Letter to the Editor
Response to “Comments on: ThreeDimensional Imaging for Breast Augmentation: Is This Technology Providing Accurate Simulations?”
Aesthetic Surgery Journal 2015, Vol 35(3) NP73–NP74 © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: [email protected] DOI: 10.1093/asj/sju152 www.aestheticsurgeryjournal.com
Jason Roostaeian, MD; and William P. Adams Jr, MD
reproduced with high-resolution detail) on which the consultations and analyses are performed. We also wonder whether she actually has the same version of the system and if she has done the annual updates, because there have been substantial improvements made in the past 2 years that have increased the accuracy and workflow. We question whether her setup has been optimized. Additionally, we differ in our understanding of optimal fill volume. This is not defined ( per Dr Hall-Findlay) as an implant that does not “extend beyond the base diameter (more accurately termed the breast width) horizontally.”1 Optimal fill volume is a tissue-based volume derived from the breast base width and the breast envelope assessment. The volumetric approach suggested by Dr Hall-Findlay is precisely what largely contributed to the 20% reoperation rates that have overshadowed this procedure. Tissue-based planning is one of the key solutions to optimize results. To be clear, 3D imaging is not a playground to place half the catalogue of different implants into the breast—a proper “time waste.” The optimal fill is determined by direct patient measurements, and then implants that “fit the breast” are imaged. The Vectra imaging system (Canfield Scientific Inc, Fairfield, New Jersey) also brackets the likely choices based on proven tissue-based principles, and these can be used or altered based on the surgeon’s directive or patient’s desires. The initial patient education session further defines the Dr Roostaeian is an Assistant Clinical Instructor in the Division of Plastic Surgery, The University of California, Los Angeles, California. Dr Adams is an Associate Clinical Professor of Plastic Surgery, the University of Texas Southwestern Medical School, Dallas, Texas. Corresponding Author: Dr William P. Adams Jr, 6901 Snider Plaza, Suite 120, Dallas, TX 75205, USA. E-mail: [email protected]
Downloaded from http://asj.oxfordjournals.org/ by guest on October 6, 2015
We are happy to respond to the comments by Dr Elizabeth Hall-Findlay.1 Experience influences our beliefs, and it appears Dr Hall-Findlay has not had a positive experience with breast 3-dimensional (3D) imaging. Much like the previous response, we are not exactly sure how to respond to her conclusion that the “simulations are far from accurate.”1 The data are the data and are based on the objective analysis in this study; these data would indicate that her opinion is not supported. Our goal in the study was to determine the accuracy of the simulations generated by 3D imaging technology. We randomly selected 20 consecutive breast augmentation patients and used an objective mathematical formula to look at volume and surface contour. The results as stated were 90% accuracy in volume and a mean of 4-mm (98% accuracy) surface contour. That is the data. Why do Dr Hall-Findlay and we differ in our conclusion? We would suggest the following. To begin with, Dr Hall-Findlay states that she has increased her consultation time with 3D imaging than with conventional photography. We have found the opposite. The setup of the 3D imaging technology is as important as actually using it. The single 3D scan is processed and networked into the examination room, allowing the surgeon to incorporate the 3D imaging into the consult. We have found this to make the consult better, faster, and more efficient. Default landmarks are typically well arranged based on default placement; however, they can be quickly adjusted if desired (checked by staff at the time of the scan). Threedimensional imaging is a powerful visual communication tool. The simulations continue to get better every year. We acknowledge that the simulations are not perfect, but in our experience they have been very close to the actual postoperative result. We caution Dr Hall-Findlay that printed 2D journal images are not nearly as detailed as a high-resolution monitor (which allow subtle coloring and shadowing to be
Aesthetic Surgery Journal 35(3)
NP74
the single most powerful technology we have implemented in the past 10 years. Nevertheless, we wanted to determine the accuracy of the technology. The objective analysis in our study demonstrates that the technology is indeed both effective and accurate.
Disclosures Dr Adams is an unpaid scientific advisor to Canfield Scientific, Inc (Fairfield, New Jersey). Dr Roostaeian declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
REFERENCE 1. Hall-Findlay E. Comments on: Three-Dimensional Imaging for Breast Augmentation: Is This Technology Providing Accurate Simulations? Aesthet Surg J. 2015;35(3): NP68-NP72.
Downloaded from http://asj.oxfordjournals.org/ by guest on October 6, 2015
specific result the patient is looking for, and fine-tuning the measured optimal fill volume can be made and demonstrated. All of this allows a directed approach with the 3D imaging and results in a better, more efficient, faster consult. We were initially interested in this technology as it had the potential to make the patient consult better, and we felt that the biggest beneficiary would be the patient; however, we wanted to know if the simulations were accurate. This was the genesis behind our study. For many years, surgeons and patients have used techniques that included bra stuffing with implant sizers, molded sizers, plastic sandwich bags, and uncooked rice kernels—all pure rubbish. These may make patients and surgeons feel better but introduce multiple variables that actually make it more confusing and less efficient. With 3D imaging, we have the opportunity to raise the standards. Because we live in a 3D world, why not do our consults in 3D and show patients something visibly tangible that is also scientifically validated? In our clinical practice, this tool has been
Response to “Comments on: ThreeDimensional Imaging for Breast Augmentation: Is This Technology Providing Accurate Simulations?”
Aesthetic Surgery Journal 2015, Vol 35(3) NP73–NP74 © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: [email protected] DOI: 10.1093/asj/sju152 www.aestheticsurgeryjournal.com
Jason Roostaeian, MD; and William P. Adams Jr, MD
reproduced with high-resolution detail) on which the consultations and analyses are performed. We also wonder whether she actually has the same version of the system and if she has done the annual updates, because there have been substantial improvements made in the past 2 years that have increased the accuracy and workflow. We question whether her setup has been optimized. Additionally, we differ in our understanding of optimal fill volume. This is not defined ( per Dr Hall-Findlay) as an implant that does not “extend beyond the base diameter (more accurately termed the breast width) horizontally.”1 Optimal fill volume is a tissue-based volume derived from the breast base width and the breast envelope assessment. The volumetric approach suggested by Dr Hall-Findlay is precisely what largely contributed to the 20% reoperation rates that have overshadowed this procedure. Tissue-based planning is one of the key solutions to optimize results. To be clear, 3D imaging is not a playground to place half the catalogue of different implants into the breast—a proper “time waste.” The optimal fill is determined by direct patient measurements, and then implants that “fit the breast” are imaged. The Vectra imaging system (Canfield Scientific Inc, Fairfield, New Jersey) also brackets the likely choices based on proven tissue-based principles, and these can be used or altered based on the surgeon’s directive or patient’s desires. The initial patient education session further defines the Dr Roostaeian is an Assistant Clinical Instructor in the Division of Plastic Surgery, The University of California, Los Angeles, California. Dr Adams is an Associate Clinical Professor of Plastic Surgery, the University of Texas Southwestern Medical School, Dallas, Texas. Corresponding Author: Dr William P. Adams Jr, 6901 Snider Plaza, Suite 120, Dallas, TX 75205, USA. E-mail: [email protected]
Downloaded from http://asj.oxfordjournals.org/ by guest on October 6, 2015
We are happy to respond to the comments by Dr Elizabeth Hall-Findlay.1 Experience influences our beliefs, and it appears Dr Hall-Findlay has not had a positive experience with breast 3-dimensional (3D) imaging. Much like the previous response, we are not exactly sure how to respond to her conclusion that the “simulations are far from accurate.”1 The data are the data and are based on the objective analysis in this study; these data would indicate that her opinion is not supported. Our goal in the study was to determine the accuracy of the simulations generated by 3D imaging technology. We randomly selected 20 consecutive breast augmentation patients and used an objective mathematical formula to look at volume and surface contour. The results as stated were 90% accuracy in volume and a mean of 4-mm (98% accuracy) surface contour. That is the data. Why do Dr Hall-Findlay and we differ in our conclusion? We would suggest the following. To begin with, Dr Hall-Findlay states that she has increased her consultation time with 3D imaging than with conventional photography. We have found the opposite. The setup of the 3D imaging technology is as important as actually using it. The single 3D scan is processed and networked into the examination room, allowing the surgeon to incorporate the 3D imaging into the consult. We have found this to make the consult better, faster, and more efficient. Default landmarks are typically well arranged based on default placement; however, they can be quickly adjusted if desired (checked by staff at the time of the scan). Threedimensional imaging is a powerful visual communication tool. The simulations continue to get better every year. We acknowledge that the simulations are not perfect, but in our experience they have been very close to the actual postoperative result. We caution Dr Hall-Findlay that printed 2D journal images are not nearly as detailed as a high-resolution monitor (which allow subtle coloring and shadowing to be
Aesthetic Surgery Journal 35(3)
NP74
the single most powerful technology we have implemented in the past 10 years. Nevertheless, we wanted to determine the accuracy of the technology. The objective analysis in our study demonstrates that the technology is indeed both effective and accurate.
Disclosures Dr Adams is an unpaid scientific advisor to Canfield Scientific, Inc (Fairfield, New Jersey). Dr Roostaeian declared no potential conflicts of interest with respect to the research, authorship, and publication of this article.
REFERENCE 1. Hall-Findlay E. Comments on: Three-Dimensional Imaging for Breast Augmentation: Is This Technology Providing Accurate Simulations? Aesthet Surg J. 2015;35(3): NP68-NP72.
Downloaded from http://asj.oxfordjournals.org/ by guest on October 6, 2015
specific result the patient is looking for, and fine-tuning the measured optimal fill volume can be made and demonstrated. All of this allows a directed approach with the 3D imaging and results in a better, more efficient, faster consult. We were initially interested in this technology as it had the potential to make the patient consult better, and we felt that the biggest beneficiary would be the patient; however, we wanted to know if the simulations were accurate. This was the genesis behind our study. For many years, surgeons and patients have used techniques that included bra stuffing with implant sizers, molded sizers, plastic sandwich bags, and uncooked rice kernels—all pure rubbish. These may make patients and surgeons feel better but introduce multiple variables that actually make it more confusing and less efficient. With 3D imaging, we have the opportunity to raise the standards. Because we live in a 3D world, why not do our consults in 3D and show patients something visibly tangible that is also scientifically validated? In our clinical practice, this tool has been
