The use of three-dimensional surface imaging and assessment of aesthetics in breast cancer surgery

Abstract

Aesthetic outcome from breast cancer surgery influences long-term psychosocial wellbeing. There is no gold standard measure. An objective measure is required in order to communicate and compare results ultimately to raise standards for patients. Simulation of aesthetic outcome can cross language and literacy barriers, explaining ideas simply which may help to prepare women for their surgery and consequently, by managing expectations translate into better satisfaction long-term. The over-arching hypotheses was that 3D surface imaging (3D-SI) can be applied to both evaluate and model aesthetic outcome in oncoplastic breast surgery. An objective aesthetic outcome tool for breast conserving treatment (BCT) was developed using measures from 3D-SI, designed to replace panel assessment and for use in conjunction with patient reported outcome measures (PROMs). An expert panel scale was constructed using Delphi methodology for the reconstruction population for use in the development of an objective tool. Subscales include volume, symmetry, breast mound position, nipple position and shape in addition to a global scale. It was used to report aesthetic outcomes for the Primary Radiotherapy and Diep FlAp reconstruction (PRADA) study. A simulation model for BCT was designed. A randomised controlled trial demonstrated significantly better preparedness for aesthetic outcome having viewed a simulation pre-operatively compared to 2D photographs or a verbal description. A low burden online patient recruitment and data collection platform was shown to be feasible, accurate, and acceptable to patients. It is scalable for use within a large multicentre study to develop an objective aesthetic outcome tool and simulation model for the reconstruction population. 3D-SI demonstrates capabilities to provide a robust method to report aesthetic outcome. The role of simulation is encouraging and research into the long-term influence on patient satisfaction is ongoing. Future research within the reconstruction population and the development of cheaper, portable 3D-SI devices will enable widespread use.