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2011 4th International Congress on Image and Signal Processing

The Planning System for Breast Augmentation with Implant Pocket Region Indices Shuh-Ping Sun Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan

Jing-Shyr Chen Aesthetic Unit Kaohsiung Veterans General Hospital Kaohsiung, Taiwan

Ben-Chih Yuan Deputy Director Fooyin University Hospital Pintung County, Taiwan Abstract—This study is to establish an optimal implant pocket region indices module, for preoperative planning and postoperative diagnosis of a female breast augmentation surgery. This optimal module converts the breast configuration indicator consisting of breast implant pocket region indices. Due to the preoperative planning for breast implant surgery is depending on breast cup and implant pocket size with extend region of major pectoralis. This study offers a full size 3D breast surface image with relative parameters let surgeon accomplish the pre-surgery planning more accuracy. In addition, the module derived from the proposed computer-aided breast pocket region indicator could be of great use as a tool of communication between patients and surgeons. Keywords-3D anthropometric measurement, Computer-aided surgery, Breast augmentation, Reverse engineering

I.

INTRODUCTION

The compute-aided system applied in this study is a reverse engineering technique which has been successfully introduced into advanced clinical usages [1, 2, 7, 10]. A special feature to these methods is to gain 3D body surface imaging friendly. With the help of different 3D imaging devices, a non-invasive recording in a seating position and the creation of a full size 3D model of the breast region are possible. Furthermore, the 3D technology provides the ability to quantitatively evaluate symmetry, volume, shape, contour, surface, and distance measurements [2, 3]. Current researches mainly involve clinically-experienced specialists for performing pre-surgery 3D computerized simulation and planning [7-10], which have significantly shortened the actual operation time and improved the surgical outcome by foreseeing the possible pitfalls that surgeons may encounter during the operation. The integration in surgical planning system for clinical engineering application to be effective, it must be user friendly. In other word, it must address the functional aspects of the surgical planning system and should be based on an understanding of the requirement of the clinical surgeons. The resulting surgical planning system would be applicable to all stage of the planning process and would proffer several benefits.

978-1-4244-9306-7/11/$26.00 ©2011 IEEE

This study introduces a three-dimensional (3D) scanning and reverse engineering system with breast region measurement methods to parameterize the breast pocket region in order to assess the preoperative planning and postoperative configuration indicator of the female breasts from a biomedical engineer’s viewpoints. However, no preoperative planning of breast implant surgery has been made by implant pocket extended indicator using 3D imaging. The normative definition of breast region can be a useful indicator before and after breast implant surgery. Three-dimensional (3D) body surface imaging represents a convince technique for breast area defined and computation. Quantification of breast area may be helpful in obtaining optimal results of breast implant surgery. In general, this easy-to-adapt system can provide a simple and convenient approach to define as well as verify the physical characteristics of female breasts. And henceforth, this practical system can help the surgeon to determine whether the postoperative breast might be in good matching with valid size as planned. II.

METHODS

The pre-surgery planning for most of clinical surgery is an important guideline. In this study we present a computer-aided preoperative planning system for the breast augmentation surgery under computer based environment. The planning system offers 3D images that can be measure breast region precisely and views from any angle of chest full size surface image. Consequently, this planning system not only can provide a computerized 3D reconstruction of the chest image, it can also incorporate functions for measurement of breast region, breast implant pocket region, as well as planning system parameterize the breast region in order to assess the preoperative planning and postoperative configuration indicator of the female breasts. The process shown in this study allows the surgical strategy to be planned and modified as many times as required. To obtained the full scale 3D breast image, the subject assumed a “normal seating” posture on a standard measuring chair, with the thighs closed up naturally and the hands freely put behind the waist, then hold her breath for measuring 3D breast image. In this study once the full scale 3D breast image

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was obtained, several reference feature positions on the body surface could be defined [1, 2 ,7] to define breast feature area (the area between the second rib and sixth rib; as shown in Fig. 1); and to gain the breast volume and implant pocket region numerically. In addition, three feature lines and related positions were defined with the area from the real human body as shown in 3D breast image (Fig. 2) and described as follows: (a) UBL (upper breast line) – the breast’s highest feature line that lies in the second rib connection line (straight line) in the middle of the anatomical thorax, approximately equals to the line connecting the midpoints of the armpits; (b) NBL (nipple base line) – the second feature line is defined as the connecting line between the nipples; and (c) LBL (lower breast line) – the breasts’ lowest feature line that approximately equals to the line connecting the lower edges of the breasts that contact with the body. The preoperative planning and postoperative diagnosis procedure can be described as follow: (1)Breast implant pocket region The breast implant pocket region for breast augmentation can be planning as figure 3. In figure 3 shown the majority condition in clinical surgery, the original breast under symmetry state by volume and breast region evaluation. The dot line in figure 3 is planning breast implant pocket region. The lower extend border line is LL+2 cm away from nipple position. The upper extend border line is the interception of UBL and circle with radius ra1. Geometric parameters (e.g., partial ellipse) are projected onto the 2D image and the breast extended border line is defined using the appropriate rulers to minimize different operator’s hand drawing margin. The shadow area is going to be the breast region after implant surgery for the best condition. (2) The postoperative diagnosis of breast implant surgery Once complete the surgery the postoperative diagnosis of breast region will begin immediately and will follow up to twenty-four weeks and collecting data every two weeks after surgery until the breast condition approach to the stable status. According clinical experience this work adopt previous result finds out that, 6 months after the normal breast implant surgery most of case’s breast configuration will approached to stable status condition [3]. The 3D breast region measurement obtained process are state as follow: According to anatomy, the position of female breast volume sector lies between the second and sixth ribs, extending beyond the chest wall, and the breast extend margin indicator between UBL and LBL can be defined as a straight line from nipple to UBL named as ra2 to compare with preoperative breast extend margin indicator ra1 (see figure 3). The major equipment and facilities for full-scale 3D breast image capture and analysis is the commercial product with clinical usage. The method presented in this work can not only prevent patients from repetitive examinations but also offer more objective parameters in contrast to the conventional methods.

III.

RESULTS

To ensure the matching between planning and postoperative diagnostic indices to reasonable range precisely, the breast extend indicator were parameterized, doctors could appraise the planning and performance of surgery with ease. To illustrate the planning and diagnosis procedure, a typical case (name as case 1) of breast implant object and breast implant pocket extended region configuration is presented as follows for breast augmentation surgery from A to C+ cup of a female of 45-yr old and 157-cm tall, weighing 52 kg and receiving a salinefilled implant bag of 260 c.c., up to 6 months survey of postsurgery. 1. Breast implant object and implant pocket region The target cup size for case 1 is 340ml and planning the original breast volume (83 ml) for receiving a saline-filled implant bag of 260 ml to build up C+ cup size. The base width of saline bag is 11.8 cm, then according table 1 the type of saline filled bag is 68LP-250 as implant object. The planning breast implant pocket extend region of case 1 is shadow area as shown in figure 4-a. The lower extend border region is 5.5cm away from nipple position and the upper extend border region is defined as indicator ra1 = 8.82 cm as show in figure 4-a and 4-c. The planning parameters of case 1 can be summarized in table 2, therefore the planning cup size and breast implant pocket extend region can be evaluated by the modules invented by this work. 3. Postoperative diagnosis of breast extend region The breast configuration evaluation of post-operative breast implant surgery should be continued while the breasts were beginning to approach a steady state. And that monitoring should be carried out until reaching the final condition. Following the postoperative female breast area measuring breast extend region indicator (ra2 as shown in figure 4-a and 4-b) to compare with the planning preoperative breast extend region indicator (ra1)the difference is less than 5%. The typical case for this study (collecting data every two weeks after surgery) find out the breast cup size and implant pocket extend indicator for planning and post-surgery was match under reasonable condition. The suggested planning and evaluation procedure presented in this typical case study can help plastic surgeons and patients acquire substantial data (Table 3) and image layouts (Fig. 4), making their understandings of breast configuration more objectively. IV.

DISCUSSION AND CONCLUSION

The analytical parameters of preoperative planning, such as breast implant object and implant pocket extend region, can be derived from a three-dimensional, full-sized image process under augmentation condition. This optimal module converts the breast implant object and implant pocket extend region to the indicator consisting of two components or indices— diameter of breast area (w) and breast region indicator (ra). The planning parameters: breast implant object and extend region can be planned and obtained objective.

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Figure 5 shows the second breast implant surgery case (weight 49kg and height 160cm). The target cup size for case 2 is 315ml a for receiving a saline-filled implant bag of 240 ml to build up C+ cup size . The base width of saline bag is 11.8 cm , then according table 1 the type of saline filled bag is 68LP-250 as implant object. The breast planning extend region of case 2 is shadow area as shown in figure 5-a. The lower extend border region is 6.3 cm away from nipple position and the upper extend border region is defined as indicator ra1 = 7.9 cm as show in figure 5-a and 5-c. Therefore the planning cup size, implant object and breast implant pocket extend region can be evaluated by the modules invented by this work. Following the postoperative female breast area measuring breast volume and breast extend region indicator (ra2 as shown in figure 5) to compare with the planning preoperative breast extend region indicator (ra1)the difference is less than 5%. This study applied the breast extend region indicator for Asian female under breast implant preoperative and postoperative situation in order to verify post-operative breast configuration whether they were in the fine condition range. Understandably, to track the post-surgery breast extend region indicator would help the physician in following the breast configuration tendency after the surgery by data analysis of the parameters as shown in table 4. Since the size of breast was aimed at cup size C+ (the most popular breast size for Asian female to upgrade), the follow-ups of 16 to 20 weeks after the surgery had shown the breast configuration to be progressing under well stable condition. This study applied the breast implant pocket extend indicator: the lower extend border (LL+2cm) and upper extend border (ra1)to compared with measurement breast region under breast implant preoperative and postoperative situation. As noted in table 4 and figure 5, most of cases the breast implant pocket extended indicator would approach to the final configuration condition for reasonable matching state between preoperative planning and postoperative diagnose. Apparently, this procedure provided doctors with relevant data required for breast appraisal with objectivity and consistency on the post-surgery breast configuration. Note that one of the goals set for this work was to get a user-friendly system that provided data and image files of breast extend region (as shown in Figs. 4 and 5) with proper layouts for the planning and postoperative evaluation. It could help plastic surgeons to acquire substantial data, making their understandings of breast condition objectively as well as clinical management and body figure appraisal more efficiently. The image layout in Fig. 4 and 5 offered an easy interface for communication between the surgeon and patient. From the viewpoint of the operating surgeon, determination of breast region indicator could be helpful and desirable to potentially facilitate the complex planning and difficult execution of breast augmentation surgery. The cases analyzed in this study, mostly for upgrading the breast cup size from A to C+, for the appraisal of overall breast conditions by breast extended region configuration

indicators. The physical indicators of preoperative planning, such as the breast implant product type and implant pocket extend region, can be derived from a three-dimensional, fullsized image process to deal with original breast. The target planning parameters of breast extended region and product type of saline bag can be a useful indicator before and after breast implant surgery. However, the preoperative planning of breast augmentation surgery have been made by breast implant pocket extended indicator using 3D imaging to obtain target planning parameters. Table 1. Model No. of implant saline bag for most often use in Taiwan area Suggesti

Model No.

on Volume

Min. Volume

Max. Volume

Base

Outward

Base

Outward

width(

height(

width(

height(

cm)

cm)

cm)

cm)

(cc)

150-170

68LP-150

10.0

2.7

9.9

3.2

175-195

68LP-175

10.6

2.8

10.4

3.3

200-220

68LP-200

11.0

3.0

10.9

3.4

225-245

68LP-225

11.4

3.1

11.3

3.4

250-270

68LP-250

11.9

3.2

11.7

3.5

275-295

68LP-275

12.2

3.3

12.1

3.6

Table 2. The planning parameters for typical clinical case Planning parameters Case Data Age:45 Heigh:157cm Weight:52Kg

Original breast width (w); Volume of saline bag; Model No.

lower breast extend region=LL + 2 cm

upper breast extend region = ra1

11.8cm;260cc; 68LP-250

RHS = 5.43 cm; LHS = 5.59 cm

RHS = 8.82 cm ; LHS = 8.8 cm

Table 3. The postoperative diagnosis with breast extend region indicator

Preoperative ra1(cm) Time

Postoperative ra2(cm)

R.H.S.

L.H.S.

R.H.S.

L.H.S.

2 weeks post-surgery

8.82

8.8

8.84

8.96

2 months post-surgery

8.82

8.8

8.8

8.9

4 months post-surgery

8.82

8.8

8.8

8.9

6 months post-surgery

8.82

8.8

8.8

8.9

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Table 4. The breast extend region for planning and postoperative diagnosis

Preoperative planning Case 1 Case 2

RHS ra1=8.82cm RHS ra1=8.63cm

LHS ra1=8.8cm LHS ra1=8.23cm

Postoperative diagnosis RHS ra2=8.8cm RHS ra2=8.67cm

LHS ra2=8.9cm LHS ra2=8.29cm

FIGURE 1 THE DEFINITION OF BREAST FEATURE AREA BY ANATOMY [4]

Figure 4. The comparison of breast implant pocket extend region for preoperative planning and postoperative image of case1

Figure 2 The feature lines to define breast region

Figure3.Preoperative planning of breast implant pocket extend region

Figure 5. The preoperative planning and postoperative diagnosis of case 2

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References [1]

S.P. Sun, K.W. Hsu, J.S. Chen, “The stable status evaluation for female breast implant surgery by calculating related physics parameters”, Computer Methods and Programs in Biomedicine, 90: 95-103, 2008. [2] Hole, John W. and Koos, Karen A. “Human anatomy”, 1992. [3] Hyun-Young Lee, Kyunghi Hong, Eun Ae Kim. Measurement protocol of women’s nude breasts using a 3D scanning technique. Applied Ergonomics, 35: 353-359,2004 [4] Oren M. Tepper, Kevin Small, Lauren Rudolph, Mihye Choi, Nolan Karp. Virtual 3-dimensional modeling as a valuable adjunct to aesthetic and reconstructive breast surgery. The American Journal of Surgery,192: 548-551, 2006 [5] S. Garson, E. Delay, R. Sinna, T. Delaporte, M. Robbe, S. Carton. “3D evaluation and mammary augmentation surgery”, Annales de Chirurgie Plastique Esthetique, 50: 643-651, 2005 [6] C. Alfano, P. Mezzana, N. Scuderi. “Acquisition and elaboration of superficial three-dimensional images in plastic and reconstructive surgery”, Indian Journal of Plastic Surgery,38: 22-26, 2005 [7] S.P. Sun, K.W. Hsu, J.S. Chen. ‘Postoperative evaluation platform of female breast implant surgery with breast configuration indicator’, Comput Biol Med, 39(7):595-603, 2009 [8] Laszlo Kovacs, Maximilian Eder, Regina Hollweck, Alexander Zimmermann, Markus Settles, Armin Schneider, Matthias Endlich, Andreas Mueller, Katja Schwenzer-Zimmerer, Nikolaos A. Papadopulos, Edgar Biemer. “Comparison between breast volume measurement using 3D surface imaging and classical techniques”, The Breast, 60: 137-145, 2007 [9] S. Garson, E. Delay, R. Sinna, S. Carton, T. Delaporte, K. “Chekaroua. 3D evaluation and breast plastic surgery”, Preliminary study. Annales de Chirurgie Plastique Esthetique, 50: 296-308, 2005 [10] S.P. Sun, J.S. Chen. “The application of full-scale 3D anthropometric digital model system on breast reconstruction of plastic surgeries”, Biomedical Engineering: Applications, Basis & Communications, 15: 200-206, 2003

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