correlated with less postoperative complications and shorter hospital stay as compared to a more liberal fluid management

Tissue Reinforcement in Implant-based Breast Reconstruction

Background: Tissue reinforcement with allogeneic or xenogeneic acellular dermal matrices (ADMs) is increasingly used in single-stage (direct-to-implant) and 2-stage implant-based breast reconstruction following mastectomy. ADMs allow surgeons to control implant position and obviate the need for submuscular implant placement. Here, we review the benefits and risks of using ADMs in implant-based breast reconstruction based on available data. Methods: A comprehensive analysis of the literature with focus on recent publications was performed. Additional information regarding the proper use of ADMs was based on our institutional experience. Results: ADM use may improve definition of the lateral confines of the breast and lower pole projection. It may facilitate direct-to-implant procedures and improve aesthetic outcomes. The effect of ADMs on complication rates remains controversial. Known patient risk factors such as obesity, smoking, and radiotherapy should be considered during patient selection. For patients with healthy, well-vascularized skin envelopes, ADM-assisted direct-to- implant reconstruction is a safe and cost-effective alternative to 2-stage implant reconstruction, with low complication rates. ADMs may be used to treat capsular contracture, and limited available data further suggest the possibility that ADMs may reduce the risk of capsular contracture. Novel synthetic or biosynthetic tissue reinforcement devices with different physical and ease-of-use properties than ADMs are emerging options for reconstructive surgeons and patients who seek to avoid tissue products from human or mammalian cadavers. Conclusions: ADM-assisted implant-based breast reconstruction may improve aesthetic outcomes. However, appropriate patient selection, surgical technique, and postoperative management are critical for its success, including minimizing the risk of complications