Clinical assessment of breast volume: updated 3D imaging demonstrates good agreement to MRI measurements

Abstract Background Accurate breast volumetry is essential for preoperative surgical planning and objective monitoring in autologous fat transplantation (AFT). Magnetic resonance imaging (MRI) is the current clinical reference but is constrained by high costs and labor-intensive manual segmentation. This study evaluates a refined volumetric algorithm for the VECTRA XT 3D imaging system, comparing its accuracy and reliability against MRI and plastic surgeons’ estimations. Methods In this retrospective cross-sectional study, 49 breasts from 27 patients undergoing therapeutic or risk-reducing breast surgery were analyzed. Breast volumes were assessed using three methods: 3D-imaging, MRI, and clinical estimations by plastic surgeons. The refined algorithm was applied to a previously established database which used identical landmarks as the previous algorithm. Statistical analysis included paired t-tests, intraclass correlation coefficients (ICC), and Bland-Altman plots to assess agreement and bias. Results MRI measurements demonstrated excellent inter-observer reliability (ICC 0.975). The refined 3D algorithm showed good reliability compared to MRI (ICC 0.774; p < 0.001) with no statistically significant difference in mean volumes ( p = 0.173). A mean bias of -34.1 cc was found between this algorithm and MRI. Surgeons’ estimation showed moderate reliability compared to 3D imaging (ICC 0.517) with significantly different means and a mean bias of 173.9 cc. Conclusions The updated VECTRA 3D algorithm provides good agreement with MRI and reliable breast volume measurements, significantly outperforming the previous algorithm and clinical estimations. While MRI remains the reference standard, this refined tool is excellent for broader clinical integration, given the non-invasive nature and workflow efficiency. Level of Evidence: Level II, diagnostic study.