We would like to congratulate Sigurdson and Kirkland on their interesting work.1 Besides the variety of methods described to assess breast volume, surface imaging represents a new alternative for precise, accurate, and observer-independent breast volume computation.2 We do appreciate this new approach by the authors, because we compared classic assessment methods to this new three-dimensional technology.3 We agree that anthropomorphic measurements are relatively feasible, cheap, and fast and can be accomplished with a standing patient. The authors also mention the limitations, especially with regard to projecting the inframammary fold onto the anterior breast surface and the resulting decrease in precision of the measurement in case of a deviation of the projected point. This aligns with our findings that anthropomorphic measurements are less reproducible and are not observer-independent, because of internal variation of the manual measurements and less anatomically well-defined landmarks.3,4
We have determined that different breast volume assessment methods measure different areas of breast tissues.3 Anthropomorphic methods attempt to derive a correlation between breast volume obtained by other assessment methods and linear measurements. The authors apply a water displacement method that is a modification of Tezel and Numanoglu’s technique, using a cylindrical container to derive a formula for breast volume determination.1,5 With this container, the posterior breast volume delimitation is defined as a planar level, comparable to molding techniques; posteriorly located breast portions are not included; and smaller volumes are computed.3 Using three-dimensional surface imaging, the rear demarcation of the volume area is not obtained either, but by using special software, the thorax wall curvature is calculable. This computed posterior breast volume delimitation is curved and shows high agreement with the segmented real thorax wall curvature obtained by magnetic resonance imaging data.2 Furthermore, the breast volume measurements obtained using three-dimensional surface imaging are highly correlated to the volume computations derived by magnetic resonance imaging, and calculated regression equations assist in comparing the different methods.2,3 We also observed that the precision of breast volume measurements is influenced by the examined breast volume and described the potential anatomical influences that are responsible for the reduced precision in breast volume calculation.2
It would be of great interest to know whether the described formula also correlates to other breast volume determination methods, whether the authors have also observed that the breast volume could influence the precision of their method, and whether the formula is applicable for the postoperative evaluation, which is desirable to assess the outcome and to clinically validate the formula by comparing the volume changes with the resection weight.
Three-dimensional surface imaging offers the possibility of quantitatively evaluating and documenting actual morphological changes of the breast region before and after surgery with regard to volume, shape, contour, projection, surface, and symmetry (Fig. 1). Currently, three-dimensional surface imaging is not a routine method and is not affordable for everyone; therefore, due to the above-named advantages, we highly appreciate the presented method, because cost effectiveness is more important these days. With further development and elimination of existing obstacles, we believe that three-dimensional technology will become more widely applicable and affordable in the field of plastic and reconstructive surgery.
Maximilian Eder, M.D.
Nikolaos A. Papadopulos, Ph.D.
Laszlo Kovacs, M.D.
Department of Plastic and Reconstructive Surgery
Klinikum rechts der Isar
Technical University Munich
The authors have no financial or commercial relationships with other people or organizations that could inappropriately influence their work.
1. Sigurdson, L. J., and Kirkland, S. A. Breast volume determination in breast hypertrophy: An accurate method using two anthropomorphic measurements. Plast. Reconstr. Surg.
118: 313, 2006.
2. Kovacs, L., Eder, M., Hollweck, R., et al. New aspects of breast volume measurement using 3D surface imaging. Ann. Plast. Surg.
3. Kovacs, L., Eder, M., Hollweck, R., et al. Comparison between the breast volume measurement using 3D surface imaging and classical techniques. Breast
4. Kovacs, L., Yassouridis, A., Zimmermann, A., et al. Optimization of the three-dimensional imaging of the breast region with 3D laser scanners. Ann. Plast. Surg.
56: 229, 2006.
5. Tezel, E., and Numanoglu, A. Practical do-it-yourself device for accurate volume measurement of breast. Plast. Reconstr. Surg.
105: 1019, 2000.
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