3-Dimensional objective aesthetic evaluation to replace panel assessment after breast-conserving treatment

Abstract

Background Two-thirds of patients with early breast cancer undergo breast-conserving treatment (BCT). Aesthetic outcome is important and has long term implications for psychosocial wellbeing. The aesthetic goal of BCT is symmetry for which there is no gold-standard measure. Panel scoring is the most widely adopted assessment but has well-described limitations. This paper describes a model to objectively report aesthetic outcome using measures derived from 3-dimensional surface images (3D-SI). Method Objective measures and panel assessment were undertaken independently for 3D-SI of women who underwent BCT 1–5 years previously. Univariate analysis was used to test for association between measures and panel score. A forward stepwise multiple linear regression model was fitted to identify 3D measurements that jointly predicted the mean panel score. The fitted model coefficients were used to predict mean panel scores for an independent validation set then compared to the mean observed panel score. Results Very good intra-panel reliability was observed for the training and validation sets (wκ = 0.87, wκ = 0.84). Six 3D-measures were used in the multivariate model. There was a good correlation between the predicted and mean observed panel score in the training (n = 190) and validation (n = 100) sets (r = 0.68, r = 0.65). The 3D model tended to predict scores towards the median. The model was calibrated which improved the distribution of predicted scores. Conclusion A six-variable objective aesthetic outcome model for BCT has been described and validated. This can predict and could replace panel assessment, facilitating the independent and unbiased evaluation of aesthetic outcome to communicate and compare results, benchmark practice, and raise standards.

Improving preparedness prior to reconstructive breast surgery via inclusion of 3D images during pre-operative counselling: a qualitative analysis

“…This is important, because over 40% of women undergoing mastectomy and reconstruction perceived their outcome to be worse than expected—particularly with regards to aesthetics [ 11 ]. Surgical teams already derive added value from utilising 3D images for aesthetic assessment after breast surgery [ 12 ]. Furthermore, an early phase randomised-controlled-trial suggested that viewing 3D images improved patient confidence going into surgery when compared with 2D photographs [ 13 ].…”

Breast Asymmetry Evaluation Using Objective Measures after Breast Cancer Surgery

“…Cosmetic outcome after breast reconstructive surgery has been found to affect the patients' quality of life and psychosomatic wellbeing [14]. As modern treatments have ensured excellent survival rates of breast cancer patients, the aesthetic outcome of the surgical procedure demands more attention in addition to disease control [28]. Subjective evaluation based on a visual assessment by one or more observers, including radiation oncologists and plastic surgeons, are employed frequently.…”

“…Another novel visual breast assessment method uses an optical flow algorithm in MATLAB which objectively classifies and numerically scores breast asymmetry [27]. Considering all the statistical data, 3D objective assessment has been proven to be more consistent and accurate, leading it to be a prospective replacement of subjective panel assessment in terms of aesthetic evaluation after breast conserving treatment [28].…”

Evaluation of Intraoperative Volumetric Assessment of Breast Volume Using 3D Handheld Stereo Photogrammetric Device

“…Breast volume is a crucial factor and a key metric that defines breast symmetry, influencing cosmesis and patient satisfaction after breast surgery [ 1 , 2 , 3 ]. Several objective methods for evaluating breast volume and symmetry are widely used, and these methods are based on linear distances such as anthropometric measurements [ 4 , 5 , 6 , 7 ], volumetric measurements using medical imaging technology [ 8 , 9 , 10 , 11 ], techniques like water displacement [ 12 , 13 , 14 , 15 , 16 ], and casting techniques [ 17 , 18 ].…”