3D-printed, patient-specific DIEP flap templates for preoperative planning in breast reconstruction: a prospective case series

Abstract

Background: Modern imaging technologies, such as computed tomographic angiography (CTA), can be useful for preoperative assessment in deep inferior epigastric artery perforator (DIEP) flap surgery. Planning perforator flap design can lead to improved surgical efficiency. However, current imaging modalities are limited by being displayed on a two-dimensional (2D) surface. In contrast, a 3D-printed model provides tactile feedback that facilitates superior understanding. Hence, we have 3D-printed patient-specific deep inferior epigastric artery perforator (DIEP) templates, in an affordable and convenient manner, for preoperative planning. Methods: Twenty consecutive patients undergoing 25 immediate or delayed post-mastectomy autologous breast reconstruction with DIEP or muscle-sparing transverse rectus abdominis (MS-TRAM) flaps are recruited prospectively. Using free, open-source softwares (3D Slicer, Autodesk MeshMixer, and Cura) and desktop 3D printers (Ultimaker 3E and Moment), we created a template based on a patient's abdominal wall anatomy from CTA, with holes and lines indicating the position of perforators, their intramuscular course and the DIEA pedicle.Results: The mean age of patients was 52 . There were 15 immediate and 10 delayed reconstructions.3D printing time took mean 18 hours and 123.7 g of plastic filament, which calculates to a mean material cost of AUD 8.25. DIEP templates accurately identified the perforators and reduced intraoperative perforator identification by 7.29 minutes (P=0.02). However, the intramuscular dissection time was not affected (P=0.34).Surgeons found the template useful for preoperative marking (8.6/10) and planning (7.9/10), but not for intramuscular dissection (5.9/10). There were no immediate flap-related complications.Conclusions: Our 3D-printed, patient-specific DIEP template is accurate, significantly reduces intraoperative perforator identification time and, hence, may be a useful tool for preoperative planning in autologous breast reconstruction.

Use of Three-Dimensional Imaging to Assess the Effectiveness of Volume as a Critical Variable in Breast Implant Selection

“…These systems can be used to create simulations that use the patient's own photographs to approximate what the result would appear like with different volumes and types of implants in place. [30][31][32][33][34] These systems have been shown to be variably effective in educating patients as to what type of result may be obtained after undergoing breast augmentation, specifically focusing on the volume of the implant. 1,3,21,31,[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] Therefore, the goal of this study was to (1) describe the results in a series of consecutive patients undergoing breast augmentation where volume was used as the primary variable in implant selection and (2) evaluate several methods of volume determination, including three-dimensional simulation, to determine which were most effective.…”

“…Historically, several methods of attempting to demonstrate to the patient the effect of increased breast volume have been described, with techniques ranging from the simple including the use of bags filled with rice or water, 17,53,54 to the use of external sizers placed in a bra, 16,19,55 to now more complex techniques related to three-dimensional imaging. 30–34 Regardless of which method is used, all embrace the philosophical concept that the patient should, within reason, have a voice in describing what kind of result she desires. 17,19,21,24,29,46,54…”

“…The Crisalix system used in this study is one of these types of systems. 3,32,33,44,50,56 The technology is based on an artificial intelligence system capable of accurately modeling, in three dimensions, the body of the patient simply using three standard digital photographs without the need for any specific hardware. The result is a three-dimensional model that can be viewed and manipulated using cloud-based technology through the Crisalix app on a computer, tablet, or mobile phone.…”

Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: breast conditions

“…PubMed Results: 11 [30][31][32][33][34][35][36][37][38][39][40] a Jablonka EM, Wu RT, Mittermiller PA, Gifford K, Momeni A.…”

Radiological Society of North America (RSNA) 3D Printing Special Interest Group (SIG) clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: Breast Conditions

“…PubMed Results: 11 [30][31][32][33][34][35][36][37][38][39][40] a. Jablonka EM, Wu RT, Mittermiller PA, Gifford K, Momeni A.…”