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3-D simulation of breast augmentation facilitates presurgical planning

Article-3-D simulation of breast augmentation facilitates presurgical planning

Key iconKey Points

  • Vectra 3D designed to predict patients' appearance after mammaplasty
  • Device aids in communicating with patients, setting expectations
  • Technical limitations include overestimation of intermammary distance, elongation of breasts with glandular ptosis

Dr. Kotlus
SHELBY TOWNSHIP, MICH. — A system for generating a 3-D photo simulation of augmentation mammaplasty outcomes is still a work in progress, but it offers a number of benefits as a tool for patient consultation and planning of breast implant surgery, according to Brett Kotlus, M.D., M.S.

Speaking at the 26th annual scientific meeting of the American Academy of Cosmetic Surgery, Dr. Kotlus reviewed his experience with and evaluation of a proprietary platform (Vectra 3D, Canfield Imaging Systems) designed to predict the appearance of patients after augmentation mammaplasty.

"This is not essential equipment, but I like using it and think patients like it, as well. By presenting information in visual terms, it definitely aids in communicating with patients and helps to set expectations, and it is helpful as a size determination tool," says Dr. Kotlus, in private practice in Shelby Township, Mich.

"In addition, this high-tech platform impresses patients with its 'wow' aspect. Many of the advanced gadgets we have are not even seen by patients, because they are used intraoperatively while patients are sedated. Using this system in the consultation process satisfies patients looking for a surgeon who keeps at the forefront with the latest in technology," Dr. Kotlus says.

Breast augmentation simulation with the Vectra 3D (top) and actual postoperative results. (Photos credit: Brett Kotlus, M.D.)
Dr. Kotlus notes that while several upgrades have already been introduced, the software still has some technical limitations and there remains room for improvement.

SYSTEM SPECIFICATIONS The Vectra 3D system, which is one of several on the market, is a standalone unit that generates an integrated image with 36-megapixel resolution from 12 cameras. It is coupled with a computer that allows for image capture and processing, and the unit features adjustable height and a built-in flash.

"The image itself is not truly 3-D, but rather a 2-D moveable image in a virtual 3-D space," Dr. Kotlus says.

The system is used to simulate the postoperative appearance based on selection of an implant of varying profile and size. It can depict the difference between saline and silicone implants and submuscular versus subglandular placement. Size can be modified in 5 cc increments, and the image can be moved in the virtual 3-D space.

"Without visual tools, surgeons face an obstacle in responding to the question, 'What will I look like after surgery?', which is what patients are mainly interested in. While surgeons have various methods for determining appropriate implant size, patients really want to know how they will look in visual terms," Dr. Kotlus says. "This simulation program is a powerful tool for facilitating the consultation and allows me to show patients what implant I think is too big, too small or just right for their breast shape and size."

ASSESSING PERFORMANCE To investigate the performance of the system, Dr. Kotlus conducted an independent study in which five observers with a nonmedical background were asked to independently review postoperative photos and simulation images placed side-by-side from the first 20 patients for whom the simulation was used. All patients had breast augmentation without lift. The surgeries were done via a transumbilical or transaxillary approach, and implant placement was subfascial or submuscular.

The reviewers were asked to rate the similarity of the images on a scale of 0 (not similar) to 4 (the same). The mean ± standard deviation score for the 20 patients was 2.2 ± 0.9, lying between "somewhat similar" and "very similar." When patients were asked to make the same comparison, the overall similarity score was 2.9.

"This information shows that patients like this tool more than uninvolved observers. Perhaps it gets women more excited about the procedure or more involved in the planning process," Dr. Kotlus says.

Patients were also asked to rate whether the simulation factored into their decision to have surgery, using a scale of 0 to 4. While the mean result was only 2.5, this score may reflect the fact that many patients were already committed to having the surgery with or without the simulation.

"Perhaps the most important question we asked the patients was whether they would recommend the simulation to a friend. Using a scale where the best possible score was 4, the mean was 3.5, indicating that patients really liked this technology," Dr. Kotlus says.

Technical limitations include overestimation of intermammary distance, elongation of breasts with glandular ptosis, blurring in the inframammary crease and underestimation of nipple-areolar complex elevation.

"The inframammary blur is a function of the morphing tools of the software, and it is possible to use the software to move the breasts closer together and reduce the intermammary distance. However, the latter adjustment is not ideal, because it leads to some distortion of breast shape," Dr. Kotlus says.

Occasionally, the software has minor glitches, and while a mastopexy simulation feature is available, it is not intuitive and not built into the breast morphing tools.

"This device and software are still in its early stages, and we have been communicating with Canfield to facilitate improvements," Dr. Kotlus says.


Dr. Kotlus reports no relevant financial interests.

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