3D volumetric analysis for planning breast reconstructive surgery

Breast reconstruction plays an integral role in the holistic management of breast cancer, with assessment of breast volume, shape, and projection vital in planning breast reconstruction surgery. Current practice includes two-dimensional (2D) photography and visual estimation in selecting ideal volume and shape of breast implants or soft-tissue flaps. Other objective quantitative means of calculating breast volume have been reported, such as direct anthropomorphic measurements or three-dimensional (3D) photography, but none have proven reliably accurate. We describe a novel approach to volumetric analysis of the breast, through the creation of a haptic, tactile model, or 3D print of scan data. This approach comprises use of a single computed tomography (CT) or magnetic resonance imaging (MRI) scan for volumetric analysis, which we use to compare to simpler estimation techniques, create software-generated 3D reconstructions, calculate, and visualize volume differences, and produce biomodels of the breasts using a 3D printer for tactile appreciation of volume differential. Using the technique described, parenchymal volume was assessed and calculated using CT data. A case report was utilized in a pictorial account of the technique, in which a volume difference of 116 cm3 was calculated, aiding reconstructive planning. Preoperative planning, including volumetric analysis can be used as a tool to aid esthetic outcomes and attempt to reduce operative times in post-mastectomy breast reconstruction surgery. The combination of accurate volume calculations and the production of 3D-printed haptic models for tactile feedback and operative guidance are evolving techniques in volumetric analysis and preoperative planning in breast reconstruction

A systematic review of intraoperative process mapping in surgery

Process mapping has been identified as a strategy to improve surgical efficiency but has been inconsistently applied in the literature and underutilised in surgical practice. In this journal, we recently described our utilisation of these approaches when applied to breast reconstruction. We showed that in surgery as complex as autologous breast reconstruction, process mapping can improve efficiency, and may improve surgical teaching, education and audit. The intraoperative period specifically is an area that can be applied not only to breast reconstruction, but to a much broader range of surgical procedures. A systematic review was undertaken of the databases Ovid MEDLINE, Allied and Complementary Medicine Database, Embase and PsychINFO. Manual searching of the references from articles identified was also conducted. Data items relating to the review aims were extracted from articles' methods, applications, and outcomes. A descriptive analysis was carried out to synthesise the information on the current usage of process mapping in the intraoperative period. Seventeen of 1,488 studies were eligible for review, with all of non-randomised study design. Studies had overlap in components of the intraoperative period to which process mapping was applied. Common areas of improvement were identified. Outcome measures were assessed in ten studies that implemented interventions based on the improvement areas to increase surgical efficiency. As such, process mapping has been used as part of larger quality improvement methods, albeit with inconsistent nomenclature, to improve surgical efficiency. While it has been applied to a range of surgical specialties, there is a lack of application to the surgical component of the intraoperative period. Greater consistency in the reporting and description of process mapping will enable further research for evidence of its benefits

3D volumetric analysis and haptic modeling for preoperative planning in breast reconstruction

Background: Preoperative planning and imaging have shown improved clinical outcome in breast reconstructions. However, an accurate, objective method of volumetric analysis has eluded investigators in the past. Furthermore, scan data from the current imaging modality are limited by the two dimensional (2D) representation on a computer screen. The introduction of 3D haptic biomodeling has led to a more intuitive understanding of the relationship between anatomical structures. Method:We describe an easy, reproducible, accessible approach to volumetric analysis of the breast, by 3Dprinting a haptic model from the scan data. This approach comprises use of a single computed tomography (CT) or magnetic resonance imaging (MRI) scan for volumetric analysis, which we use to compare to simpler estimation techniques, create software-generated 3D reconstructions, calculate and visualize volume differences, and produce biomodels of the breasts using a 3D printer for tactile appreciation of volume differential. Results:Using the technique described, parenchymal volume was assessed and calculated using CT data. Two cases of breast asymmetry were utilized in a pictorial account of the technique, in which a volume difference of 116cm3 and 124.61 cm3 respectively was calculated, aiding reconstructive planning. Conclusion: Preoperative planning can improve aesthetic and clinical outcomes in breast reconstruction by achieving symmetry, reducing operative length and complications. We demonstrate that our technique of volumetric analysis and the production of 3D haptic biomodels will be a valuable addition to the current array of preoperative planning tools. Our findings warrant a further evaluation of the technique for correlation with clinical outcomes through trials