3d imaging for breast augmentation
Breast augmentation, also known as mastopexy, is a surgical procedure that’s performed to enhance the size and shape of the breasts. Breast implants are often used in conjunction with the procedure, but they’re not always necessary. In some cases, the patient may have enough natural tissue to use for augmentation.
The main goal of this procedure is to give you an enhanced appearance by increasing the size and projection of your breasts. It can also improve your self-confidence and body image after breast feeding or weight loss.
In some cases, patients choose to undergo a breast lift as well as breast augmentation because they want to correct sagging skin that results in drooping breasts. A combination of these two procedures will produce better results than either one alone.
If you’re interested in learning more about how 3D imaging can help you achieve your aesthetic goals, call us today at (555) 555-5555 or visit us online at www.3dimageforbreastaugmentation.com
3d imaging for breast augmentation
Application of Tissue Engineering Materials in Breast Reconstruction
In 2011, Melchels et al. (16) first introduced a computer-aided technology to construct 3D models of the breast, laying the foundation for future 3D printing (Table 1). In 2013, Tsuji et al. (17) implanted polypropylene mesh cages into rabbits’ bilateral fat pads and injected minced type I collagen sponge into the cage to act as a scaffold. At 6- and 12-months follow-up, study of the removed cages verified that adipose tissue regeneration actually occurred. Although the implant did not match the shape of the breast and was too rigid to replace soft tissue, these results inspired the concept of 3D bio-implants for breast reconstruction.
Table 1
Summary of tissue engineering materials in breast reconstruction.
| References | Materials | Advantages |
|---|---|---|
| Melchels et al. (16) | Computer-aided technology | The concept of 3D models of the breast appeared for the first time, laying the foundation for future 3D printing. |
| Findlay et al. (18) | Acrylic acid porous chamber | It could produce a quantity of viable breast tissue satisfactory for transplantation. |
| Tsuji et al. (17) | Polypropylene mesh cages and injected minced type I collagen sponge | Inspired the concept of 3D bio-implants for breast reconstruction. |
| Chhaya et al. (19) | Multi-layer reticulated polycaprolactone hemispherical scaffold and delayed fat injection | Fat necrosis could be avoided. |
| Luo et al. (20) | Alg-PDA scaffold | It demonstrated great flexibility and similar elastic modulus to normal breast tissues. |
| Tytgat et al. (21) | Gel-MA–Car-MA scaffold | Its mechanical properties were comparable with the natural mammary tissue. |
Open in a separate window
Aside from purely cosmetic issues, the size of breast implants poses an additional engineering problem in 3D bioprinting for breast reconstruction. If the implants are too small, they cannot maintain the optimal shape of the breast and will also limit subsequent tissue regeneration. As a solution, Findlay (18) designed a porous chamber, similar to the shape of a female breast, made from acrylic acid, which was implanted into a pig model together with vascularized tissue. This was intended to meet the demand for vascularization of a large quantity of regenerated breast tissue. The results at 6 weeks were successful in producing an implant filled with neovascularized tissue, which was close to the useful volume necessary for human breast reconstruction.
Unfortunately, although this method produced a quantity of viable breast tissue satisfactory for transplantation, the main component was only fibrous tissue, with only a small quantity of fat core inside it. Although the implanted tissue certainly would not collapse after implantation and the appearance could be maintained for a long time, the texture was hard and the cosmetic effect was poor. Additionally, infection after implantation could also occur.
As noted previously, the criteria for optimal breast reconstruction are quite rigorous. Using a 3D printing technology not only requires the materials to maintain a pleasing cosmetic breast shape, but must also virtually match the human breast in mechanical properties. Therefore, the selection of materials is crucial. In 2016, Chhaya (19) implanted a multi-layer reticulated polycaprolactone hemispherical scaffold into the subglandular pockets of immunocompetent minipigs and injected a small amount of fat at 2 weeks post-implantation. The results showed that fat necrosis could be avoided, and adipose tissue regeneration could be promoted by the delayed fat injection. Polycaprolactone is a kind of bioactive, biodegradable, thermoplastic polymer with excellent biocompatibility and good mechanical properties. The delayed fat injection provided optimal conditions for angiogenesis around the scaffold and guaranteed the survival and subsequent regeneration of adipose tissue. These animal experiments established the basis for a structured scaffold implantation, a technique for stimulation of angiogenesis and optimization of the local microenvironment for various growth factors to play a role in tissue regeneration. Exploring the properties of different materials to perfect breast reconstruction, in 2019, biofunctional scaffolds incorporating dopamine-modified alginate (Alg) and polydopamine (PDA) were fabricated using 3D printing (20). The experimental results showed that the Alg-PDA scaffold demonstrated great flexibility and similar elastic modulus to normal breast tissues (Figure 1).
1H NMR spectra (A) and UV–Vis absorption (B) spectra of Alg, DA, and Alg-DA. Photographs of the 3D-printed Alg-PDA scaffold. The scaffold maintained its original structure without deformation and cracks suffering from bending, rolling, and stretching (C). SEM images in the inside of struts of pure alginate (D) and Alg-PDA scaffolds (E).
Of particular importance, 14 days following scaffold implantation in mice with a breast cancer, the tumor size of the cancer was significantly reduced. Human breast epithelial cells (MCF-10A) were then implanted on the scaffolds and cultured for seven days. The results showed that the scaffold could support the proliferation of breast epithelial cells (Figures 2, ,33).
MRI images of the breast cancer region implanted with Alg-PDA scaffold for 1 and 14 days (A). Yellow circles indicate the location of the scaffold (B). Photoacoustic imaging (C) and photoacoustic intensity (D) of Alg scaffolds and Alg-PDA scaffolds before (in vitro) and after implantation at tumor sites of mice for 2 and 9 days.Figure 3
Proliferation of MCF-10A cells seeded on 3D-printed Alg, Alg-PDA, and 48-well plate (control) scaffolds during seven days of culture. © 2019 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved (20). *indicates statistically significant.
This kind of PDA scaffold has been used in other biomedical engineering fields, and in the future, we hope to utilize this PDA scaffold in breast reconstruction with the added benefit of reducing the risk of local breast cancer recurrence.
Similarly, Tytgat et al. (21) used an extrusion-based 3D printing to develop scaffolds composed of both methacrylamide-modified gelatin (Gel-MA) and methacrylated κ-carrageenan (Car-MA). In vitro experiments showed that this hydrogel scaffold remained stable over time, absorbed large amounts of water, and its mechanical properties were comparable with the natural mammary tissue (Figure 4).
Scheme of a layer of the printed scaffolds (A). Optical microscopy images of Gel-MA (upper panel) and Gel-MA – Car-MA scaffolds (center). The scale bars represent 500 μm (B). Image of freeze-dried Gel-MA – Car-MA scaffolds. The scale bar represents 5 mm (C).
Clinical Application of 3D Printing Scaffold in Breast Reconstruction
In 2016, a study on tissue engineering for human breast reconstruction was carried out in Australia (22) (Table 2). Morrison designed an acrylic perforated dome-shaped chamber implant with 3 mm holes, ranging in size from 140 to 360 ml. Five female patients, ages 35–49 years, were selected for unilateral breast reconstruction. The specific plan was to implant it with the vascular pedicle fat flap, but it was reoperated to remove the implant 6 months after the initial operation. Analysis of the tissue removed with the implant demonstrated newly formed blood vessels, fibrous tissue, and a portion was adipose tissue. However, the implant material itself was not degradable, the texture was hard, and the resultant cosmetic assessment was poor. Koichi (23) studied bilateral breast reconstruction, utilizing preoperative three-dimensional imaging to estimate the required replacement volume. Then, he used 3D printing technology and polypropylene copolymer as the bioink to print the new breast form. According to the breast volume calculated, a single- or double-pedicle flap was developed to reconstruct the breast in combination with the 3D printed mold (Figure 5). With modest alteration, reconstruction of patients with breast ptosis (24) could also achieve good cosmetic results (Figure 6).
Table 2
Summary of 3D printing scaffold in breast reconstruction.
| References | Scaffolds | Advantages |
|---|---|---|
| Morrison et al. (22) | Acrylic perforated dome-shaped chamber | After 6 months, newly formed blood vessels, fibrous tissue, and a portion was adipose tissue. |
| Tomita (23, 24) | Polypropylene copolymer breast form | With the 3D printed mold, a single- or double-pedicle flap was developed to reconstruct the breast. |
| Hummelink (25) | PolyLactic acid breast prosthesis | It used a mirror image of the contralateral breast to design the breast prosthesis by 3D printing. |
| Juliang (26) | Porous polycaprolactone breast implant | The bioprinting material is a biocompatible and biodegradable polymer. |
(A) Required flap volume was estimated from bilateral breast images using a 3D image data analysis software. (B,C) Total flap volume was estimated using the formula shown, and flap type was determined preoperatively. (D) Contralateral breast shape was horizontally inverted, and an acrylonitrile–butadiene–styrene copolymer breast mold was created using a personal 3D printer. (E) After vascular anastomosis, the de-epithelialized flap was placed in the mold and fixed to shape a symmetric breast. Copyright © 2015, © 2015 American Society of Plastic Surgeons (23).
(A) In the initial surgery, TE placement in the affected breast and mastopexy of the contralateral breast using the vertical scar technique are performed. (B) Four to six months postoperatively, a 3D bilateral breast imaging is performed after confirming that the shape of the contralateral breast is somewhat stabilized, and a 3D-printed breast mold is created based on the mirror image of the shape of the contralateral breast. (C) In DIEP flap surgery, the direction of the flap and volume of graft tissue are determined using the breast mold. Copyright © 2017, Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons (24).
Stefan (25) took a similar approach, but used a mirror image of the contralateral breast to design the breast prosthesis by 3D printing using PolyLactic Acid as the printing material. Some attempts to utilize this approach to partial breast reconstruction have been disappointing, and some cases would require additional surgery to correct the problem with an obvious negative impact on the physical and mental health of the patients.
Although the emergence of 3D printing technology provides great potential opportunities for breast reconstructive surgeons with a more predictive precision and personalization with regard to the size and shape for the individualized patients, there remain limitations in virtually all aspects including the materials, shape, and structure of the breast prosthesis to be printed. To date, clinical application of 3D printing technology continues to suffer from the same problems as traditional prosthetic reconstruction, such as bilateral breast asymmetry and capsular contraction.
As an initial introduction to the clinical experience of this technology, a biodegradable breast implant employing 3D printing technology, sized according to a tissue defect from a wide local excision, was undertaken in 2016. Professor Zhang Juliang (26) of Xijing Hospital admitted a 27-year-old female patient with a left breast invasive cancer measuring 4.0 × 3.0 cm. Following the completion of six cycles of neoadjuvant chemotherapy, the cancer had reduced in size to 3.5 × 1.4 × 2.1 cm. The patient was adamantly requesting breast conservation surgery. The decision was made to pursue a wide local excision of the cancer, then, with the use of CAD to measure the resultant breast defect, breast reconstruction would incorporate 3D printed, biodegradable materials. Specifically, the breast MRI plain and enhanced scan data of the surgical defect were used to construct a three-dimensional image to precisely define the size and shape of the breast implant. The bioprinting material was the same as previously described, polycaprolactone, a biocompatible and biodegradable polymer. The preset deformation and degradation time was expected to be 2 years. The 3D biomaterial printer, developed independently by the State Key Laboratory of mechanical manufacturing system engineering of Xi’an Jiaotong University, was used to print the personalized porous breast implant, ideal for the needs of the patient (Figures 7A–F).
Design and printing of personalized biodegradable implants for patients. (A,B) Breast magnetic resonance imaging front view; (C,D) Three dimensional images were constructed according to the MRI image; (E) Simulated three dimensional images of tumor resection and scaffold implantation in surgery. (F) General shape of degradable breast implants (the material is polycaprolactone) and internal structure of degradable breast implants (26).
The whole operation was performed under aseptic conditions (Figures 8A–C). Follow-up 9 months later was particularly encouraging, with a good cosmetic appearance, and the MRI showed that the implant had a good compatibility with the patient’s own autogenous tissue. There was an abundant vascularity and granulation tissue throughout the implant, especially through the holes in the scaffold, and the appearance of new soft tissue (Figures 9A–C). From an oncologic perspective, with the follow-up extended to the end of December 2017, there was no recurrence or evidence of metastasis.
Patients underwent computer-assisted 3D printing of degradable materials for breast reconstruction (A–C).
