title: Objective evaluation of the latissimus dorsi flap for breast reconstruction using three-dimensional imaging.
abstract: BACKGROUND
  The latissimus dorsi muscle flap is a common method for the reconstruction of the breast following mastectomy. The study aimed to assess the quality of this reconstruction using a three-dimensional (3D) imaging method. The null hypothesis was that there was no difference in volume between the reconstructed breast and the opposite side.
  
  
  METHODS
  This study was conducted in forty-four patients who had had immediate unilateral breast reconstruction by latissimus dorsi muscle flap. The breast was captured using the 3D imaging system. Ten landmarks were digitised on the 3D images. The volume of each breast was measured by the application of Breast Analysis Tool software. The symmetry of the breast was measured using Procrustes analysis. The impact of breast position, orientation, size and intrinsic shape on the overall breast asymmetry was investigated.
  
  
  RESULTS
  The null hypothesis was rejected. The reconstructed breast showed a significantly smaller volume when compared to the opposite side, p < 0.0001, a mean difference of 176.8 cc and 95% CI (103.5, 250.0). The shape and the position of the reconstructed breast were the main contributing factors to the measured asymmetry score.
  
  
  CONCLUSIONS
  3D imaging was efficient in evaluating the outcome of breast surgery. The latissimus dorsi muscle flap on its own for breast reconstruction did not restore the volume and shape of the breast fully lost due to complete mastectomy. The modification of this method and the selection of other or additional surgical techniques for breast reconstruction should be considered. The asymmetry analysis through reflection and Procrustes matching was a useful method for the objective shape analysis of the female breast and presented a new approach for breast shape assessment. The intrinsic breast shape and the positioning of the breast were major components of postoperative breast asymmetry. The reconstructed breast was smaller overall than the un-operated breast at a significant level when assessing the breast volume using the surface area. 3D imaging by multiple stereophotogrammetry was a useful tool for volume measurements, shape analysis and the evaluation of symmetry.
authors.affiliation: Canniesburn Plastic Surgery Unit Glasgow, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK. h.henseler@btinternet.com
authors.forename: Helga
authors.initials: H
authors.lastname: Henseler
authors.forename: Joanna
authors.initials: J
authors.lastname: Smith
authors.forename: Adrian
authors.initials: A
authors.lastname: Bowman
authors.forename: Balvinder S
authors.initials: BS
authors.lastname: Khambay
authors.forename: Xiangyang
authors.initials: X
authors.lastname: Ju
authors.forename: Ashraf
authors.initials: A
authors.lastname: Ayoub
authors.forename: Arup K
authors.initials: AK
authors.lastname: Ray
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation; D010780:Photogrammetry; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D006113:United Kingdom