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The application of full-scale 3D anthropometric digital model system on breast reconstruction of plastic surgeries Article  in  Biomedical Engineering Applications Basis and Communications · October 2003 DOI: 10.4015/S1016237203000304

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THE APPLICATION OF FULL-SCALE 3D ANTHROPOMETRIC DIGITAL MODEL SYSTEM ON BREAST RECONSTRUCTION OF PLASTIC SURGERIES SHUH-PING SUN', JING-SHYR CHEN'

Biomed. Eng. Appl. Basis Commun. 2003.15:200-206. Downloaded from www.worldscientific.com by 213.85.255.5 on 06/22/14. For personal use only.

'Department of Biomedical Engineering , I-Shou University 2Department of Plastic Surgery, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan

ABSTRACT A full-scale 3D anthropometric digital model system is a set of technology that combined with 3D digital imaging system, computer 3D image processing system, reverse engineering and Computer-Aided Design. The purpose of this studied is to make a full size solid breast model by using the 1:1 anthropometric digital model technique to assist breast reconstruction plastic surgery colon the same size of symmetrical breast of the patient. The full-sized simulating breast model created in this studied not only can assist plastic surgeons by making more symmetric breasts on the other side during the reconstruction of the breast surgeries, but also can go into a process of analyzing if the two sides of the breasts are symmetrical. This studied is used the 3D optics scanner to scan on patients' breasts to obtain the breast 3D image data and then used reverse engineering technique and CAD software to simulate and to analyze the 3D image model of the reconstruction breasts. If this type of solid model is needed during the medical treatment, it can apply 3D digital data into a Rapid Prototyping machine to make the full-sized solid model. Doctors can using this solid model go into a process of evaluation and planning before the surgeries and consider being an important reference on breast reconstruction surgeries so that it can reduce patients' inconvenience and promote the medical treatment qualities.

Biomed Eng Appl Basis Comm, 2003 (October); 15: 200-206. Keywords: Reverse Engineering, 3D Anthropometric Measurement, Plastic Surgeries, ComputerAided-Design.

1. INTRODUCTION As for humans, breasts held a unique position. Not only do the breasts have normal physiological functions, but also they represent the symbols of females. Sometimes mental setbacks can be more painful than physical wound when losing breasts. If Received: Aug 25, 2003; Accepted: Oct 9, 2003 Correspondence: Shuh- Ping Sun, Professor Department of Biomedical Engineering,

I-Shou University, Kaohsiung County, Taiwan 840 Email : spsun@isu.edu.tw

females eliminated their breast due to breast cancers, at this time, they will be facing the impact of breast cancer recovers and mastectomy afterwards at the same time. Moreover, the spirit of females will suffer under a great pressure. According to what the scholars have found is that simply used extraneous fake breasts cannot improve or ease the feeling of patients' body images. However, breast reconstruction surgeries can lower the impact to the lowest level. In general, about sixty percent of patients who have breast cancers receive various methods of reconstruction after eliminating the breasts [1-8]. There are more and more breast cancers patients after eliminating the breasts to receive the breasts reconstruction surgeries.

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The satisfactory breast reconstruction surgery ought to have the same size, position and appearance with the normal breasts. In the past, one cannot know whether the sizes of breasts were symmetrical or the appearance was the same by the scientific parameters after and before the reconstruction surgery. It only can be estimated by doctors or let patients get their own feelings. As for the simulation of the reconstructing breasts system in this studied, the evaluating data and technology can convince apply before and after the reconstruction surgeries in order to obtain some physical parameters of the breasts then process the related assessment of surgeries. Therefore, this studied used 1:1 3D anthropometric digital model system that combined with 3D digital imaging system, computer 3D image processing system, reverse engineering and ComputerAided-Design [9-13] is an analysis focusing on before and after the breasts reconstruction plastic surgery. It can increase the truth of estimation before the surgery and to simulate the reconstruction of the shape, position and the size of the breasts to assure whether can promote the accuracy of the plastic surgeries. After surgeries, it will use the non-contact method to establish breasts 3D model rapidly measure the volume, surface area and related physics parameters of the breasts effectively to assist the estimation whether the breasts are symmetrical so that it can reduce patients' inconvenience and promote the medical treatment qualities.

the breasts and the symmetry of the related position after the reconstruction surgeries so that it can enhance the precision of the reconstruction surgeries.

2.2 The Application of Full-Sized Breasts Solid Model System on Breast Reconstruction After females eliminated the breasts due to related diseases, plastic surgeons can reconstruct the breasts again for patients. A beautiful breast can be achieved from putting the water bags or microsurgery on rectus abdominis skin flaps transplant. However, so far the breast reconstruction surgeries cannot evaluate the needs for solid; such as, volume, position, shape and other related physics parameters. The evaluation that described previously actually held an important position in the accuracy of plastic surgeries. This studied used full-scale solid breast model [14], which focused on the surgery problems of delayed breast reconstruction that can provide a solving plan for simulation of solid evaluation before surgeries. The standard operation procedure established for 1:1 image and solid model to human appearance breast reconstruction, which is shown in Table I . The process is used by 3D digital imaging facility to get the 3D image of human body precisely and rapidly (Particular appropriate to complex irregular curved Table 1 . The flow chart of 3D full-scale anthropometric digital model system applies to the breast reconstruction

2. METHODS MATERIALS AND PROCEDURES'

The human body chest

Optics scanner to scan 3D chest curved

2.1 Mechanism of Breast Reconstruction The timing of breast reconstruction can divide into: immediate breast reconstruction and delayed breast reconstruction. Delayed breast reconstruction is slightly difficult than the immediate breast reconstruction. Firstly, due to the lack of skin, most of the skin surface have been eliminated when preceding the first mastectomy and then to stitch the wound into one straight line. Therefore, skin will be taken away from stomach, back or hips, thighs and other areas of the body to replace it when preceding the reconstruction. The thesis will mainly be discussed about the medical treatment evaluation of before and after delayed breast reconstruction surgeries. Applied the full-scale 3D anthropometric digital model system integrated in this studied, will obtained the needed volume of the reconstructing breasts tissues (For example, tissue thickness and the biggest measure area of the surface and the like), shapes and other related physics symbols. Secondly, to evaluate the volume of

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Edit and combine 3D points date

Make Rebuild breast image as stl. file

Build the 3D image model for simulating reconstruction breast model 1. Minor reflex to take simulating Breast shape 2.Boolen calculation to get rebuild breast image 3. Making Rebuild breast image model

CAD system to analyze simulating reconstruction breast model

Rapid Prototyping Machine Making breasts solid model

CAD system evaluation breast symmetry after reconstructing plastic surgeri es

Evaluate and planning before the surgeries


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Biomed. Eng. Appl. Basis Commun. 2003.15:200-206. Downloaded from www.worldscientific.com by 213.85.255.5 on 06/22/14. For personal use only.

face). Also after establishing shape surfaces, edit and revise, the 3D image will deliver to CAD system to analyze it or using rapid prototyping machine to make the solid model. The process is focused on the forming of reconstruction breast image and solid model to obtain 3D physical parameters of that simulated breast. It obtains some major steps as followed. (1) Using optics scanner to scan and obtain the 3D image of female's chest with only single side breast. Applied the reverse engineering technique mirror reflex the 3D image to take simulating Breast shape and combine the file into a complete breast file (Figure 1,2) (2) Using the 3D image process facility to defined and created reconstruction breast model as a solid image file. Using 3D Rapid Prototyping machine to make the solid breasts model for surgery simulation. (Figure 3)

Fig.2 Mirror reflex 3Dimage to take simulating Breast shape

(3) Using simulation breasts solid model evaluate breast shape and position before go into a delayed breast reconstruction surgery. (Figure 4) (4) By using the simulation breast solids model to measure the thickness, longest length and the widest width of reconstructing breasts. (Figure 5)

(5) Using the longest length, widest width and the thickness and other physics parameters of the breasts that had been measure previously to draw the needs of the biggest area and position for breast reconstruction on the belly, and then the surgery may process and completed with solid breasts model for breast pocket evaluation. (Figure 6) The major software and hardware facilities for full-scale anthropometric digital model system to

Fig.1 The clinical case for delayed breast reconstruction before surgery with only single side breast.

Fig.3 Defined and created reconstruction breast model as a solid image file and solid breasts model for surgery simulation.

Fig.4 Using simulation breasts solid model evaluate breast shape and position before go into a surgery

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simulating reconstruction breast model are shown on Table II .

2.3 Evaluation Processes and Steps after Breast Reconstructing Plastic Surgeries

Biomed. Eng. Appl. Basis Commun. 2003.15:200-206. Downloaded from www.worldscientific.com by 213.85.255.5 on 06/22/14. For personal use only.

After reconstruction surgeries, the evaluation on whether the breasts are symmetrical sizes should take into account as an important reference document of the surgery. Whether doctors and patients can trust each other is also an important index. Following by the flow chart of Table 1 and using CAD analyzing software can evaluate the volume and sizes of the breast effectively after the breast reconstruction. Related steps are as followed.

(1) Obtaining the 3D surface data of the breasts after surgeries(Figure 7), and acquire 3D image of the reconstructing breast and the whole chest and then by using the position of the breasts of anatomy to cut into two individual breasts. (2) Establishing the optimized breast data as a NURBS surfaces in order to provide related CAD software edition and geometry usage. This process can compared the usage of related physics parameters with both sides of the breast shapes to evaluate the sizes symmetrical of breast. (Figure 8)

Fig.5 Using the simulation breast solids model to measure the thickness, longest length and the widest width of the reconstructing breasts.

3. RESULTS AND DISCUSSIONS 3.1 Simulation and Evaluation before Breast Reconstruction Surgeries The data resources on breasts in this thesis are based on a real case. Thus, while taking samples in the hospital, to obtain data may cause different phenomenon due to patients' breathing ups and downs

Fig.6 Using the longest length , widest width and the thickness that had been measure previously to draw the needs of the biggest area and position for breast reconstruction on the belly, then the surgery may be process

Fig.7 The clinical case for delayed breast reconstruction after surgery with solid breasts model for breast pocket evaluation

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Table 2. The major equipment and facilities for fullscale anthropometric digital model system

Biomed. Eng. Appl. Basis Commun. 2003.15:200-206. Downloaded from www.worldscientific.com by 213.85.255.5 on 06/22/14. For personal use only.

Equipment and Facilities

3D Optics Scanner

Scan clinical 3D

(Digital image system)

chest surface

Polywork (3D point data editor)

3D image combination usage

Geomagic Studio

Breasts 3D image edition

(3D image editor)

and establishment for simulating reconstruction breast model. Calculating the volume,

Catia (3D solid model CAD system)

By scanning the breast parts of the eliminating breasts of the patient and through the process of full scale 3D anthropometric digital model system, a complete breast model by using single side breast shape mirror reflex 3D image to take simulating breast shape, which had been optimized and simulated the eliminating breast model will be made by using rapid prototyping machines. By using solid model of simulation breast then to calculate the volume, surface area, thickness and some physics parameters of the simulation breasts model. Doctors can have more precise basis and evaluation during the reconstructing surgeries by using that solid model of simulation breast and related physics parameters. In the past, when doctors were in the reconstructing surgeries, the needing for amount of reconstructing materials were usually depend on the doctors' estimations and feelings. There was no exact basis and easily caused the sizes of breasts unequal. Therefore, it can be a nice reference basis for doctors when performing surgeries based on solid full-scale breast model of simulation to provide related physics parameters in this thesis and to let doctors have a better precise estimation for an amount of reconstructing materials. Another advantage is that full-scale breasts solid model for simulation can let patients understand the result after reconstructing breast beforehand before going into a surgery (Figure 3). Plastic surgeons can go into a process of evaluating

area and opposite

position of breast 3D

Fig.8 Using CAD system to evaluate the sizes symmetrical of breast

and that may also caused some mistakes when gathering information, it may cause a slightly gap between the part of the nipple on the complete breasts and the shape of real nipples; however, the limitation is acceptable. The data will be in Geomagic Studio software and the final goal is to be optimum on breast and breast shapes.

Application

image Rapid Prototyping

Making breasts

Machine

solid model

the shape and position before the surgery (Figure 4). Plastic surgeons can measure the thickest of the breasts, the longest length and the widest width of the reconstructing breasts surface by simulation model of breast reconstruction (Figure 5). After completed the evaluation above, plastic surgeons can go into a process of evaluating on patients' bodies before the surgery begins. Using the longest length, widest width and the thickness that had been measure previously to draw the needs of the biggest area and position for breast reconstruction on the belly, then the surgery may be process (Figure 6). This can promote the accuracy of the surgery and cut down the time of these kinds of plastic surgeries. The clinical case for delayed breast reconstruction after surgery with solid breasts model for breast pocket evaluation as shown in figure 7. 3.2 The Evaluation after Breast Reconstruction After surgeries, the evaluation of symmetric for

the plastic surgeries not only can verify the accuracy of the plastic surgeries, but also it is an important index to establish the confidence of patients'. Therefore, the estimation and calculation of reconstructing the surface area, volume and related position parameters of breasts are also part of this studied. This thesis will take spherical method sample the 3D image of the breasts shape in non-contact way. The area surface and volume of breasts can be seem as an important basis for evaluation of symmetry of breasts. According to the previous steps, the data file of the breasts will imported into solid model CAD software to calculate individual area surface and volume (Figure 8) of each breast and

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related physics parameters of the breasts so that it can provide a scientific data to doctors and patients in order to understand the level of symmetry of patients' breasts after surgeries and it has reached the purpose of symmetric evaluation. Right now, breast reconstructions have been alternative mature technologies. Even patients can precede a second level of nipple reconstruction after the breast reconstruction is completed and then it will recover a complete appearance of females' breasts. Due to the defect of the body and the psychological damage, reconstructing plastic surgeons worldwide have been working hard and the accuracy of technology and methods are gradually making them up. However, as far as it seems, immediate breast reconstruction also can be used in this method. This method goes with the doctors beforehand before the mastectomy begins. To understand the position, volume and the shape of the elimination first and then go into a process of analyzing. It can evaluate the needing of shape, volume and embedding position of padding materials for breast reconstruction before going into mastectomy. Surely, it can promote the accuracy of this kind of reconstructing surgeries. Due to the using method of this studied, it needs to use various data processing systems and the techniques are multi-field. However, after integrated every step taking samples from human breast shape as a standard operation procedure developed in this studied have been optimized, it can reduce down the mistakes caused by human and the timing on taking the breasts samples to the lowest level and cut down the complexity as well.

patients for saving some medical resources. The method provided by the paper is workable on surgeries of breast reconstruction after recovery, and it can adjust the configuration of 3D anthropometric digital model module in this studied afterwards in order to be suitable for evaluation of related physical parameters before the breast-job surgeries and enhance the perfection of breast job surgeries. The application of full-scale 3D anthropometric digital model system to the breast job surgeries will be the following study.

REFERENCES 1. Donald A. Hudson, FRCS: Aesthetic Modification for Delayed Autologous Breast Reconstruction: Using a Thoracodorsal Flap to Create a Breast Pocket, Annals of Plastic Surgery 2001 ; 47,6: 584-590 2. Wellish DK, Schain WS, Noone RB, et al: Psychosocial correlates of immediate versus delayed reconstruction of the breast. Plast Reconst Surg 1985; 76: 713-8. 3. Carlson GW, Jones G, Bostwick J: Breast reconstruction, Plastic Surgery Indication, Operations, and Outcomes volume 1 page. Mosby 2000; 587-605 4. Frazier TG, Noone RB: An objective analysis of immediate simultaneous reconstruction in the treatment of primary carcinoma of the breast. Cancer 1985; 55: 1202-5. 5. Georgiade GS, Riefkohl L, Cox E, et al: longterm, clinical outcome of immediate reoconstruction after mastectomy. Plast Reconstr Surg 1985; 76: 415-20. 6. Hartrampf CR, Bennett GK: Autogenous tissue reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69: 216-2244. 7. Fujino T, Harashina T, Aoyagi F: Reconst-ruction for aplasia of the breast and pectoral region by microvascular transfer of a free flap from the buttock. Plast Reconstr Surg 1975: 56: 178-81. 8. LeQuang C: Two new free flaps proceeding from aesthetic surgery: the lateral mammary flap. In Transactions of the 7th international congress of plastic and reconstructive surgery, Rio de Janeirio. 1979. Eccerpta medica.

4. CONCLUSIONS In this studied, which provides the clinical application of the full size digital anthropometric digital model system on breast reconstruction, can let doctors evaluate the volume, shape and position of reconstructing breasts before surgeries. It can minimize the difference between expectation of the patients and the outcome of the surgery to the lowest level. The breast reconstruction treatment planning procedure, which provides in this paper, will make the procedure of reconstructing the 3D breasts image and solid model to be operated in standard process to reduce the mistakes and carelessness caused by lack of proper reference parameters. Due to doctors can actually obtain simulating volume, shape, position and some related parameters of the breast before breast reconstruction; doctors will positive completes the surgery assessment to promotes the accuracy of surgeries. In addition, it can increase the quality of medical treatment and promote the confidence of

9. Swaelens, B. and J.P. Kruth. Medical applications in rapid prototyping techniques, Proceedings of the Fourth International Conference on Rapid Prototyping, 1993 June ; 14-17:107-120. 10. Jacobs, A., B. Hammer, G. Niegel, T. Lambrecht, H. Schiel, M. Hunziker and W. Steinbrich. First experience in the use of stereolithography in medicine, Proceedings of the Fourth International Conference on Rapid prototyping, 1993 June ; 14-

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17:121-134. 11. Adachi, J., T. Hara, N. Kusu and H. Chiyokura. Surgical simulation using rapid prototyping, Proceedings of the Fourth International Conference on Rapid Prototyping, 1993 June ; 14-17:135-142.

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12. Kaneko, T., M. Kobayashi, Y. Tsuchiya, T. Fujino, M. Itoh, M. Inomata, M. Uesugi, K. Kawashima, T. Tanijiri and N. Hasegawa. Free Surface 3dimensional shape measurement system and its application to Mictotia ear reconstruction, The Inaugural Congress of the International Society for Simulation Surgery, 1992.

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13. Chin-Jung Wu, Shuh-Ping Sun, Wen-Lin Hsu, JauMing Ruan, The Application of CAD 3-D Modules for Image of Simulation in Radiation Therapy, Therapeutic Radiology and Oncology, 2000 ; 7, 3:169-176. 14. Shuh-Ping Sun, Jing-Shyr Chen, Chun-Lian Xue, The Fabrication of Full-Size Female Breast Model, 2002 Conference on Biomedical Engineering Technology, Kaohsiung, Taiwan.

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