4D Breast Imaging, Part II. Clinical Implementation and Validation of a Computer Imaging System for Breast Augmentation Planning

Goals/Purpose:  No prior publications exist describing the impact of 3D imaging on the consultation process for breast augmentation, nor have existing software products that claim simulation features been validated either objectively by measurement or subjectively by patient feedback.  We report results on 45 consecutive patients in whom 4D imaging was used during their initial consultation to plan their implant size and type.   Follow up automated measurements are used to validate the accuracy of the simulation function of the software.  Subjective patient feedback is described.  The positive effect on practice productivity is also described.

Methods/Technique:   After installing the 4D imaging system in a single surgeon’s practice, breast augmentation consultations were carried out, integrating the imaging system as part of the consultation experience over a two year period.   The first 45 consecutive breast augmentations were enrolled for the purposes of this study.  Only primary breast augmentation patients were considered, excluding women with ptosis, secondary problems, and reconstruction patients.   Six month follow-up imaging was obtained.  Automated measurements from the initial saved simulation images were compared to the actual automated measurements obtained at six months, using Pearson’s correlation coefficient.  Shortly thereafter, questionnaires were sent in a blinded fashion to the same group of patients along with a copy of their preoperative and simulation images for their assessment of the accuracy and usefulness of the imaging experience.  

Separately, practice productivity was evaluated by comparing the one year period from March, 2009-March, 2010 to the periods March-September, 2007 and March-September, 2008 in terms of breast augmentation closure rates, interval to scheduling surgery, implant ordering metrics and consultation length. 

Results/Complications:   Across all linear and volumetric parameters studied, breast augmentation simulations correlated highly with the actual surgical outcomes, with an overall R value= 0.74.  Subjective assessment revealed that 95% of patients thought the simulations were accurate.  Patients responded favorably to the use of imaging with 89% expressing that it enhanced trust in the surgeon, and 81% reporting that it helped in the choice of implant size.   Despite a 95% satisfaction rate in this group of breast augmentation patients, approximately 48% indicated that if they were to have the surgery again, they would elect to place a larger implant.

Compared to historical controls for the two years preceding the use of imaging, closure rates in one surgeon’s practice increased from 40% to 73%, with same day scheduling increasing from 14% to 47%.   Compared to the previous year, the number of implants purchased increased 27%.  Over the same period, consultation length decreased by approximately 50%.

Conclusion:   4D breast imaging appears to be an accurate system for analysis, planning, simulation and education of patients considering primary breast augmentation.  The simulation software described here performed well for a statistically significant group of patients in a private practice setting.  Patient satisfaction with the imaging experience was very favorable.  Practice productivity was enhanced dramatically by the efficiency metrics of closure rates, interval to scheduling surgery, and physician contact time.  Early data indicates use of 4D imaging may increase the quality and number of patients undergoing breast augmentation through better patient education and better physician communication.