Ann Surg Treat Res.  2022 Oct;103(4):195-204. 10.4174/astr.2022.103.4.195.

Clinical use of perioperative magnetic resonance imaging-based breast volumetric analysis in final implant volume prediction for two-stage breast reconstruction

• Kim MJ
• Kim TW
• Hahn HM
• Lee IJ

• KMID: 2534119
• DOI: http://doi.org/10.4174/astr.2022.103.4.195

Abstract

Purpose
Breast volume is an important factor in breast reconstruction; however, the surgeon is expected to deliver the volume expectation with his aesthetic inspiration. Therefore, objective volumetry must be developed. This study aimed to conduct an MRI-based breast volumetric analysis. With periodic analysis of 2-stage breast reconstruction, we suggest the possibility of clinical use of breast volumetry in implant volume prediction.
Methods
This retrospective study included 140 patients who underwent unilateral 2-stage breast reconstruction (tissue expander followed by implant insertion) between January 1, 2017 and December 31, 2019. The MRI image was converted into a 3-dimensional image with a reconstruction program (A-VIEW, Coreline Soft). MRI image was obtained before the surgery and then at 1, 3, 6, 12, and 24 months postoperatively. The volume was automatically calculated.
Results
Compared with the preoperative volume, maximized volume and differences were noted at 1 month and minimized at 1 year. The correlation between MRI-based preoperative breast volumetry and the mastectomy specimen volume was 0.611. Volume difference between the MRI-based preoperative state and the implant volume showed a minimal difference at 1 year. The final implant size prediction formula was calculated using the 1-year postoperative volume (P < 0.001, R ²= 0.594).
Conclusion
To avoid breast reconstruction based solely on the surgeon’s subjective assessment, MRI-based breast volumetry could be a useful method to develop more scientific and objective breast reconstruction planning. We suggest a volume prediction formula that describes the relationship between the postoperative breast volume and the final breast implant size.

Keyword

Breast implantation; Magnetic resonance imaging; Mammaplasty; Three-dimensional imaging

Figure

• 

  Fig. 1 MRI-based three-dimensional (3D) reconstructed breast image. Using an artificial intelligence-based 3D image reconstruction program (A-VIEW, Coreline Soft, Seoul, Korea), the breast tissue boundary was drawn automatically and manually revised using only one conductor (purple area). (A, B) The dorsal boundary was set as a parallel line of the chest wall curvature in front of the rib. The lateral border was defined as the point at which the subcutaneous fat of the breast was located at the same level as the subcutaneous fat of the thorax wall. After revision, each image was automatically integrated into a 3D image. (C, D) Extracted breast volume.

• 

  Fig. 2 Periodical change of cancer-involved breast site and three-dimensional volumetry in 2-stage breast reconstruction compared to preoperative volume. The solid line indicates the breast cancer site volume, while the dotted line indicates body mass index (BMI). The relationship between the cancer-involved site volume and BMI was plotted in a single figure. Breast volume and BMI were maximized and minimized at 1 month and 1 year postoperatively, respectively.

• 

  Fig. 3 Periodical trend of breast volume difference between MRI-based preoperative state and actual implant volume. Box plot represents the median (interquartile range) postoperative breast volume change compared to the final implant size. The mean breast volume change is represented by a black line. The median breast volume at 1 year postoperatively showed a minimal volume difference (P < 0.001).

• 

  Fig. 4 Univariable linear regression using final implant size and postoperative breast volume. The relationship between the final implant size and the postoperative breast volume at 1 year is represented as a distributed chart. The solid line indicates the equation of 1-year postoperative breast volume according to the final implant size.

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