Enhancing breast projection in autologous reconstruction using the St Andrew's coning technique and 3D volumetric analysis

Michael P. Chae, Warren Matthew Rozen, Nakul Gamanlal Patel, David J. Hunter-Smith, Venkat Ramakrishnan

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: An increasing number of women undergo mastectomy for breast cancer and postmastectomy autologous breast reconstruction has been shown to significantly improve the psychosexual wellbeing of the patients. A goal of treatment is to achieve symmetry and projection to match the native breast, and/or the contralateral breast in the case of a unilateral reconstruction. Autologous reconstruction, particularly with the deep inferior epigastric artery perforator (DIEP) flap, is particularly advantageous as it can be manipulated to mimic the shape and turgor of the native breast. However, very few techniques of shaping the breast conus when insetting the DIEP flap to enhance aesthetic outcome have been reported to date. With the aide of three-dimension (3D) photography and 3D-printed mirrored image of the contralateral breast as a guide intraoperatively, we describe our St Andrew's coning technique to create a personalized flap projection. Method: We report a prospective case series of 3 delayed unilateral breast reconstructions where symmetrization procedure to the contralateral breast was not indicated. Using a commercial 3D scanner (VECTRA XR, Canfield Scientific), the breast region was imaged. The mirrored image was 3D-printed inhouse using a desktop 3D printer. Results: In all cases, projection of the breast mound was able to be safely achieved, with a demonstrated central volume (or 'cone') able to be highlighted on imaging and a 3D printed breast. A 3D print of the contralateral breast was able to be used intraoperatively to guide the operative approach. Conclusions: The St Andrew's coning technique is a useful aesthetic maneuver for achieving breast projection during DIEP flap breast reconstruction, with 3D imaging techniques able to assist in perioperative assessment of breast volume.

Original languageEnglish
Pages (from-to)706-714
Number of pages9
JournalGland Surgery
Volume6
Issue number6
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • Autologous breast reconstruction
  • Coning technique
  • Deep inferior epigastric artery perforator (DIEP)
  • Shaping
  • Three-dimension photography (3D photography)
  • Three-dimension scanning (3D scanning)

Cite this

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title = "Enhancing breast projection in autologous reconstruction using the St Andrew's coning technique and 3D volumetric analysis",
abstract = "Background: An increasing number of women undergo mastectomy for breast cancer and postmastectomy autologous breast reconstruction has been shown to significantly improve the psychosexual wellbeing of the patients. A goal of treatment is to achieve symmetry and projection to match the native breast, and/or the contralateral breast in the case of a unilateral reconstruction. Autologous reconstruction, particularly with the deep inferior epigastric artery perforator (DIEP) flap, is particularly advantageous as it can be manipulated to mimic the shape and turgor of the native breast. However, very few techniques of shaping the breast conus when insetting the DIEP flap to enhance aesthetic outcome have been reported to date. With the aide of three-dimension (3D) photography and 3D-printed mirrored image of the contralateral breast as a guide intraoperatively, we describe our St Andrew's coning technique to create a personalized flap projection. Method: We report a prospective case series of 3 delayed unilateral breast reconstructions where symmetrization procedure to the contralateral breast was not indicated. Using a commercial 3D scanner (VECTRA XR, Canfield Scientific), the breast region was imaged. The mirrored image was 3D-printed inhouse using a desktop 3D printer. Results: In all cases, projection of the breast mound was able to be safely achieved, with a demonstrated central volume (or 'cone') able to be highlighted on imaging and a 3D printed breast. A 3D print of the contralateral breast was able to be used intraoperatively to guide the operative approach. Conclusions: The St Andrew's coning technique is a useful aesthetic maneuver for achieving breast projection during DIEP flap breast reconstruction, with 3D imaging techniques able to assist in perioperative assessment of breast volume.",
keywords = "Autologous breast reconstruction, Coning technique, Deep inferior epigastric artery perforator (DIEP), Shaping, Three-dimension photography (3D photography), Three-dimension scanning (3D scanning)",
author = "Chae, {Michael P.} and Rozen, {Warren Matthew} and Patel, {Nakul Gamanlal} and Hunter-Smith, {David J.} and Venkat Ramakrishnan",
year = "2017",
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language = "English",
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Enhancing breast projection in autologous reconstruction using the St Andrew's coning technique and 3D volumetric analysis. / Chae, Michael P.; Rozen, Warren Matthew; Patel, Nakul Gamanlal; Hunter-Smith, David J.; Ramakrishnan, Venkat.

In: Gland Surgery, Vol. 6, No. 6, 01.12.2017, p. 706-714.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Enhancing breast projection in autologous reconstruction using the St Andrew's coning technique and 3D volumetric analysis

AU - Chae, Michael P.

AU - Rozen, Warren Matthew

AU - Patel, Nakul Gamanlal

AU - Hunter-Smith, David J.

AU - Ramakrishnan, Venkat

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: An increasing number of women undergo mastectomy for breast cancer and postmastectomy autologous breast reconstruction has been shown to significantly improve the psychosexual wellbeing of the patients. A goal of treatment is to achieve symmetry and projection to match the native breast, and/or the contralateral breast in the case of a unilateral reconstruction. Autologous reconstruction, particularly with the deep inferior epigastric artery perforator (DIEP) flap, is particularly advantageous as it can be manipulated to mimic the shape and turgor of the native breast. However, very few techniques of shaping the breast conus when insetting the DIEP flap to enhance aesthetic outcome have been reported to date. With the aide of three-dimension (3D) photography and 3D-printed mirrored image of the contralateral breast as a guide intraoperatively, we describe our St Andrew's coning technique to create a personalized flap projection. Method: We report a prospective case series of 3 delayed unilateral breast reconstructions where symmetrization procedure to the contralateral breast was not indicated. Using a commercial 3D scanner (VECTRA XR, Canfield Scientific), the breast region was imaged. The mirrored image was 3D-printed inhouse using a desktop 3D printer. Results: In all cases, projection of the breast mound was able to be safely achieved, with a demonstrated central volume (or 'cone') able to be highlighted on imaging and a 3D printed breast. A 3D print of the contralateral breast was able to be used intraoperatively to guide the operative approach. Conclusions: The St Andrew's coning technique is a useful aesthetic maneuver for achieving breast projection during DIEP flap breast reconstruction, with 3D imaging techniques able to assist in perioperative assessment of breast volume.

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KW - Coning technique

KW - Deep inferior epigastric artery perforator (DIEP)

KW - Shaping

KW - Three-dimension photography (3D photography)

KW - Three-dimension scanning (3D scanning)

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