title: Three-dimensional evaluation of breast augmentation and the influence of anatomic and round implants on operative breast shape changes.
abstract: BACKGROUND
  Currently, postoperative outcome analysis in breast augmentation is essentially subjective, and objective evaluation of treatment efficacy is lacking. This study evaluates the influence of anatomic and round implant parameters on breast contour changes after subpectoral breast augmentation using three-dimensional (3D) surface imaging.
  
  
  METHODS
  3D surface breast scans of 17 patients (34 breasts) undergoing subpectoral breast augmentation with round implants and of ten patients (20 breasts) receiving anatomic implants via an axillary approach under endoscopic assistance or a submammary fold incision were obtained before and 6 months postoperatively. 3D linear distance, breast volume, and surface measurement were correlated with the implanted round and anatomic implant parameters, and the resulting breast shape changes were evaluated.
  
  
  RESULTS
  Total breast volume changed in correlation with the implant size (2.4% difference; r=0.894; p<0.001). Implant volume and type influence the nipple-to-inframammary fold distance (N-IMF). Every inserted 100 ml implant volume enlarges the N-IMF distance by 0.8 cm (anatomic>round; p=0.01). Postoperatively, the IMF dropped by an average of 1.3 cm for round implants and by 1.1 cm for anatomic implants, without relevant differences between the applied surgical incision and the selected implants (p>0.05). Breast projection increased significantly more with anatomic implants (2.4 cm) than with round implants (1.7 cm) (p=0.01). The breast projection increase was 22% less than expected for round implants and 25% less than expected for anatomic implants based on the manufacturer implant parameters (p<0.01), without essential differences regarding the surgical incision.
  
  
  CONCLUSIONS
  3D breast shape changes induced by round and anatomic implants after subpectoral augmentation mammaplasty are objectively documented including breast projection, volume, and N-IMF distance changes. 3D surface imaging may have a potential clinical contribution to objective surgical outcome research.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266.
authors.affiliation: Department of Plastic Surgery and Hand Surgery, Research Group CAPS-Computer Aided Plastic Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany, l.kovacs@lrz.tum.de.
authors.forename: Laszlo
authors.initials: L
authors.lastname: Kovacs
authors.forename: Maximilian
authors.initials: M
authors.lastname: Eder
authors.forename: Alexander
authors.initials: A
authors.lastname: Zimmermann
authors.forename: Daniel
authors.initials: D
authors.lastname: Müller
authors.forename: Tibor
authors.initials: T
authors.lastname: Schuster
authors.forename: Nikolaos A
authors.initials: NA
authors.lastname: Papadopulos
authors.forename: Edgar
authors.initials: E
authors.lastname: Biemer
authors.forename: Markus
authors.initials: M
authors.lastname: Klöppel
authors.forename: Hans-Günther
authors.initials: HG
authors.lastname: Machens
mesh_terms: D001940:Breast / Q000033:anatomy & histology* / Q000601:surgery*; D019928:Breast Implantation / Q000379:methods; D018427:Breast Implants; D004954:Esthetics; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D016462:Mammaplasty / Q000379:methods*; D009929:Organ Size; D017060:Patient Satisfaction; D010781:Photography / Q000379:methods; D020034:Silicone Gels
chemical_list: D020034:Silicone Gels