Preoperative implant selection for two stage breast reconstruction with 3D imaging

Implants used for two-stage breast reconstruction are selected exclusively on the basis of the directly measured linear parameters. Therefore, the relevant implant is not always chosen despite the wide range of available products. The aim was to analyze the clinical usefulness of three-dimensional (3D) imaging in the breast implant selection. In 50 patients after unilateral two-stage breast reconstruction, height, width, projection and total volume of both breasts were triply obtained with measuring tape (anthropometric method), thermoplastic casting (thermoplastic method) and 3D imaging (optical method). We measured skin fold thickness with skin caliper. In the optical method, we subtracted the covering tissues and calculated the parameter - "estimated breast implant volume" (EBIV), together with the corresponding "anthropometrically estimated breast implant volume" (aEBIV) in the anthropometric method. Reliability of the three methods was described as repeatability and accuracy, both quantified with parameters: "technical error measurement" (TEM) and "reliability factor" (R). Repeatability showed variation among the repeated measurements. Accuracy determined variability between the real volume of the implant used for reconstruction and the obtained volumetric parameters. Repeatability was the highest for the optical method, comparing to anthropometric and thermoplastic methods (p<0.0001). Accuracy was the highest in the optical method for EBIV, comparing to aEBIV in the anthropometric method and the total volume in three methods (p<0.0001). Level of accuracy for EBIV was in the range of variability among the commercially available implants (p>0.05). In conclusion, implants for breast reconstruction are precisely selected with the 3D scanning method, in comparison to widely used direct measurements or thermoplastic casting.