Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery

The Breast xxx (2015) 1e12

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Review

Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery Rachel L. O'Connell a, Roger J.G. Stevens a, Paul A. Harris b, Jennifer E. Rusby a, * a b

Breast Surgery Department, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK Plastic Surgery Department, Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK

a r t i c l e i n f o

a b s t r a c t

Article history: Received 27 November 2014 Received in revised form 18 February 2015 Accepted 22 March 2015 Available online xxx

Three-dimensional surface imaging (3D-SI) is being marketed as a tool in aesthetic breast surgery. It has recently also been studied in the objective evaluation of cosmetic outcome of oncological procedures. The aim of this review is to summarise the use of 3D-SI in oncoplastic, reconstructive and aesthetic breast surgery. An extensive literature review was undertaken to identify published studies. Two reviewers independently screened all abstracts and selected relevant articles using specific inclusion criteria. Seventy two articles relating to 3D-SI for breast surgery were identified. These covered endpoints such as image acquisition, calculations and data obtainable, comparison of 3D and 2D imaging and clinical research applications of 3D-SI. The literature provides a favourable view of 3D-SI. However, evidence of its superiority over current methods of clinical decision making, surgical planning, communication and evaluation of outcome is required before it can be accepted into mainstream practice. © 2015 Elsevier Ltd. All rights reserved.

Keywords: Breast cancer Breast surgery Oncoplastic surgery Reconstructive surgery Three dimensional surface imaging

Introduction Contour, shape, position, volume and symmetry of the breasts are the most important factors which influence cosmesis and patient satisfaction after breast surgery [1,2]. In the pre-operative stages, all of these aspects should be critically analysed by the surgeon to determine whether surgery is indicated and, if so, what is the most appropriate type of operation. In breast cancer surgery, the primary aim of removing the cancer must be reconciled with the secondary aim of preserving (or even enhancing) breast aesthetics. Traditionally pre-operative planning and “on table” decisions are based on the surgeon's experience, anthropomorphic measurements and weight of the tissue removed. The cosmetic success of the operation can be subjectively evaluated by patients' and surgeons' visual assessment. Independent clinicians (and/or lay people) may be recruited to perform a ‘panel assessment’ of photographs in which the various aspects of cosmesis such as breast shape, size and cleavage are considered in

* Corresponding author. Tel.: þ44 020 8661 3118. E-mail addresses: rachel.o'[email protected] (R.L. O'Connell), rjgs@doctors. org.uk (R.J.G. Stevens), [email protected] (P.A. Harris), jennifer.rusby@rmh. nhs.uk (J.E. Rusby).

addition to overall appearance [3,4]. Such assessments are subjective and often lack accuracy and reproducibility [5,6]. Patientreported outcome measures (PROMs) measure any aspect of a patient's health status. Various PROMs have been used to evaluate patients' satisfaction after breast surgery, for example BREAST-Q [7,8]. Despite many of these PROMs being well designed and validated, the results are the subjective views of the patient and it is not uncommon for patient satisfaction and panel assessment to give divergent results [9]. There have been many attempts to derive objective measures of outcome. Breast volume is a potentially useful measurement in planning and evaluating breast surgery. Traditionally, breast volume has been calculated using anthropomorphic methods [10,11], mammogram [12], Archimedes principle of water displacement (where the patient lowers her breast into a water-filled vessel of known volume) [13], thermoplastic/plaster casting of the breast and subsequently filling the cast to determine volume [14,15], computed tomography (CT) [16] and magnetic resonance imaging (MRI) [17]. These methods are time consuming and expensive or awkward and cumbersome for the patient. During mammography, CT and MRI the patient is leaning into the machine, supine or prone and the breast may be compressed or elongated depending on position, therefore is not representative of the patient's appearance

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when standing. Further details of comparison of these techniques are summarised in a review [18]. In the 1970s, Edstron described‘ split and reversed negatives’ where photographic negatives of the left and right breast were processed and laid next to the non-negative right and left breast. The constructed images of perfectly symmetrical breasts were compared with the original photographs of the patients' breasts [19,20]. Linear measurements between two landmarks on the torso, known as anthropometry have been used to objectively quantify aesthetics. Measuring parameters such as breast projection has limitations due to correctly identifying the underlying chest wall, and is prone to intra- and inter-observer error. Calculating measurements from photographs, known as photogrammetry an alternative though it may be more difficult to identify some of the anatomical landmarks [21]. Two software systems have been developed to objectively evaluate the aesthetic surgical outcomes of breast surgery using two-dimensional (2D) photographs. The Breast Analysing Tool (BAT©) [22] evaluates symmetry by comparing breast area, breast circumference and nipple position between the breasts. The Breast Cancer Conservative Treatment cosmetic result (BCCT. core) software [23,24] performs similar symmetry calculations and also analyses colour differences and the appearance of the scar. Further details of methods of assessing cosmetic results after breast surgery are described in recent articles by Cardoso et al. [21,25,26], Oliveira et al. [27] and Kim et al. [6]. The use of 3D-SI in the clinical setting was first described by Burke and Beard [28,29] in 1967 to analyse facial structures. Recently 3D-SI has been used as a research and clinical tool in aesthetic, oncoplastic and reconstructive breast surgery (which will hereafter be referred to as breast surgery). Initial studies established the optimal technique to obtain images and tested accuracy and reproducibility [30e38]. Subsequent case series have examined the use of 3D-SI in clinical practice. The aim of this review is to summarise the use of 3D-SI (photography and laser) in the field of breast surgery to give the reader a broad overview of the research and clinical uses of 3D-SI and to consider whether current limitations are likely to be overcome. Methods Search criteria A literature search was conducted in January 2015 using PubMed, MEDLINE, EMBASE, SCOPUS, CINAHL, Thomas Reuters Web of Science, The Cochrane Library, including the Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effect (DARE), the Cochrane Methodology Register, Health Technology Assessment Database, the NHS Economic Evaluation Databases and Cochrane Groups. The search terms used were: ‘3D’, ‘3-D’, ‘3-Dimensional’, ‘3 Dimensional’, ‘three-dimensional’, ‘three dimensional’, ‘stereo-photogrammetry’ and ‘breast’. Inclusion, exclusion criteria and endpoints Two reviewers independently screened all results and selected the relevant articles using specific criteria (Table 1). The references from all the articles identified were examined for further relevant studies. Specific endpoints were identified: 1. 2. 3. 4.

Image acquisition Calculations and data obtainable with 3D-SI Comparison of 3D-SI with 2D imaging Clinical research applications of 3D-SI

Table 1 Predetermined inclusion and exclusion criteria for literature search. Inclusion criteria Primary data from prospective and retrospective studies Human studies Data included outcome results from 3D-SI Exclusion criteria Techniques, technical reports, letters Did not undergo peer review Outcomes were not related to oncoplastic or aesthetic breast surgery outcomes (e.g. radiotherapy planning) No extractable outcomes Not published in English

Data abstraction The data were extracted from studies satisfying the inclusion criteria and verified by two independent authors. Disagreements were resolved by consensus. Included studies investigated the use of 3D surface imaging (3D-SI), but none compared patient outcomes with and without 3D-SI as part of their management, therefore no specific statistical analysis or meta-analysis was possible. Results Four thousand and fifty citations were identified by the search. The search was narrowed as shown in the attrition diagram (Fig. 1). In order to summarise the literature we will explain the methods of 3D-SI, describe their use in the calculation of volume and contour asymmetry and report on clinical applications and limitations. Image acquisition 3D surface imaging of the breast can be achieved by laser scanning or photography (also known as stereo-photogrammetry). 3D laser scanning images are achieved by the principle of triangulation: a laser beam is projected on the patient's torso, the rays are reflected and captured by a detector which is sensitive to their orientation [32,39]. The locations of all of the reflecting point on the torso's surface can then be determined in three dimensions. Several single images are taken from multiple angles. This may be done using one laser taking sequential shots or simultaneous lasers. The breast region of interest is either marked on the patient before the scan according to a pre-defined protocol or can be placed on the 3D image. Using computer software, a 3D image is constructed from which calculations can be made. 3D photographic images are achieved by perceiving the same object from several different viewpoints (as in binocular vision) [40]. Up to twelve synchronized cameras located in pairs at various heights and angles take photographs of the breast region. Spatial computation of x, y and z coordinates of individual points are then configured using computer software to generate a 3D image. As with 3D laser scanning, marks are placed on the patient's torso or on the image generated to define the region of interest. A recent review by Tzou et al. compared five of the current 3D-SI technologies on the market, 3dMD, Axisthree, Canfield, Di3D and Crisalix [41], therefore further details of these devices have not been documented in this review. Fig. 2 shows one of the 3D-SI systems available. The majority of the systems currently in use are heavy and bulky which limits the use of the imaging to one room or a single hospital. However newer versions of the equipment are have been developed that smaller, more portable and cost effective [42e45].

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Fig. 1. Attrition diagram summarising search strategy.

There has been interest in the Microsoft Kinect device which is used for the Xbox360 and Windows gaming consoles. It uses a pseudo-structured light scanning approach whereby the distance between it and the objects in the field of view are calculated, enabling the generation of a 3D model. Wheat et al. [46] concluded that the measurements between the anatomical landmarks on the female mannequin using the Kinect system showed acceptable agreement with manual measurements using callipers. Oliveira

et al. [47] found that by applying super-resolution to the image to increase the spatial resolution, the correlation between 3D image and manual measurement of nipple height was 0.95. Pohlmann et al. concluded that the device had potential to be used in clinical practice [48]. Calculations obtainable from 3D surface imaging Mammometrics The term mammometrics has been adopted to describe the establishment of fixed planes and points to perform objective breast measurements (Fig. 3). By standardising these landmarks, volume, shape and symmetry can be assessed and it is possible to compare one breast with the other or changes in the same breast over time [49]. Studies have validated the accuracy of mammometrics compared with traditional direct anthropomorphic

Fig. 2. Typical 3D imaging system. Reproduced with permission from Canfield Scientific.

Fig. 3. 3D image of the breasts showing landmarks and calculations. Reproduced with permission from the patient.

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measurements [31]. Bland-Altman plots illustrated excellent agreement for many of the measurements, however when the landmarks from which measurements are taken are ill-defined the agreement is reduced [50]. Volume calculation By marking the boundaries of the breast, a 3D image of the breast mound surface is created. Computer software can interpolate an artificial chest wall behind the breast mound based on the boundary curve. The enclosed volume is then calculated. Results are dependent on the software used to integrate the images and the assumptions made in calculations e.g. chest wall curvature and inframammary fold (IMF) position in patients with ptosis. Some investigators have resorted to awkward, semi-prone patient positioning [35] to eliminate the effect of ptosis, others have evolved software and calculations to take these factors into account [51]. Kovacs et al. [30] compared a 3D laser scanner to three traditional methods. MRI showed the highest measurement precision, followed by 3D laser scanning, then thermoplastic and anthropomorphic measurements. They concluded 3D laser imaging provided an acceptable method of measuring volume with good patient tolerance. Rao et al. [52] drew similar conclusions when comparing 3D laser scanning to water displacement, casting and the Grossman-Poudner device and Henseler et al. [33] found 3D-SI to be more reproducible than water displacement. Other studies have demonstrated that MRI and 3D-SI volume calculations are well correlated [36]. Knowing the intercept and slope of the regression line of correlation enabled acceptable prediction of the MRI volume from the 3D method [53]. Others [54] have been more sceptical in the interpretation of their study results, questioning the accuracy of 3D-SI in breast volume analysis. Their main concerns were standardisation due to difficulty identifying the margins of the breast and in their study they found thermoplastic casts and plastic cups

to have better accordance with volume of the operated breast than 3D-SI and MRI. Direct measurement of water displacement of mastectomy specimens has been used as the gold standard in comparisons with volumes using 3D laser scanning [34,55] and 3D photography [31].There was a strong linear association between mastectomy volume and volume calculated by 3D laser. Similarly, the relative difference between the mastectomy volumes and the volumes calculated by 3D photography was 2%, non-significant. Thomson et al. [56] investigated accuracy by measuring known volumes of simple geometric shapes and measuring breasts and comparing results to plaster casts. Based on linear regression there was excellent correlation between the imaged and actual values. A further study compared expander reconstructed breast volume with the known volume in the expander. The ratio of 3D-SI measured volume to known expander volume was 1.265 [57], however the group did not state whether they controlled for volume of skin and subcutaneous fat. Variability in repeated volume measurements of 3D photography was investigated by Henseler et al. [58]. They found the correlation between the size of a plaster breast model and the variability of the measurements revealed a significant correlation indicating that the larger the model, the more variable the results. There was a non-significant trend towards this for the live breast models but the small sample size of 6 limits the ability to detect a significant relationship. Reasons postulated for this variability were lighting conditions, positioning the breast at the centre of the image, calibration process and variation in identifying breast boundaries. Overall, the average variation was between 19 and 33 cm3 which is less than the volume difference noticeable by clinical evaluation, suggesting that reproducibility is adequate. Papers reporting volume calculations are summarised in Table 2.

Table 2 Summary of papers reporting volume calculations. Author (ref)

Year

Use of 3D surface imaging

Surgical planning pre- and intra-operatively Galdino [70] 2002 1. Pre-operative planning 2. Tracking changes over time 3. Assess for implant leak Tepper [71] 2008 1. Pre-operative volume analysis 2. Post-operative volume analysis Tanabe [71] 2005 1. Intra-operative assessment of volume and contour 2. Mammometrics Esme [73] 2009 1. Intra-operative assessment of contour, shape, volume

No of patients 5

12

Surgical technique

Author specific conclusion regarding use of 3D surface imaging in the study

Augmentation, reconstruction, asymmetry surgery, breast reduction, mastopexy Tissue expander reconstruction

Very helpful in providing objective information pre-operatively

2

Implant reconstruction TRAM reconstruction

1

Augmentation

Gladilin [74]

2011

1. Simulation of post-operative images 2. Pre-operative planning

3

Augmentation

Donfrancesco [75]

2013

1. Simulation of post-operative images

150

Augmentation

Ciechomski [76]

2012

1. Simulation of post-operative images

15

Augmentation

Szychta [77]

2014

1. Measuring breast implant volume

50

Implant reconstruction

Ahcan [78]

2012

12

DIEP/msTRAM reconstruction

Eder [79]

2013

1. To produce a breast replica cast to assist moulding the correct shape during reconstruction 1. To develop a formula to predict resection weight in reduction mammoplasty

59

Reduction mammoplasty

Provides benefit as a method for assessing tissue expansion. Data obtained during the operation gave precise information about volume and contour of the breast Valuable tool to determine the changing dimensions of the breasts after augmentation mammoplasty Enables realistic prediction and quantitative optimization of postsurgery breast appearances Patients feel the simulation is very accurate and helps them in choosing the implant The web based 3D simulation has potential to pave the way towards personalized web-enabled medicine Potential to assist in optimal breast implant selection The surgeon may be able to perform better and faster reconstruction with the mould N/A

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Table 2 (continued ) Objective assessment of outcome Henseler [62] 2012 1. Assess volume and symmetry postoperatively Isogai [1] 2006 1. Assess shape, volume and symmetry postoperatively

44

Latissimus dorsi reconstruction

51

TRAM, latissimus dorsi, implant reconstruction

Tepper [80]

2009

1. Volume 2. Mammometrics

14

Augmentation

Tepper [81]

2008

30

Reduction mammoplasty

Blechman [82]

2013

29

Implant reconstruction

Choi [84]

2013

90

Fat grafting

Small [85] Del Vecchio [86] Auclair [87] Del Vecchio [88] Howes [89]

2014 2014 2013 2012 2014

1. Volume, tissue distribution over time 2. Mammometrics over time 1. Volume over time 2. Mammometrics over time 1. Volume over time to assess fat retention 1. Volume to assess fat retention 1. Volume to assess fat retention 1. Volume pre and post-operatively 1. Volume to assess fat retention 1. Volume to assess fat retention

73 30 20 1 1

Spear [90]

2014

1. Volume to assess fat retention

10

Fat grafting from different donor sites Fat grafting Fat grafting with implant Fat grafting instead of revision implant Fat grafting instead of implant reconstruction Fat grafting

Yoshimura [91]

2010

1. Volume to assess fat retention 15 2. Mammometrics Quantifying post-operative changes over time 14 Eder [92] 2011 1. Pre-operative volume/contour analysis 2. Post-operative volume/contour analysis 3. Mammometrics 13 Ji [93] 2014 1. Pre-operative volume/contour analysis 2. Post-operative volume/contour analysis 3. Mammometrics 4. Tissue distribution changes 1. Pre-operative volume/contour 2010 Small [94] 15 2009 Choi [95] analysis 2011 Quan [96] 2. Post-operative volume/contour analysis 3. Mammometrics 4. Tissue distribution changes Comparing different surgical techniques in terms of cosmetic outcome Derderian [97] 2009 1. Pre-operative volume analysis 20 2. Post-operative volume analysis Szychta [98]

2013

Eder [99]

2013

Kovacs [100]

2012

3D surface imaging role in Moyer [63] 2008

Hirsch [101]

2014

1. Volume/contour analysis over time 2. Mammometrics 1. Pre-operative volume/contour analysis 2. Post-operative volume/contour analysis 3. Tissue distribution changes 1. Pre-operative volume analysis 2. Post-operative volume analysis 3. Mammometrics breast conserving therapy (BCT) 1. Assess volume and symmetry postoperatively

1. Assess volume and symmetry postoperatively

Fat grafting instead of revision implant

Efficient in evaluating the outcome of breast surgery It is accurate and quick, However data defects can occur whilst scanning. Useful for documentation of true changes with breast augmentation over time Able to define long-term post-operative changes following breast procedures N/A Provides a tool to monitor percentage retention associated with fat transfer Provides volumetric measurements N/A N/A N/A Able to accurately measure and compare the maintenance of volume Only 7 patients included in 3D assessment because authors did not appreciate importance of calibration and standardized patient position. N/A

Augmentation

Able to quantify absolute inframammary fold change

Augmentation

It is an objective and effective way for evaluating breast morphology changes over time

Reduction mammoplasty

It holds future promises as a method of standardizing breast surgery analysis It may ultimately provide guidelines for pre-operative surgical planning

N/A

29

Implant reconstruction, wise pattern skin resection, alloderm and dermal pedicle Latissimus dorsi reconstruction

48

Reduction mammoplasty

It will contribute to an objective surgical outcome analysis in the near future

27

Augmentation

Volume measurements are of high accuracy

23

Breast conserving therapy

21

Breast conserving therapy

The resulting image and calculations from the software do not give a tangible number that relates to cubic centimetres or corresponds to a subjective rating. It only provides an objective measure of results and does not take into account the patients' opinion of their cosmesis

N/A

N/A ¼ No specific conclusions regarding the use of 3D surface imaging in the study.

Asymmetry and shape Symmetry of the breasts is dependent not only on the volume of the breasts but also on shape [59]. One method to assess asymmetry is to reflect the mirror image of one of the patient's breasts onto the other. An example is shown (Fig. 4). The shape differences

in various locations can then be quantified to describe the asymmetry. A study evaluating breast symmetry using 3D photography in natural, non-operated, non-pathological breasts measured the degree of breast asymmetry using the root mean squared (RMS) [60]. Using the superimposed images of the two breasts the

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(BAD) between the left and right breast using the 3D-SI and frontal views of the 2D photography using BCCT.com software. The BCCT.core software measured smaller mean breast areas and mean BADs correlated poorly with the 3D method. These findings are because 3D-SI allows the whole of the breast to be viewed and analysed while 2D methods evaluate the visible frontal breast area, and not the lateral, non visible aspects of the curved breast. Henseler et al. [61] compared assessment of 2D photographs by a panel of six plastic surgeons using the Harris score [69] (poor/fair/ good/excellent) with 3D-SI for the evaluation of latissimus dorsi (LD) flap reconstruction in forty-four patients. The inter-observer reliability of the panel assessment, measured by kappa value, was rated good or substantial, indicating reasonable reproducibility. Asymmetry scores were obtained for each reconstruction based on calculations from 3D-SI. The relationship between the 3D asymmetry and panel scores was highly significant. Fig. 4. 3D image demonstration reflection of one breast onto the other. Reproduced with permission from the patient.

distance between the two breast surfaces was calculated over the entire breast. The degree of asymmetry was then quantified using the RMS, squaring the mean distance to give a positive value regardless of whether left is larger than right or vice versa. Taking the square root gives the magnitude of the set of numbers. The study found an average RMS of 5.93 ± 2.4 mm when assessing eighty-seven women. It was significantly higher in those patients with a higher BMI, cup size and chest wall circumference. Other studies have used RMS or similar methodology to assess asym
topography has also been used [1]. This metry [2,61e64]. Moire involves dividing the breast into four equal zones based on the projection, like contour lines at ¼, ½ and ¾ of the outward projection, and then superimposing the mirror image of one breast onto another to obtain a surface area ratio for each zone (surface area ratio ¼ [surface area of reconstructed breast/surface area of the normal breast]  100). This method was initially introduced in engineering to measure fine deviations and distortions of surfaces [65]. Each of the studies described above gives an overall answer to the symmetry question, either by measuring overall volume, or average RMS or surface area ratio. Those based on landmark asymmetry [62] are affected by asymmetry of position as well as volume. Catanuto et al. [66,67] and Farinella [68] developed a laser scanner to evaluate breast shape. The resulting digitalized image of the chest wall surface could then be mapped according to curvature of the breast to describe the geometrical properties of the region. They concluded that this is superior to asymmetry and volume calculations since small deformations of the chest wall or spine will impact on the appearance of the breasts even when the volume or symmetry of the breast mound is similar. 3D surface imaging compared with 2D imaging Conventional 2D photography is currently used to record breast surgical aesthetic outcome. As already discussed, 2D photographs may be evaluated in a ‘panel assessment’ whereas computer software such as BCCT.core and BAT© can produce an objective composite score for aesthetic outcome. By definition, this involves implicit or explicit weighting of the components of aesthetic outcome to come to a single score. Some groups have compared 3D-SI with 2D imaging in the assessment of outcome. Eder et al. [39] compared 3D laser imaging and BCCT.core software in 23 patients undergoing free TRAM (transverse rectus abdominis myocutaneous) breast reconstruction. BCCT.core and 3D-SI were compared by analysing breast surface area difference

Clinical and research applications Table 3 summarises the clinical studies which have used 3D-SI with a summary of the study population and size as well as any author conclusions regarding the use of 3D-SI. Surgical planning pre- and intra-operatively Planning of breast surgery is dependent on the surgeon's experience and anthropomorphic measurements. 3D-SI offers a potential source of objective data for the planning of surgery. One of the earlier breast 3D-SI papers by Galdino et al. [70] described five cases studies, three of which used 3D photography to aid the planning of surgery. The first was for a post-mastectomy reconstruction and second for a mastopexy to correct congenital asymmetry. Tepper et al. [71] used 3D laser scanning to aid unilateral tissue expander (TE) implant reconstruction. Pre-operative base width measurements as well as 3D volumetric data were used to determine TE size. 3D volumes were also obtained upon conclusion of expansion as a guide for the definitive implant shape and size. Of the twelve patients enrolled into the study, eleven underwent contralateral symmetry procedures and the authors stated that 3D volumes helped to direct the surgical management. Two other early studies used 3D-SI intra-operatively to aid and evaluate breast reconstructions and augmentations in terms of volume and contour [72,73]. None of these studies included a control group, so it is impossible to know how much value is added by 3D assessment over what would be achieved by surgical acumen alone. 3D-SI is currently used to simulate what a cosmetic augmentation might achieve in terms of size and shape. It has been demonstrated that simulated images are accurate [74] and patients felt they helped them to choose the size and shape of the implant [75]. Potentially even more accessible to patients and surgeons alike is the development of a web based consultation tool whereby 2D digital photos are reconstructed into a 3D image which can be altered to simulate augmentation, though further studies are needed to validate its use [76]. Szychta et al. [77] tested the accuracy (variability between real volume of implant used and calculated volume) in measuring implant volumes. The estimated breast implant volumes (EBIV) were calculated by subtracting the volume of covering tissues from the calculated reconstructed breast volume in patients who had undergone two stage breast reconstructions. Accuracy was better using 3D-SI than anthropometric and thermoplastic methods. The authors concluded that the 3D-SI, therefore, had potential to assist in selection of the optimal breast implant by calculating the EBIV using the contralateral breast in order to determine the volume of the optimal implant. However, much of aesthetic surgery is said to

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Table 3 Summary of clinical studies which have used 3D imaging. Author (ref)

Year

Mammometrics Lee [50] 2011

Losken [31]

2005

Volume calculation Eriksen [54] 2011

Aspect of 3DSI being evaluated

No of patients

Patient population

Results

Mammometrics versus direct anthropometry and traditional photogrammetry

23

14: No previous breast surgery 9: Breast reconstruction

Mammometrics versus direct anthropometry

10

Preoperative patients

7 out of the 9 distances measured had excellent agreement. A lower level of agreement was observed for some measures because of difficulty identifying less well localized points on the body Relative difference between 3DSI and direct measurements for rater 1 was 6% ± 6.6%, and rater 2 was 6% ± 6.9%

Compared3DSI, plastic cups, thermoplastic casts, MRI with mastectomy specimen volume (Archimedes principle) Volume reproducibility using 3DSI and accuracy compared to water displacement

12

Patients undergoing mastectomy

6

Does not state if participants have previously had breast surgery

Henseler [32]

2011

Henseler [33]

2013

Volume reproducibility whilst patient having imaging when prone. Each patient imaged 3 times

6

Does not state if participants have previously had breast surgery

Henseler [58]

2012

Compared3DSI volume with plaster cast breast models Assessed variability of repeated 3DSI volumes in human breasts

6

Does not state if participants have previously had breast surgery

Koch [53]

2011

22

Kovacs [32]

2006

Compared3DSI volume calculations with MRI Variance of 3D volume measurements Correlation between volume measured by 3DSI and MRI

Previous breast surgery in 8 patients, none in 14 6: No previous breast surgery 5: Breast augmentation 5: Breast reduction

Kovacs [30]

2007

Compared3DSI volume calculations with MRI, thermoplastic casting and anthropomorphic measurements.

6

Does not state if participants have previously had breast surgery

Lewis [57]

2014

10

Tissue Expander reconstruction

Liu [38]

2013

Compared known tissue expander filled volume with 3DSI of the breasts Assessed volumetric changes on3DSI according to respiratory states

10

Patients who had undergone augmentation

Liu [51]

2012

Developed a new method to calculate volume change between pre and postoperative images

10

Pre and post augmentation.

Losken [31]

2005

Compared 3DSI volumes with mastectomy specimen volume, and reproducibility and agreement between readers

14

Patients undergoing mastectomy

Mailey [37]

2013

Compared 3DSI volume calculation with known implant volume

22

Augmentation

Rao [52]

2003

Compared 3DSI volume calculations with water displacement, casting and Grossman-Poudner device

Not stated

Does not state if participants have previously had breast surgery

16

Casting and plastic cups measured better accordance with volume of operated breast than3DSI or MRI which resulted in higher values The mean breast volume difference between 3D and water displacement was 207.05 ml, t-test NS. Volume measurements by 3DSI (SD 36) were more reproducible than water displacement (SD 62.6) Standard deviation volume ¼ 6.25% Posing error between 1st and 2nd image capture was not significant (p ¼ 0.119) Correlation between size of breast and variability of 3DSI measurement showed a non-significant correlation (larger the breast, higher the variability) Variation in repeated measurements of breast volume in was 32.95 ml Linear regression model demonstrated r2 ¼ 0.59e0.77 Mean deviation 2.86% ± 0.98% in patients with no surgery Mean deviation 4.19 ± 1.51% in augmentation patients Mean deviation 2.47% ± 0.52% in reduction patients Mean volume by MRI ¼ 441.42 ml ± 137.05 and 3DSI ¼ 452.51 ml ± 141.88, r ¼ 0.995 MRI showed highest precision with a mean deviation (% of mean breast volume) of 1.56 ± 0.52%. 3D surface imaging precision was 2.27 ± 0.99% Ratio of measured volume to TE volume was 1.265 Keeping patients in the same respiration state is crucial for accurate measurement of volume change Volumetric change using new method was 256.1 ml ± 61.1 and 281.9 ml ± 73.7 for the old method (true value ¼ 256.0 ml ± 61) Difference between mastectomy volume and 3DSI volumes were not significant by t test analysis Coefficient of reproducibility for rater 1 ¼ 0.8, and rater 2 ¼ 0.92 Agreement between readers showed highly significant inter-rater reliability coefficient (0.975; p < 0.025) Difference in volume between actual and 3D volumes varied from 0 to 106 ml (0e30%), with an absolute mean difference of 12.2% (42.5 ml) Volume assessment using 3DSI correlates closely (<5% error) with measurements obtained from traditional methods (continued on next page)

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Table 3 (continued ) Thomson [56]

2009

Compared3DSI volume of geometric shapes of known volume Compared3DSI volumes of breasts with plaster casts

7

Does not state if participants have previously had breast surgery

Yip [33] Veitch [55]

2012

Compared3DSI volumes with mastectomy specimen volume

30

Patients undergoing mastectomy

be an “art” rather than a science so an experienced surgeon would override the “advice” given by 3D-SI. 3D volume evaluation might improve the implant choices made by less experienced surgeons. This would be difficult to test and has not been done to date. Ahcan et al. [78] used 3D-SI to produce a breast replica cast, which is a hollow mould made from the contralateral breast to aid shaping of a tissue flap into a breast shape intra-operatively, to better resemble the other breast in post-mastectomy reconstruction. In their series of twelve flap-based breast reconstructions, the operation times were shorter than using standard methods without a cast and no secondary procedures were needed. Finally Eder et al. have developed formulas using 3D-SI to predict required resection weight in reduction mammoplasty. However, it is not clear if they or others are using this currently in clinical practice [79]. Objective assessment of outcome Objective measurements of volume and symmetry using 3D-SI have been applied in the evaluation of breast surgery aesthetic outcomes. Henseler et al. [62] used 3D photography to compare immediate unilateral LD breast reconstruction with the unaffected breast in forty-four patients. The reconstructed breast was of significantly smaller volume. The sub-components of asymmetry were also studied, and shape was the most contributory component, followed by position of the breast, orientation and then size. Similarly, Isogai [1] compared the reconstructed and nonreconstructed breast in terms of volume and asymmetry. This study consisted of 51 cases, 16 TRAM, 15 LD and 20 TE reconstructions. It was found that TRAM flaps after mastectomy and LD flaps after partial mastectomy gave the best symmetry results. Tepper et al. [80] evaluated objective changes after augmentation mammoplasty. As well as establishing the post-operative volume changes they found that the anterior-posterior projection significantly increased. However, this was 20.9% less than expected based on implant dimensions. This was thought to be due to tissue attenuation of the overlying pocket and posterior displacement of the chest wall after augmentation. Tepper et al. [81] have also reported on the anatomic changes occurring after short scarmedial pedicle reduction mammoplasty. Using 3D laser imaging, they identified that there was a significant increase in the percentage of tissue above the IMF. Blechman et al. [82] used a multimodality approach to assessing the outcomes from using a lateral inframammary fold incision for nipple-sparing mastectomy, including 3D-SI and clinical outcomes. 3D-SI of seven patients preand post-operatively demonstrated that the reconstructed breasts were larger, wider and more projected than the pre-operative breasts. Fat grafting to the breast has been met with renewed enthusiasm over the last five years after initial safety concerns. Quantitative information about the rate of fat survival is important for guiding surgeons and patients. A recent review analysed several methods for evaluating this including 3D-SI [83]. The authors concluded that 3D-SI is a suitable tool when frequent follow-up and fast data acquisition is needed. Choi et al. [84] measured volume

Excellent correlation between known geometric volume and3DSI (r > 0.995, P < 1014).3DSI tended to underestimate volume Excellent correlation between3DSI and plaster casting volumes (r > 0.992, P < 1011) Strong linear correlation between mastectomy volume and3DSI volume (r ¼ 0.95, p < 0.001)

retention over time using 3D photography and found that it was dependent on volume injected and time, where patients receiving larger volumes of fat retained more volume long term. Across all volume groups approximately 40e50% of the injected fat volume survived long term. A study at the same centre compared fat grafting from the abdomen and thighs. There was no difference in fat retention between the two donor sites [85]. Del Vecchio et al. [86] investigated the graft to capacity ratio. Using 3D-SI they ascertained that the ratio was 113%, and that in outliers where the ratio was outside one standard deviation, the percentage volume maintenance had an inverse relationship with the ratio. The same centre has begun to use a combination of implants and fat grafting when the overlying soft tissue is thin or insufficient. 3D-SI demonstrated that an average of 57% of the volume of fat graft persisted at one year after surgery [87]. In a further study they used an external expansion device (BRAVA, Inc., Miami, Florida) to prepare the breasts for implant exchange with fat grafting [88], in their case study the volume of the breasts were larger post-operatively than pre-operatively. In aesthetic surgery, fat grafting has been used as an alternative to implants for augmentation. One case report [89] used 3D-SI to document the volume changes over time. Another study [90] successfully imaged seven patients to assess fat retention demonstrating one third fat retention. A third study [91] used progenitorenriched adipose tissue transplantation instead of replacement of breast implant after complications. The authors assessed graft retention and found it to be between 40 and 80%. Quantifying post-operative changes over time It is well known that breast morphology changes over time after surgery. Detailed objective information could facilitate preoperative patient counselling and pre-operative planning. Eder et al. [92] evaluated fourteen patients over a six month follow up period after sub-pectoral breast augmentation. Breast volume, linear distance between specific anatomic landmarks, breast surface area and contour deviations were compared. The IMF dropped by an average of 1.4 cm between the first post-operative image (2e3 days post-surgery) and the final image at six months. Breast volumes decreased from the first post-operative volume, and the final breast volume was reached between one and three months after surgery. A similar study was undertaken by Ji et al. [93] using 3D-SI to investigate morphological changes after dual-plane augmentation mammoplasty. They found that sternal notchnipple distance was stable after one month, whereas nipple to IMF continued to increase until 6 months as volume redistributed from upper to lower pole. The authors concluded that the dualplane technique preferentially increases fullness in the lower pole. Small et al. [94] used 3D photography to investigate morphological changes over time after short scar-medial pedicle reduction mammoplasty. Volume loss occurred during the first year and, again, they demonstrated that the percent of tissue in the upper pole decreased from 76% to 69%, illustrating the ‘bottoming out’ phenomenon which was described in another of their

Please cite this article in press as: O'Connell RL, et al., Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery, The Breast (2015), http://dx.doi.org/10.1016/j.breast.2015.03.011

R.L. O'Connell et al. / The Breast xxx (2015) 1e12

publications [95]. A subsequent study by the group demonstrated that between post-operative years one and three there was no further significant volume loss or further redistribution of the breast tissue [96]. The authors concluded that by compiling a series of actual changes post-operatively using 3D-SI it may be possible to provide guidelines for pre-operative planning. Comparing different surgical techniques in terms of cosmetic outcome It is difficult to objectively compare the aesthetic outcome of one type of procedure with another in breast surgery. 3D-SI is a potential solution. Derderian et al. [97] analysed outcomes of wise-pattern breast reconstruction using AlloDerm and a vascularized dermal-subcutaneous pedicle. Pre-operative and postoperative volume discrepancy between the affected and unaffected breasts was measured using 3D-SI. There were no statistically significant differences in percentage volume differences between this group and data previously published using tissue expansion. Another recent study compared aesthetic outcome and patient satisfaction after LD reconstruction with and without thoracodorsal nerve division [98]. 3D-SI was used to assess volume changes between six weeks and six months post-operatively. There was no difference in the decrease in volume between the two groups. One drawback of this study is the follow up time. It may be that a substantial proportion of the volume loss due to the denervation of the muscle occurs before 6 weeks or after 6 months. Eder et al. [99] recently compared outcomes of T-scar and vertical-scar reduction mammoplasty using 3D laser imaging, though the authors acknowledged that the indication for each technique is slightly different according to age and body habitus. Morphological changes after T-scar reduction mammoplasty were completed 3e6 months earlier than after vertical-scar reduction and also that post-operative soft tissue migration from the superior to the inferior breast portion occurred significantly more in the vertical-scar group. Kovacs et al. [100] compared round and anatomical implants for breast augmentation in 27 patients to objectively assess both types of implant on contour. While overall breast volume increased in accordance with the implant volume, breast projection increased 22% less than expected for round implants and 25% less than expected for anatomical implants. There was no significant difference in the amount by which the IMF dropped between the two. 3D surface imaging role in breast conserving therapy (BCT) The majority of published data regarding the use of 3D-SI in breast cancer surgery focuses on breast reconstruction after mastectomy. As with post-mastectomy reconstruction there is a lack of objective measurement of BCT. Moyer et al. [63] addressed this by using 3D photography to assess symmetry in 23 patients after BCT and compared with a control group of 35 ageematched, unoperated patients. The degree of asymmetry was significantly higher in the BCT group. There was a positive correlation between percentage of breast tissue excised and asymmetry but tumour location, age and reoperation did not impact on asymmetry scores. This study is small and may have been underpowered to show further statistically significant differences. Another study [101] assessed the cosmetic outcomes following BCT using 3D-SI, panel assessment and questionnaire between two ethnic groups. Interestingly all raters reported that the African American patients had greater asymmetry than the white patients but there was no statistically significant differences in 3D objective outcomes. With a larger study it may be possible to identify risk factors and the subtle changes to the breast which result in a poor outcome according to panel and objective measurements.

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Discussion In any review of a relatively new imaging modality it is difficult to find documented evidence of failure or inadequacy as only the protagonists will publish initially. 3D-SI has a number of positive features: image acquisition is fast, there is no contact by the machinery or operator with the patient's body and there is no radiation or chemical exposure risk. The procedure does not require the patient to move into awkward positions or remain still for more than a few seconds. Studies report that imaging is accurate and reproducible [30,31,33,34,37,38,58]. Since studies of the same patient over time are central to many of the potential clinical applications of this technology, reproducibility must be tested to a very high degree of accuracy. Such “internal validity” is of greater importance in these studies, than achieving comparable measures with other tests such as mastectomy specimen volume or MRI. Evaluation of the cosmetic success of the surgery and objective comparison of different techniques has been lacking in the field of breast surgery but 3D-SI offers the potential for an objective semiautomated assessment of cosmetic outcome following surgery. It has already begun to improve surgeons' understanding of morphological changes occurring post-operatively, thus potentially allowing these pitfalls to be avoided. In the current era when outcome measurement is a priority, evaluation of local recurrence rates, patient satisfaction and aesthetic outcome will need to be taken together to evaluate a breast surgical service. In order to be used in a comparative way, the wealth of information encompassed in a 3D image would need to be summarised by some form of measurement and scoring system which would, inherently, lead to some subjectivity in terms of assigning values to parameters and weighting them in an overall score. To date many of the articles reporting the use of 3D-SI have stated that surgeons or patients found the 3D-SI useful (see Table 3). For example, in aesthetic surgery, the ability to simulate likely outcomes with different volume implants is an attractive patient education tool and patients report finding it helpful [75]. However, there is no data comparing patient satisfaction after augmentation in women who did and did not have access to 3D simulation. It has been stated that 3D-SI could be used to predict outcome after breast conservation, and therefore improve planning, but, to date, this has not been tested. Until a prospective trial has been carried out we do not know whether 3D-SI leads to better surgical planning than clinical acumen alone. A further area of promise which has not been studied is in the enhancement of communication between clinicians. Many plastic surgical units are geographically remote from the referring breast surgeons. 2D photographs are sometimes used in multidisciplinary meetings [102] to facilitate discussion, but they have their own limitations, and it may be that a 3D image will be more informative. Again, the added value of 3D surface images has not been investigated. One exciting project in the field of 3D imaging is the PICTURE project [103], [104]. This is a large European collaborative project to develop a tool that could predict a patient's breast appearance after breast-conserving surgery. This could potentially improve the patient experience, expectations and education in this area. It will also be developed to assist in improving surgical planning and outcomes. The project is currently in the prototype development stage but it will be of great interest to the breast surgery community to see if this 3D tool is helpful to the patients and surgeons alike. Limitations One of the main limitations of this technology is the cost, up to £62,000 (or $100,000). Such an outlay may not be justifiable in

Please cite this article in press as: O'Connell RL, et al., Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery, The Breast (2015), http://dx.doi.org/10.1016/j.breast.2015.03.011

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small centres where the throughput of patients is low. However, cheaper and more portable devices are becoming available which may bridge the gap. Innovation in this field is exciting, for example the use of games console devices to generate 3D images. Staff must be trained in use of the equipment, software and interpretation of results and it has been recognised that room lighting may affect results so must be standardised, and the equipment must be calibrated regularly to maintain optimal performance. Failure to recognise and adjust for these may result in data being inaccurate or unusable [90]. This may lead to misleading results or failure of studies. Imaging is thought to be less accurate in the ptotic breast due to the infra-mammary fold being obscured when the breast is imaged in the upright position, and estimation of the chest wall adds another dimension of uncertainty. Authors have developed innovative methods to try and overcome these issues [35,51], but at present there is no consensus on which method is best. Reproducibility is of crucial importance in studies of evolving changes over time. Small variations in patient positioning, placement of landmarks and intra- or inter-observer measurements could mask or exaggerate clinically relevant findings. This is a problem particularly in breast appearance because of the paucity of fixed bony landmarks in comparison with, for example, the face. Conclusion While 3D-SI is an exciting development, it has yet to demonstrate its value in clinical practice. Studies to date have been singlecentred and relatively small. Further research is needed to determine whether this technology accurately predicts post-operative outcome, enhances surgical decision making, objectively evaluates outcome and improves communication within a multidisciplinary team and with patients or whether it will remain, as currently, a tool for patient education and marketing in the aesthetic surgical sector. Conflict of interest statement All authors have no conflicts of interest. Funding sources There are no specific funding sources to declare for this article submission, but the Royal Marsden / Institute for Cancer Research is an NIHR Biomedical Research Centre and this support is acknowledged. Ethical approval Ethical approval was not required for this article submission. References [1] Isogai N, Sai K, Kamiishi H, Watatani M, Inui H, Shiozaki H. Quantitative analysis of the reconstructed breast using a 3-dimensional laser light scanner. Ann Plast Surg 2006;56:237e42. [2] Onesti MG, Mezzana P, Martano A, Scuderi N. Breast asymmetry: a new vision of this malformation. Acta Chir Plast 2004;46:8e11. [3] Thomson HJ, Potter S, Greenwood RJ, Bahl A, Barker J, Cawthorn SJ, et al. A prospective longitudinal study of cosmetic outcome in immediate latissimus dorsi breast reconstruction and the influence of radiotherapy. Ann Surg Oncol 2008;15:1081e91. [4] Kim EK, Eom JS, Hwang CH, Ahn SH, Son BH, Lee TJ. Immediate transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction in underweight Asian patients. Breast Cancer 2014 Nov;21(6):693e7. [5] Cardoso MJ, Cardoso J, Santos AC, Barros H, Cardoso de OM. Interobserver agreement and consensus over the esthetic evaluation of conservative treatment for breast cancer. Breast 2006;15:52e7. [6] Kim MS, Sbalchiero JC, Reece GP, Miller MJ, Beahm EK, Markey MK. Assessment of breast aesthetics. Plast Reconstr Surg 2008;121:186ee94e.

[7] Pusic AL, Chen CM, Cano S, Klassen A, McCarthy C, Collins ED, et al. Measuring quality of life in cosmetic and reconstructive breast surgery: a systematic review of patient-reported outcomes instruments. Plast Reconstr Surg 2007;120:823e37. [8] Kanatas A, Velikova G, Roe B, Horgan K, Ghazali N, Shaw RJ, et al. Patientreported outcomes in breast oncology: a review of validated outcome instruments. Tumori 2012;98:678e88. [9] Sneeuw KC, Aaronson NK, Yarnold JR, Broderick M, Regan J, Ross G, et al. Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients' ratings, observers' ratings, and objective assessments. Radiother Oncol 1992;25:153e9. [10] Smith Jr DJ, Palin Jr WE, Katch VL, Bennett JE. Breast volume and anthropomorphic measurements: normal values. Plast Reconstr Surg 1986;78: 331e5. [11] Westreich M. Anthropomorphic breast measurement: protocol and results in 50 women with aesthetically perfect breasts and clinical application. Plast Reconstr Surg 1997;100:468e79. [12] Katariya RN, Forrest AP, Gravelle IH. Breast volumes in cancer of the breast. Br J Cancer 1974;29:270e3. [13] Schultz RC, Dolezal RF, Nolan J. Further applications of Archimedes' principle in the correction of asymmetrical breasts. Ann Plast Surg 1986;16:98e101. [14] Campaigne BN, Katch VL, Freedson P, Sady S, Katch FI. Measurement of breast volume in females: description of a reliable method. Ann Hum Biol 1979;6:363e7. [15] Edsander-Nord A, Wickman M, Jurell G. Measurement of breast volume with thermoplastic casts. Scand J Plast Reconstr Surg Hand Surg 1996;30:129e32. [16] Neal AJ, Torr M, Helyer S, Yarnold JR. Correlation of breast dose heterogeneity with breast size using 3D CT planning and dose-volume histograms. Radiother Oncol 1995;34:210e8. [17] Fowler PA, Casey CE, Cameron GG, Foster MA, Knight CH. Cyclic changes in composition and volume of the breast during the menstrual cycle, measured by magnetic resonance imaging. Br J Obstet Gynaecol 1990;97:595e602. [18] Xi W, Perdanasari AT, Ong Y, Han S, Min P, Su W, et al. Objective breast volume, shape and surface area assessment: a systematic review of breast measurement methods. Aesthetic Plast Surg 2014;38:1116e30. [19] Edstrom LE, Robson MC, Wright JK. A method for the evaluation of minor degrees of breast asymmetry. Plast Reconstr Surg 1977;60:812e4. [20] Chavoin JP, Teysseyre A, Grolleau JL. “Morphobreast”: patient's data bank management for objective selection of implant's volume in hypotrophic breasts. Ann Chir Plast Esthet 2005;50:487e93. [21] Cardoso MJ, Cardoso JS, Vrieling C, Macmillan D, Rainsbury D, Heil J, et al. Recommendations for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat 2012;135:629e37. [22] Fitzal F, Krois W, Trischler H, Wutzel L, Riedl O, Kuhbelbock U, et al. The use of a breast symmetry index for objective evaluation of breast cosmesis. Breast 2007;16:429e35. [23] Cardoso MJ, Cardoso J, Amaral N, Azevedo I, Barreau L, Bernardo M, et al. Turning subjective into objective: the BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast 2007;16: 456e61. [24] Cardoso JS, Cardoso MJ. Towards an intelligent medical system for the aesthetic evaluation of breast cancer conservative treatment. Artif Intell Med 2007;40:115e26. [25] Cardoso MJ. Is three better than two? the use of 3D scanners in the assessment of aesthetic results in local breast cancer treatment. Breast 2012;21: 227e8. [26] Cardoso MJ, Oliveira H, Cardoso J. Assessing cosmetic results after breast conserving surgery. J Surg Oncol 2014;110:37e44. ~es A, Cardoso MJ. Methods for the aesthetic [27] Oliveira HP, Cardoso JS, Magalha evaluation of breast Cancer conservation treatment: a technological review. Curr Med Imaging Rev 2013;9:32e46. [28] Burke PH, Beard FH. Stereophotogrammetry of the face. A preliminary investigation into the accuracy of a simplified system evolved for contour mapping by photography. Am J Orthod 1967;53:769e82. [29] Burke PH, Beard LF. Stereo-photogrammetry of the face. Rep Congr Eur Orthod Soc 1967:279e93. [30] Kovacs L, Eder M, Hollweck R, Zimmermann A, Settles M, Schneider A, et al. Comparison between breast volume measurement using 3D surface imaging and classical techniques. Breast 2007;16:137e45. [31] Losken A, Seify H, Denson DD, Paredes Jr AA, Carlson GW. Validating threedimensional imaging of the breast. Ann Plast Surg 2005;54:471e6. [32] Kovacs L, Yassouridis A, Zimmermann A, Brockmann G, Wohnl A, Blaschke M, et al. Optimization of 3-dimensional imaging of the breast region with 3-dimensional laser scanners. Ann Plast Surg 2006;56:229e36. [33] Henseler H, Khambay BS, Bowman A, Smith J, Paul SJ, Oehler S, et al. Investigation into accuracy and reproducibility of a 3D breast imaging system using multiple stereo cameras. J Plast Reconstr Aesthet Surg 2011;64: 577e82. [34] Yip JM, Mouratova N, Jeffery RM, Veitch DE, Woodman RJ, Dean NR. 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. Ann Plast Surg 2012;68:135e41. [35] Henseler H, Ju X, Ayoub A, Ray AK. The importance of the pose in threedimensional imaging of the ptotic breast. J Plast Reconstr Aesthet Surg 2013;66:1551e6.

Please cite this article in press as: O'Connell RL, et al., Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery, The Breast (2015), http://dx.doi.org/10.1016/j.breast.2015.03.011

R.L. O'Connell et al. / The Breast xxx (2015) 1e12 [36] Kovacs L, Eder M, Hollweck R, Zimmermann A, Settles M, Schneider A, et al. New aspects of breast volume measurement using 3-dimensional surface imaging. Ann Plast Surg 2006;57:602e10. [37] Mailey B, Freel A, Wong R, Pointer DT, Khoobehi K. Clinical accuracy and reproducibility of portrait 3D surgical simulation platform in breast augmentation. Aesthet Surg J 2013;33:84e92. [38] Liu C, Ji K, Sun J, Luan J. Does respiration influence breast volumetric change measurement with the three-dimensional scanning technique? Aesthet Plast Surg 2014 Feb;38(1):115e9. [39] Eder M, Waldenfels FV, Swobodnik A, Kloppel M, Pape AK, Schuster T, et al. Objective breast symmetry evaluation using 3-D surface imaging. Breast 2012;21:152e8. [40] Tepper OM, Small K, Rudolph L, Choi M, Karp N. Virtual 3-dimensional modeling as a valuable adjunct to aesthetic and reconstructive breast surgery. Am J Surg 2006;192:548e51. [41] Tzou CH, Artner NM, Pona I, Hold A, Placheta E, Kropatsch WG, et al. Comparison of three-dimensional surface-imaging systems. J Plast Reconstr Aesthet Surg 2014;67:489e97. [42] Henseler H, Kuznetsova A, Vogt P, Rosenhahn B. Validation of the Kinect device as a new portable imaging system for three-dimensional breast assessment. J Plast Reconstr Aesthet Surg 2014 April;67(4):483e8. [43] Hoeffelin H, Jacquemin D, Defaweux V, Nizet JL. A methodological evaluation of volumetric measurement techniques including three-dimensional imaging in breast surgery. Biomed Res Int 2014;2014:573249. [44] Patete P, Eder M, Raith S, Volf A, Kovacs L, Baroni G. Comparative assessment of 3D surface scanning systems in breast plastic and reconstructive surgery. Surg Innov 2013;20:509e15. [45] Patete P, Riboldi M, Spadea MF, Catanuto G, Spano A, Nava M, et al. Motion compensation in hand-held laser scanning for surface modeling in plastic and reconstructive surgery. Ann Biomed Eng 2009;37:1877e85. [46] Wheat JS, Choppin S, Goyal A. Development and assessment of a Microsoft Kinect based system for imaging the breast in three dimensions. Med Eng Phys 2014;36:732e8. [47] Oliveira HP, Silva MD, Magalhaes A, Cardoso MJ, Cardoso JS. Is kinect depth data accurate for the aesthetic evaluation after breast cancer surgeries? Iberian Conference on Pattern Recognition and Image Analysis (IbPRIA). 2013. p. 261e8. LNCS 7887. €hlmann Stefanie TL, Hewes Jeremy, Williamson Andrew I, et al. Breast [48] Po volume measurement using a games console input device, breast imaging, lecture notes in computer science. Volume 2014;8539:666e73. [49] Tepper OM, Unger JG, Small KH, Feldman D, Kumar N, Choi M, et al. Mammometrics: the standardization of aesthetic and reconstructive breast surgery. Plast Reconstr Surg 2010;125:393e400. [50] Lee J, Kawale M, Merchant FA, Weston J, Fingeret MC, Ladewig D, et al. Validation of stereophotogrammetry of the human torso. Breast Cancer (Auckl) 2011;5:15e25. [51] Liu C, Luan J, Ji K, Sun J. Measuring volumetric change after augmentation mammaplasty using a three-dimensional scanning technique: an innovative method. Aesthetic Plast Surg 2012;36:1134e9. [52] Rao AK, Karanas Y, Galdino GM, Girod SC. Three-dimensional photography for calculating pre- and post-operative volume in breast surgery. International Congress Series, vol. 1256; 2003. p. 1355. [53] Koch MC, Adamietz B, Jud SM, Fasching PA, Haeberle L, Karbacher S, et al. Breast volumetry using a three-dimensional surface assessment technique. Aesthetic Plast Surg 2011;35:847e55. [54] Eriksen C, Lindgren EN, Olivecrona H, Frisell J, Stark B. Evaluation of volume and shape of breasts: comparison between traditional and three-dimensional techniques. J Plast Surg Hand Surg 2011;45:14e22. [55] Veitch D, Burford K, Dench P, Dean N, Griffin P. Measurement of breast volume using body scan technology(computer-aided anthropometry). Work 2012;41(Suppl. 1):4038e45. [56] Thomson JG, Liu YJ, Restifo RJ, Rinker BD, Reis A. Surface area measurement of the female breast: phase I. Validation of a novel optical technique. Plast Reconstr Surg 2009;123:1588e96. [57] Lewis PG, Mattison GL, Kim HY, Gupta SC. Evaluation of 3D photographic imaging as a method to measure differential volumes in reconstructed breast tissue. Plast Reconstr Surg 2014;133(3):39. [58] Henseler H, Smith J, Bowman A, Khambay BS, Ju X, Ayoub A, et al. Investigation into variation and errors of a three-dimensional breast imaging system using multiple stereo cameras. J Plast Reconstr Aesthet Surg 2012;65:e332e7. [59] Nahabedian MY, Galdino G. Symmetrical breast reconstruction: is there a role for three-dimensional digital photography? Plast Reconstr Surg 2003;112:1582e90. [60] Losken A, Fishman I, Denson DD, Moyer HR, Carlson GW. An objective evaluation of breast symmetry and shape differences using 3-dimensional images. Ann Plast Surg 2005;55:571e5. [61] Henseler H, Smith J, Bowman A, Khambay BS, Ju X, Ayoub A, et al. Subjective versus objective assessment of breast reconstruction. J Plast Reconstr Aesthet Surg 2013;66:634e9. [62] Henseler H, Smith J, Bowman A, Khambay BS, Ju X, Ayoub A, et al. Objective evaluation of the latissimus dorsi flap for breast reconstruction using threedimensional imaging. J Plast Reconstr Aesthet Surg 2012;65:1209e15. [63] Moyer HR, Carlson GW, Styblo TM, Losken A. Three-dimensional digital evaluation of breast symmetry after breast conservation therapy. J Am Coll Surg 2008;207:227e32.

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[64] Liu C, Luan J, Mu L, Ji K. The role of three-dimensional scanning technique in evaluation of breast asymmetry in breast augmentation: a 100-case study. Plast Reconstr Surg 2010;126:2125e32. [65] Takasaki H. Moire topography. Appl Opt 1970;9:1467e72. [66] Catanuto G, Patete P, Spano A, Pennati A, Baroni G, Nava MBNew technologies for the assessment of breast surgical outcomes. Aesthet Surg J 2009;29: 505e8. [67] Catanuto G, Spano A, Pennati A, Riggio E, Farinella GM, Impoco G, et al. Experimental methodology for digital breast shape analysis and objective surgical outcome evaluation. J Plast Reconstr Aesthet Surg 2008;61:314e8. [68] Farinella GM, Impoco G, Gallo G, Spoto S, Catanuto G, Nava MB. Objective outcome evaluation of breast surgery. Med Image Comput Comput Assist Interv 2006;9:776e83. [69] Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 1979;5:257e61. [70] Galdino GM, Nahabedian M, Chiaramonte M, Geng JZ, Klatsky S, Manson P. Clinical applications of three-dimensional photography in breast surgery. Plast Reconstr Surg 2002;110:58e70. [71] Tepper OM, Karp NS, Small K, Unger J, Rudolph L, Pritchard A, et al. Threedimensional imaging provides valuable clinical data to aid in unilateral tissue expander-implant breast reconstruction. Breast J 2008;14:543e50. [72] Tanabe YN, Honda T, Nakajima Y, Sakurai H, Nozaki M. Intraoperative application of three-dimensional imaging for breast surgery. Scand J Plast Reconstr Surg Hand Surg 2005;39:349e52. [73] Esme DL, Bucksch A, Beekman WH. Three-dimensional laser imaging as a valuable tool for specifying changes in breast shape after augmentation mammaplasty. Aesthet Plast Surg 2009;33:191e5. [74] Gladilin E, Gabrielova B, Montemurro P, Heden P. Customized planning of augmentation mammaplasty with silicon implants using three-dimensional optical body scans and biomechanical modeling of soft tissue outcome. Aesthet Plast Surg 2011;35:494e501. [75] Donfrancesco A, Montemurro P, Heden P. Three-dimensional simulated images in breast augmentation surgery: an investigation of patients' satisfaction and the correlation between prediction and actual outcome. Plast Reconstr Surg 2013;132:810e22. [76] de Heras Ciechomski P, Constantinescu M, Garcia J, Olariu R, Dindoyal I, Le Huu S. Development and implementation of a web-enabled 3D consultation tool for breast augmentation surgery based on 3D-image reconstruction of 2D pictures. J Med Internet Res 2012 Feb 3;14(1):e21. [77] Szychta P, Raine C, Butterworth M, Stewart K, Witmanowski H, Zadrozny M, et al. Preoperative implant selection for two stage breast reconstruction with 3D imaging. Comput Biol Med 2014;44:136e43. [78] Ahcan U, Bracun D, Zivec K, Pavlic R, Butala P. The use of 3D laser imaging and a new breast replica cast as a method to optimize autologous breast reconstruction after mastectomy. Breast 2012;21:183e9. [79] Eder M, Grabhorn A, Waldenfels F, Schuster T, Papadopulos NA, Machens HG, et al. Prediction of breast resection weight in reduction mammaplasty based on 3-dimensional surface imaging. Surg Innov 2013;20:356e64. [80] Tepper OM, Small KH, Unger JG, Feldman DL, Kumar N, Choi M, et al. 3D analysis of breast augmentation defines operative changes and their relationship to implant dimensions. Ann Plast Surg 2009;62:570e5. [81] Tepper OM, Choi M, Small K, Unger J, Davidson E, Rudolph L, et al. An innovative three-dimensional approach to defining the anatomical changes occurring after short scar-medial pedicle reduction mammaplasty. Plast Reconstr Surg 2008;121:1875e85. [82] Blechman KM, Karp NS, Levovitz C, Guth AA, Axelrod DM, Shapiro RL, et al. The lateral inframammary fold incision for nipple-sparing mastectomy: outcomes from over 50 immediate implant-based breast reconstructions. Breast J 2013;19:31e40. [83] Herold C, Ueberreiter K, Busche MN, Vogt PM. Autologous fat transplantation: volumetric tools for estimation of volume survival. A systematic review. Aesthet Plast Surg 2013;37:380e7. [84] Choi M, Small K, Levovitz C, Lee C, Fadl A, Karp NS. The volumetric analysis of fat graft survival in breast reconstruction. Plast Reconstr Surg 2013;131: 185e91. [85] Small K, Choi M, Petruolo O, Lee C, Karp N. Is there an ideal donor site of fat for secondary breast reconstruction? Aesthet Surg J 2014;34:545e50. [86] Del Vecchio DA, Del Vecchio SJ. The graft-to-capacity ratio: volumetric planning in large-volume fat transplantation. Plast Reconstr Surg 2014;133: 561e9. [87] Auclair E, Blondeel P, Del Vecchio DA. Composite breast augmentation: softtissue planning using implants and fat. Plast Reconstr Surg 2013;132: 558e68. [88] Del Vecchio DA. “SIEF”esimultaneous implant exchange with fat: a new option in revision breast implant surgery. Plast Reconstr Surg 2012;130: 1187e96. [89] Howes BH, Fosh B, Watson DI, Yip JM, Eaton M, Smallman A, et al. Autologous fat grafting for whole breast reconstruction. Plast Reconstr Surg Glob Open 2014;2:e124. [90] Spear SL, Pittman T. A prospective study on lipoaugmentation of the breast. Aesthet Surg J 2014;34:400e8. [91] Yoshimura K, Asano Y, Aoi N, Kurita M, Oshima Y, Sato K, et al. Progenitorenriched adipose tissue transplantation as rescue for breast implant complications. Breast J 2010;16:169e75.

Please cite this article in press as: O'Connell RL, et al., Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery, The Breast (2015), http://dx.doi.org/10.1016/j.breast.2015.03.011

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[92] Eder M, Waldenfels F, Sichtermann M, Schuster T, Papadopulos NA, Machens HG, et al. Three-dimensional evaluation of breast contour and volume changes following subpectoral augmentation mammaplasty over 6 months. J Plast Reconstr Aesthet Surg 2011;64:1152e60. [93] Ji K, Luan J, Liu C, Mu D, Mu L, Xin M, et al. A prospective study of breast dynamic morphological changes after dual-plane augmentation mammaplasty with 3D scanning technique. PLoS One 2014;9:e93010. [94] Small KH, Tepper OM, Unger JG, Kumar N, Feldman DL, Choi M, et al. Redefining pseudoptosis from a 3D perspective after short scar-medial pedicle reduction mammaplasty. J Plast Reconstr Aesthet Surg 2010;63:346e53. [95] Choi M, Unger J, Small K, Tepper O, Kumar N, Feldman D, et al. Defining the kinetics of breast pseudoptosis after reduction mammaplasty. Ann Plast Surg 2009;62:518e22. [96] Quan M, Fadl A, Small K, Tepper O, Kumar N, Choi M, et al. Defining pseudoptosis (bottoming out) 3 years after short-scar medial pedicle breast reduction. Aesthet Plast Surg 2011;35:357e64. [97] Derderian CA, Karp NS, Choi M. Wise-pattern breast reconstruction: modification using AlloDerm and a vascularized dermal-subcutaneous pedicle. Ann Plast Surg 2009;62:528e32.

[98] Szychta P, Butterworth M, Dixon M, Kulkarni D, Stewart K, Raine C. Breast reconstruction with the denervated latissimus dorsi musculocutaneous flap. Breast 2013;22:667e72. [99] Eder M, Kloppel M, Muller D, Papadopulos NA, Machens HG, Kovacs L. 3-D analysis of breast morphology changes after inverted T-scar and vertical-scar reduction mammaplasty over 12 months. J Plast Reconstr Aesthet Surg 2013;66:776e86. [100] Kovacs L, Eder M, Zimmermann A, Muller D, Schuster T, Papadopulos NA, et al. Three-dimensional evaluation of breast augmentation and the influence of anatomic and round implants on operative breast shape changes. Aesthet Plast Surg 2012;36:879e87. [101] Hirsch EM, Chukwu CS, Butt Z, Khan SA, Galiano RD. A pilot assessment of ethnic differences in cosmetic outcomes following breast conservation therapy. Plast Reconstr Surg Glob Open 2014;2:e94. [102] Rusby JE, Gough J, Harris PA, MacNeill FA. Oncoplastic multidisciplinary meetings: a necessity or luxury? Ann R Coll Surg Engl 2011;93:273e4. [103] http://www.inescporto.pt/~hfpo/papers/Sabczynski_VPH_2014 [accessed 11.02.2015]. [104] https://www.ucl.ac.uk/ctg/trials/breast/picture/picture-XS.

Please cite this article in press as: O'Connell RL, et al., Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery, The Breast (2015), http://dx.doi.org/10.1016/j.breast.2015.03.011