Invited Discussion on: An Intraoperative Measurement Method of Breast Symmetry Using Three-Dimensional Scanning Technique in Reduction Mammaplasty

Abstract

We congratulate the authors on their excellent study, which showed convincingly that intraoperative 3D scanning significantly improves breast symmetry after reduction mammoplasty [1]. This study represents a significant advance in the field of breast reduction surgery for patients and surgeons alike. Patients with macromastia (i.e., disproportionately large breasts) can experience physical discomfort such as stiff shoulders and poor posture due to the weight of the breasts. The condition can also have a psychological impact, with many patients reporting mental distress or more serious mental health problems. For these patients, breast reduction is an important solution. However, this procedure carries a significant challenge for the surgeon, who must determine how much volume should be removed in both breasts such that excellent symmetry is achieved. This decision is complicated by the multitude of variables that are in play, including skin sagging and tension, mammary gland mass, areola papilla position, and inframammary fold height. While there are several devices that can analyze threedimensional volume before surgery [2] and thus can determine in detail how much tissue must be excised, it remains difficult to accurately excise that amount during surgery. Consequently, at present, the aesthetic success of breast reduction surgery depends largely on the experience and skill of the surgeon. Therefore, there is great need for an intraoperative method that objectively evaluates the amount of breast volume that must be excised on each side. The authors report that using a handheld 3D scanner to measure the breasts during reduction surgery significantly improved the symmetry of the breasts 3 months after surgery when compared to a control group of patients who underwent this surgery without such 3D scanning. This is an outstanding discovery: not only does this method markedly improve postoperative breast symmetry, it is also very easy, can be performed while the patient is in the supine position, and does not compromise the cleanliness of the surgical field during the operation. These features suggest that this device will be very helpful for surgeons, especially those who are inexperienced. The method does have some limitations that may require further development. First, the authors reported that it takes 10 to 15 minutes to analyze the data. While this time is acceptable, it is possible that the surgeon may have to make several corrections during the operation. In this case, the repeated analyses will greatly extend the total operation time. Second, the handheld 3D scanner and its supporting software cost 12,000 US dollars, which is somewhat expensive. Nonetheless, these limitations are significantly outweighed by the advantages of this method, which include its potential applicability in breast reconstruction using implants and autologous tissues, and breast augmentation with fat injection. We anticipate that these advantages will promote further development of handheld 3D scanners for & Rei Ogawa [email protected]