David H. Mordaunt

Four-Dimensional Breast Imaging, Part I: Introduction of a Technology-Driven, Evidence-Based Approach to Breast Augmentation Planning

Although there are many three-dimensional imaging systems currently available on the market, all of them require a high degree of interaction on the part of the user, making them clinically impractical. Moreover, though claims have been made regarding the validity of these systems for imaging the breast form, there have been no previous reports validating any commercially-available implant simulation models in the plastic surgery literature. In this article, the authors describe the development and evaluate the efficacy of a novel four-dimensional (automated three-dimensional) breast imaging system, validating it as an evidence-based simulation tool for patient consultation, surgical planning, and outcomes analysis in cosmetic breast augmentation. This report, based on a series of longitudinal correlation studies with several patient cohorts, found a highly statistically significant degree of correlation and reliability between the automated measurements obtained with the four-dimensional system and manual measurements.

Four-Dimensional Breast Imaging, Part II: Clinical Implementation and Validation of a Computer Imaging System for Breast Augmentation Planning

BACKGROUND No publications exist describing the impact of three-dimensional imaging on the consultation process for breast augmentation, nor have existing software products claiming simulation features been validated. OBJECTIVES The authors describe the application of four-dimensional technology during patient consultation to assist in planning implant size and type. METHODS Forty-six primary breast augmentation patients underwent preoperative consultation with 4D simulation software; 35 out of 46 also received follow-up imaging. At six months postoperatively, simulated measurements were compared to actual measurements and questionnaires were mailed to patients asking them to assess the imaging experience. A follow-up phone survey 18 months postoperatively examined the persistence of patient attitudes about implant size and imaging. Practice productivity was evaluated by comparing specific parameters (such as scheduling rates) between three separate time periods for the same clinic. RESULTS Across all parameters, breast augmentation simulations correlated highly with positive surgical outcomes (R-value = 0.68). The majority (95%) of patients believed the simulations were accurate; 89% also expressed that it enhanced trust in the surgeon and 74% reporting that it helped in choosing an implant size. Despite 48% also indicating that they would select a larger implant if they were to undergo surgery again, no patients have undergone reoperations of any kind. Compared to historical controls, scheduling rates in the practice increased from 40% to 77% after addition of simulation software. CONCLUSIONS 4D breast imaging appears to be an accurate system for analysis, planning, simulation, and patient education for women considering primary breast augmentation, and application of this technology during the consultation process was correlated with a high degree of patient satisfaction and practice productivity.