title: Correlation of Prediction and Actual Outcome of Three-Dimensional Simulation in Breast Augmentation Using a Cloud-Based Program.
abstract: BACKGROUND
  Breast augmentation is among the most frequently performed cosmetic plastic surgeries. Providing patients with "realistic" 3D simulations of breast augmentation outcomes is becoming increasingly common. Until recently, such programs were costly and required significant equipment, training, and office space. New simple user-friendly cloud-based programs have been developed, but to date there remains a paucity of objective evidence comparing these 3D simulations with the post-operative outcomes.
  
  
  OBJECTIVE
  To determine the aesthetic similarity between pre-operative 3D simulation generated by Crisalix and real post-operative outcomes.
  
  
  METHODS
  A retrospective review of 20 patients receiving bilateral breast augmentation was conducted comparing 6-month post-operative outcomes with 3D simulation using Crisalix software. Similarities between post-operative and simulated images were measured by three attending plastic surgeons and ten plastic surgery residents using a series of parameters.
  
  
  RESULTS
  Assessment reveals similarity between the 3D simulation and 6-month post-operative images for overall appearance, breast height, breast width, breast volume, breast projection, and nipple correction. Crisalix software generated more representative simulations for symmetric breasts than for tuberous or ptotic breasts. Comparison of overall aesthetic outcome to simulation showed that the post-operative outcome was more appealing for the symmetric and tuberous breasts and less appealing for the ptotic breasts.
  
  
  CONCLUSIONS
  Our data suggest that Crisalix offers a good overall 3D simulated image of post-operative breast augmentation outcomes. Improvements to the simulation of the post-operative outcomes for ptotic and tuberous breasts would result in greater predictive capabilities of Crisalix. Collectively, Crisalix offers good predictive simulations for symmetric breasts.
  
  
  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 http://www.springer.com/00266 .
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Vorstenbosch
authors.affiliation: Section of Plastic Surgery, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada. aislur@gmail.com.
authors.forename: Avi
authors.initials: A
authors.lastname: Islur
mesh_terms: D019928:Breast Implantation / Q000295:instrumentation / Q000379:methods*; D000067917:Cloud Computing; D015331:Cohort Studies; D003198:Computer Simulation; D004954:Esthetics; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016462:Mammaplasty / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D058996:Quality Improvement; D012189:Retrospective Studies; D012984:Software
keywords: Breast augmentation; Pre-operative planning; Three-dimensional simulation