Development and validation of a photogrammetry-based preoperative method (BREAST-E) for quantitative breast morphometric analysis and volume estimation of breast in reconstructive surgery.

Abstract

The demand for reproducible, reliable, and cost-effective tools regarding preoperative breast surgery planning is significant in low- and middle-income countries (LMICs) due to limited advanced imaging access, insufficient standardisation, and high cost. This study developed the BREAST-E technique for accurate and standardised breast volume analysis. A photogrammetry method assessed four ptosis levels: (i) no-ptosis, (ii) mild, [Watterson PA, et al. Plastic and Reconstructive Surgery. 1995;95:1185-94] moderate, and (iv) severe. Key parameters included marker counts (20, 40, and 60), photo angles (10°, 20°, and 30°), and offset adjustments (-0.01, 0, and +0.01). Two-dimensional (2D) images were converted into 3D models via Photomodeler for volume estimation. Clinical validation involved 12 patients (13 breasts) undergoing mastectomy, comparing estimated breast volumes to mastectomy specimens. The primary endpoint was accuracy of volume estimation compared with mastectomy specimen volume, while secondary endpoints included reliability, agreement, and workflow feasibility. The BREAST-E technique yielded promising accuracy [Pearson correlation coefficient (R) = 0.899 and mean absolute error (MAE) = 98.12 mL] and encouraging reliability (ICC = 0.995-0.996) across ptosis levels. Bland-Altman analysis indicated negligible bias, while Cronbach's alpha (reaching 0.994) demonstrated robust internal consistency. Clinical validation also implied strong performance (R = 0.789, MAE = 104.69 mL, and mean error = -27.00 mL). Consequently, no-ptosis presented the highest reliability (ICC = 0.81 and Cronbach's alpha = 0.92) with minimal bias, whereas moderate and severe ptosis levels demonstrated greater variability. This study successfully indicated that a reproducible, accessible, and cost-effective method for analysing breast volume was accomplished through the proposed BREAST-E technique for LMICs.