How Reliable Is Breast Volume Assessment When the Patient Is Lying Flat?-Volumetric Assessment of Breast Volume Using a Vectra H2 Handheld Device in Different Positions

Abstract

(1) Background: Three-dimensional (3D) volumetric assessment is receiving increased recognition in breast surgery. It is commonly used for preoperative planning and postoperative control with the patient standing in an upright position. Recently, intraoperative use was evaluated with patients in the supine position. The aim of this prospective study was to evaluate the volumetric changes in 3D surface imaging depending on the patient's position. (2) Methods: 3D volumetric analysis was performed using a Vectra-H2 device with patients in standing, sitting, and supine positions. A total of 100 complete datasets of female breasts were included in the study. The measured volumes of each evaluated breast (n = 200) were compared between the three positions. (3) Results: The mean difference between the 3D volumetric assessments of the sitting and standing positions per breast was 7.15 cc and, thus, statistically insignificant (p = 0.28). However, the difference between supine and standing positions, at 120.31 cc, was significant (p < 0.01). (4) Conclusions: The 3D volumetric assessment of breasts in the supine position did not statistically correlate with the validated assessment of breast volume in the standing position while breast volume in the sitting position is reliable and correlates with the assessment of a standing patient. We conclude that intraoperative volumetric assessment should be performed with patients in an upright sitting position.

Keywords: 3-D volumetric assessment; Vectra; Vectra H2 handheld device; breast operation; breast volume; breast volumetry.

Figure 1

Taking the lateral image of a patient positioned correctly in a standing position (standing upright, back leaning to a wall, with arms slightly abducted and palms placed on the wall).

Figure 2

Taking the frontal image of a patient positioned correctly in a sitting position (sitting with the upper body upright at an angle of 90°, and as with the standing position, arms slightly abducted and hands positioned symmetrically).

Figure 3

Graphical representation of the mean breast volumes for each position. * p > 0.05, ** p < 0.01.

Figure 4

Graphical representation of the median differences of the measured breast volumes per breast between the different positions. * p > 0.05, ** p < 0.01.

Figure 5

3D volumetric assessment of a patient six months after a reduction mammaplasty (patient 1) in the standing position. The measured breast volumes were 533 cc on the right side and 523 cc on the left side, showing a very symmetrical result.

Figure 6

3D volumetric assessment of patient 1 in the sitting position. The measured breast volumes were 529 cc on the right side and 519 cc on the left side, thus correlating very closely with the volumetric assessment in the standing position. Additionally, note the very similar reconstructed shape of the breast compared to the standing position.

Figure 7

3D volumetric assessment of patient 1 in the supine position. The measured breast volumes were 301 cc on the right side and 287 cc on the left side, thus indicating a significant deviation from the volumes in the standing and sitting positions. Additionally, it is worth noting the striking disparity in the shape of the breast in the supine position compared to the other two positions.