Improving Volumetric Symmetry in Reduction Mammoplasty Using Intraoperative 3-Dimensional Photogrammetry

Abstract Background Achieving breast symmetry represents a critical endpoint in reduction mammoplasty. Historically, surgeons have been predominantly depended on anthropometric parameters, such as linear measurements and tactile evaluation, to guide intraoperative decision-making. Nonetheless, there remains a substantial unmet need for objective, intraoperative volumetric assessment techniques. While 3-dimensional volumetric analyses have become well-established tools for preoperative planning and postoperative evaluation, the literature on intraoperative volumetric assessment is still quite limited and relies on scanning devices lacking rigorous validation. Objectives In this study, following extensive preliminary investigations, we present the first evaluation of the validated Vectra H2 3D photogrammetric imaging system applied intraoperatively during reduction mammoplasty. The primary aim was to investigate if integrating this objective intraoperative volumetric data could facilitate improved postoperative breast volume symmetry. Methods We analyzed 100 patients undergoing reduction mammoplasty with supero-medial pedicle and wise pattern skin resection. We compared volumetric differences of the last 50 reduction mammoplasty procedures before using intraoperative volumetric measurements (group A; control) to the first 50 reduction mammoplasties after implementation of intraoperative volumetric analysis using Vectra H2 3D photogrammetry (group B; intraoperative 3D). The follow-up period was 12 months. Results Fifty patients were included in group A and 50 patients in group B. Patient demographics, mean resection weight, and complications did not differ statistically significantly. The 3-month postoperative volumetric differences between the breasts of the same patient averaged 5.8% ± 3.0% (mean ± SD, 0.1%-12.2%) in Group A (control) and 2.9% ± 1.5% (mean ± SD, 0.8%-6.9%) in Group B (intraoperative 3D). These differences were statistically significant (P < .05). Conclusions In our study, intraoperative 3D photogrammetry for volumetric analysis significantly improved volumetric symmetry following reduction mammoplasty. Although the volumetric differences in both groups were relatively small, the technique facilitated the intraoperative identification of outliers and resulted in superior volumetric symmetry. Level of Evidence: 3 (Therapeutic)