Aesth Plast Surg (2015) 39:369–376
DOI 10.1007/s00266-015-0493-9
ORIGINAL ARTICLE
Preoperative Magnetic Resonance Imaging-Based Breast
Volumetry for Immediate Breast Reconstruction
Hyungsuk Kim1 • Goo-Hyun Mun1 • Elrica Sapphira Wiraatmadja2 •
So-Young Lim1 • Jai-Kyong Pyon1 • Kap Sung Oh1 • Jeong Eon Lee3 •
Seok Jin Nam3 • Sa-Ik Bang1
Received: 4 February 2015 / Accepted: 17 April 2015 / Published online: 30 April 2015
Ó Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery 2015
Abstract
Background Preoperative breast magnetic resonance
imaging (MRI) is a routine test for oncologic evaluation.
However, determining breast volume using a preoperative
MRI obtained as a part of oncologic evaluation has not yet
been attempted for immediate breast reconstruction. The
study introduces the benefit of MRI-based volumetry, not
only in autologous breast reconstruction but also in im-
plant-based breast reconstruction.
Methods Forty patients preparing for autologous breast
reconstruction with a deep inferior epigastric artery per-
forator (DIEP) flap and 30 patients for implant-based breast
reconstruction from June 2011 to June 2012 were included
in this study. In every DIEP case, we collected data about
actual resected breast tissue weight during mastectomy and
final flap weight inserted intraoperatively. Computed to-
mography (CT) was for preoperative CT angiography for
microsurgical breast reconstruction, whereas MRI was
performed for oncologic evaluation. In every implant-
based reconstruction case, MRI-based breast volume was
measured in the same way for DIEP patients and resected
& Sa-Ik Bang
si55.bang@samsung.com
1
Department of Plastic Surgery, Samsung Medical Center,
Sungkyunkwan University School of Medicine, 81 Irwon-ro,
Gangnam-gu, Seoul 135-710, South Korea
2
Division of Plastic Surgery, Faculty of Medicine, University
of Indonesia-Cipto Mangunkusumo Hospital, Jl.Diponegoro
71, Jakarta 13410, Indonesia
3 Keywords Magnetic resonance imaging
Breast
Department of Surgery, Samsung Medical Center,
Sungkyunkwan University School of Medicine, 81 Irwon-ro,
Gangnam-gu, Seoul 135-710, South Korea
BREAST
breast tissue weight was measured intraoperatively. In
addition, we also added or subtracted the breast volume by
any modification, such as reduction and augmentation on
the ipsilateral or contralateral side. To determine the ac-
curacy of MRI-based volumetry, Pearson correlation co-
efficients were calculated to quantify the correlation
between CT and MRI-based volumetry data and intraop-
erative volume measurements.
Results For DIEP patients, the mean resected breast tis-
sue weight during mastectomy was more closely related to
the mean estimated breast volume using MRI than to the
mean estimated breast volume using CT (Pearson coeffi-
cient 0.928 and 0.782; p = 0.001). MRI gave a closer
correlation to final flap weight than CT (Pearson correla-
tion coefficient 0.959 and 0.873; p = 0.001). For implant-
based reconstruction patients, the breast volume measured
by MRI correlated closely with the actual mean weight of
resected breast specimens (0.937; p = 0.001). Mean net
implanted volume was more closely related to mean esti-
mated breast volume using MRI than to mean resected
breast tissue weight during mastectomy (0.893 and 0.880;
p = 0.001).
Conclusions Reliable volumetric information can be ob-
tained using MRI for breast implant volume and au-
tologous tissue needed in optimizing symmetry in breast
reconstruction.
Level of Evidence IV This journal requires that authors
assign a level of evidence to each article. For a full de-
scription of these Evidence-Based Medicine ratings, please
refer to the Table of Contents or the online Instructions to
Authors www.springer.com/00266.
reconstruction
Preoperative imaging
Volumetry
DIEP
flap
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Introduction
Measuring breast volume is valuable prior to performing
breast reconstruction surgery. Symmetry in shape and
volume is important main goals in plastic surgery, and
matching volume is one of the most noticeable endpoints of
breast reconstruction. Accordingly, it would be helpful for
surgical planning including actual flap design and implant
selection if information about breast volume could be ob-
tained preoperatively. For this reason, a simple and accu-
rate method to gather breast volume information is
required. Breast volume can be measured by many differ-
ent techniques including mammography, thermoplastic
cast, Archimedes principle, computed tomography (CT),
magnetic resonance imaging (MRI), anatomical and an-
thropomorphic measurements with formula, and three-di-
mensional scanners [1–8].
Herold et al. reported the usefulness of MRI-based
volumetry for planning reconstructive surgery to correct
asymmetric breasts and objectively assessed the postop-
erative results [9]. Determining breast volume for imme-
diate breast reconstruction using a preoperative MRI
obtained as a part of oncologic evaluation had not been
previously attempted. Such information would be valuable
for the planning of a free DIEP flap procedure and for the
planning of implant-based breast reconstruction. The pre-
sent study reports our experience with recycling magnetic
resonance data by calculating breast volume for a series of
immediate breast reconstruction procedures.
Patients and Methods
Patients and Data Collection
After obtaining informed consent from patients and ap-
proval from the institutional review board, a retrospective
medical record review was conducted from June 2011 to
June 2012. This study examined the cases of all female
patients who underwent breast reconstruction for breast
cancer including autologous breast reconstruction with a
deep inferior epigastric artery perforator (DIEP) flap only
and implant-based breast reconstruction. A total of 54 pa-
tients preparing for autologous breast reconstruction with a
DIEP flap and 46 patients for implant-based breast recon-
struction were included in this study. All of the mastec-
tomies were performed first by general surgeons including
total mastectomy (TM), skin-sparing mastectomy (SSM),
and nipple-sparing mastectomy (NSM) followed by breast
reconstruction surgery. Any patient who had undergone
surgery that could affect breast volume (i.e., breast con-
serving surgery) before mastectomy was excluded. Patient
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Aesth Plast Surg (2015) 39:369–376
data were collected from medical records including age,
body mass index, mastectomy specimen weight, final flap
weight for DIEP patients, surgically placed implant volume
for implant-based reconstruction patients, hospital stay,
and other details related to the breast reconstruction. Sur-
gical complications including seroma, hematoma, infec-
tion, flap failure, implant rupture, and wound revision were
recorded. During the follow-up period, we monitored any
complications and additional operations needed after breast
reconstruction.
DIEP Breast Reconstruction Subgroup
In every DIEP case, we collected data about actual resected
breast tissue weight during mastectomy and final flap weight
inserted intraoperatively. Preoperative CT angiography
(CTA) was performed for microsurgical breast reconstruc-
tion and MRI was performed for oncologic evaluation. One
of the co-authors (G.H.M.) performed all of the procedures in
the DIEP case series. The CT image data were available in
every DIEP patient. Fourteen DIEP patients were excluded
because of unsuitable preoperative MRI data (14 delayed
breast reconstruction cases). In each method, breast volumes
were assessed. CT-based breast volumetry was performed as
described previously [1]. Helical CT evaluations of the DIEP
and recipient sites were performed during the preoperative
period (ranging from 2 days to 2 months before surgery).
CTA was performed using a Light-Speed VCT 64-slice
scanner (GE Medical Systems, Milwaukee, WI, USA). The
raw image data were reconstructed in the axial plane with a
slice thickness of 1.25 mm and an interval of 1.25 mm in a
standard algorithm kernel. A volume rendering technique
was performed, and multiplanar reformation images were
reproduced with an Aquarius Workstation (TeraRecon, San
Mateo, CA, USA). The volume of breast tissue was measured
using a particular tool bar of the PathSpeed picture archiving
and communication system (GE Medical Systems Integrated
Imaging Solutions, Mt. Prospect, IL, USA). Breast tissue
excluding the skin was defined manually on the axial view.
The volume (mm3) was calculated by integrating each
polygonal area (mm2) automatically measured with an im-
age-editing tool. The areas were multiplied by slice thickness
(2.5 mm) to calculate the volume of the breast tissue (Fig. 1).
MRI was performed using an Achieva 3.0T (Philips
Medical Systems, Best, Holland) during the oncological
work-up period. The raw data were reconstructed in the
axial plane with a slice thickness of 1.5 mm and an interval
of 1.5 mm in a standard algorithm kernel. A volume ren-
dering technique was performed using an Aquarius Work
station, and multiplanar reformation images were repro-
duced. The volume of breast tissue was measured using a
particular tool bar of the Aquarius Workstation. Breast
Aesth Plast Surg (2015) 39:369–376 371

Fig. 1 Estimation of breast

volume. The breast is manually
identified on the CT (left) and
MR (right) image (outlined in
white)

Fig. 2 Estimation of breast

volume. The breast was
manually identified on MRI and
visualized in a three-
dimensional reconstructed
image. (Above, left) Calculated
breast volume in the region of
interest of the breast is marked
(at arrow)

tissue excluding the skin was defined manually on the three boundary was completed automatically on the remaining
T1-weighted axial images with the highest projection, most axial images. The volume (mm3) was calculated auto-
proximal, and most distal breast mound. The breast matically measured with the image-editing tool (Fig. 2).

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Implant-Based Breast Reconstruction Subgroup
For 46 patients with implant-based breast reconstruction,
two patients who underwent only implant change, three
patients receiving only tissue expander insertion, and 11
patients with no MRI data were excluded. The remaining
30 patients included implant insertion cases following tis-
sue expander removal with or without contralateral breast
modification. The senior author (S.I.B.) performed all of
the procedures in the implant-based reconstruction case
series. MRI-based breast volume was measured for this
subgroup of patients in the same way as for DIEP patients,
and resected breast tissue weight was measured intraop-
eratively. In addition, we also added or subtracted the
breast volume by any modification, such as reduction and
augmentation, on the ipsilateral or contralateral side. For
bilateral breast augmentation, net implanted volume was
calculated by subtracting contralateral side augmentation
volume. For breast reduction on the contralateral side, net
volume was calculated by adding contralateral reduction
volume. Data about interval time from tissue expander
insertion to removal, final tissue expander inflation volume,
and types of implant used were recorded.
Statistical Analyses
The data analyses were performed using the Statistical
Package for Social Sciences Windows version 19.0 (SPSS,
Chicago, IL, USA). Variables were compared and analyzed
between groups categorized by the breast reconstruction
method using the chi-square test for categorical variables
and the Student’s t test for continuous variables. Pearson
correlation coefficients were calculated to quantify the
correlation between CT and MRI-based volumetry data and
intraoperative volume measurements including implant
volume, net implanted volume, final expander volume,
resected breast tissue weight, and final flap weight. p values
B0.05 were considered statistically significant. The curves
were fitted using the calculated mean values for each
concentration using S-plus 6 software (Insightful Corpo-
ration, Seattle, WA, USA).
Results
The mean (±standard deviation) patient age was
43.50 ± 6.85 years (range 31–60) in DIEP patients and
41.83 ± 8.12 years (range 27–55) in implant-based pa-
tients. The mean BMI was 21.84 ± 2.23 kg/m2 (range
16.10–26.77) in DIEP patients and 22.13 ± 2.77 kg/m2
(range 18.91–31.36) in implant-based patients. All cases
had immediate unilateral breast reconstruction. The mean
for the hospital stay was 15.39 ± 2.21 (range 11–21). A
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Aesth Plast Surg (2015) 39:369–376
mastectomy including nipple-areolar complex and breast
skin envelope was performed in 32 patients (18 in DIEP
patients, 14 in implant-based patients), skin-sparing mas-
tectomy in 20 patients (10 in DIEP patients, 10 in implant-
based patients), and nipple-sparing mastectomy in 18 pa-
tients (12 in DIEP patients, six in implant-based patients).
The follow-up period was 11.08 ± 5.07 months (range
6–22) in DIEP patients and 11.13 ± 5.03 months (range
6–23) in implant-based patients. Four patients had under-
gone radiation therapy in the pre-reconstruction period and
six patients in the post-reconstruction period. Thirty-four
patients had undergone chemotherapy and 50 patients had
undergone hormone therapy. There was no statistically
significant difference in patient demographics between the
two groups except the period of hospital stay (Table 1).
The mean resected breast tissue weight was
353.56 ± 164.64 g (range 130–873) and mean MRI-based
breast volume was 366.59 ± 148.58 mm3 (range
108.61–790.05). No intraoperative complications were
observed. Donor site seroma occurred in two DIEP patients
and subsided with few aspirations. There was a case of
chest hematoma that required evacuation in the DIEP pa-
tient group. During the follow-up period, wound revision
was needed in three patients: necrotic wound was found in
one patient and the other two were eschar cases. Each
patient was satisfied with the surgical results and indicated
that she would recommend the surgery to other possible
candidates. There were no statistically significant differ-
ences between the two groups in terms of all parameters
studied (i.e., mastectomy specimen weight, breast volume
measure with MRI, seroma, hematoma, and wound revi-
sion) (Table 2).
DIEP Breast Reconstruction Subgroup
The mean CT-based breast volume was
373.89 ± 128.80 mm3 (range 147–650) and mean MRI-
based breast volume was 391.51 ± 148.43 mm3 (range
186.43–790.05) preoperatively. There was a correlation
between the two volumetric data sets (Pearson correlation
coefficient 0.888; p = 0.001). The mean resected breast
tissue weight was 371.63 ± 171.32 g (range 130–873) and
mean final flap weight was 381.60 ± 135.39 g (range
200–729) intraoperatively. There was a correlation be-
tween the two intraoperative data sets (Pearson correlation
coefficient 0.930; p = 0.001). The mean resected breast
tissue weight during mastectomy was more closely related
to the mean estimated breast volume using MRI, than to the
mean estimated breast volume using CT (Pearson correla-
tion coefficient 0.928 and 0.782; p = 0.001). MRI gave a
closer correlation to final flap weight than CT (Pearson
correlation coefficient 0.959 and 0.873; p = 0.001)
(Table 3).
Aesth Plast Surg (2015) 39:369–376 373

Table 1 Patient demographics

Demographics All patients (n = 70) DIEP patients (n = 40) Implant-based patients (n = 30) p*

Age (years) 42.79 ± 7.42 43.50 ± 6.85 (31–60) 41.83 ± 8.12 (27–55) 0.356
Height (cm) 158.82 ± 5.72 157.88 ± 5.92 (147.1–171.4) 160.108 ± 5.28 (150.8–167.6) 0.112
Weight (kg) 55.36 ± 7.39 54.37 ± 6.84 (40.5–72.6) 56.67 ± 7.98 (44.4–86.0) 0.199
2
BMI (kg/m ) 21.96 ± 2.46 21.84 ± 2.23 (16.10–26.77) 22.13 ± 2.77 (18.91–31.36) 0.628
Hospital stay (days) 15.39 ± 3.03 14.08 ± 2.59 (11–21) 17.13 ± 2.71 (11–21) 0.001
Mastectomy subtype (%) 0.579
TM 32 (45.7) 18 (45.0) 14 (46.7)
SSM 20 (28.6) 10 (25.0) 10 (33.3)
NSM 18 (25.7) 12 (30.0) 6 (20.0)
Operation side (%) 0.405
Left 39 (55.7) 24 (60.0) 15 (50.0)
Right 31 (44.3) 16 (40.0) 15 (50.0)
Follow-up period (months) 11.10 ± 5.01 11.08 ± 5.07 (6–22) 11.13 ± 5.03 (6–23) 0.962
Chemotherapy (%) 34 (48.6) 16 (40.0) 18 (60.0) 0.098
Radiation therapy (%)
Pre-reconstruction 4 (5.7) 2 (5.0) 2 (6.7) 0.766
Post-reconstruction 6 (8.6) 3 (7.5) 3 (10.0) 0.712
Hormone therapy (%) 50 (71.4) 28 (70.0) 22 (73.3) 0.760
DIEP deep inferior epigastric artery perforator flap, BMI body mass index, TM total mastectomy, SSM skin-sparing mastectomy, NSM nipple-
sparing mastectomy
* Values are the mean for continuous variables and number (percentage) for categorical variables. The p values for continuous variables were
obtained using Student’s t test and p values for categorical variables were obtained using v2 tests

Table 2 Comparison of surgical variables and complications between DIEP and implant-based patient groups
All patients (n = 70) DIEP patients (n = 40) Implant-based patients (n = 30) p*

Mastectomy specimen weights (g) 353.56 ± 164.64 371.63 ± 171.32 (130–873) 329.47 ± 154.83 (140–769) 0.292
Breast volume measure with MRI 366.59 ± 148.58 391.51 ± 148.43 333.36 ± 144.56 0.106
(mm3) (186.43–790.05) (108.61–692.20)
Seroma (%) 2 (2.9) 2 (5.0) 0 (0) 0.214
Hematoma (%) 1 (1.4) 1 (2.5) 0 (0) 0.383
Wound revision (%) 3 (4.3) 2 (5.0) 1 (3.3) 0.733
DIEP deep inferior epigastric artery perforator flap
* Values are the mean for continuous variables and number (percentage) for categorical variables. The p values for continuous variables were
obtained using Student’s t test and p values for categorical variables were obtained using v2 tests

Implant-Based Breast Reconstruction Subgroup
The subgroup consisted of thirty eligible patients of implant
insertion following tissue expander removal (18 cases
without any modification on the contralateral breast, 11 cases
with augmentation on the contralateral breast, and one case
with reduction on the contralateral breast). Implants used
were mainly Allergan Natrelle style 110 (15 patients), fol-
lowed by Allergan Natrelle style 10 (13 patients), and Al-
lergan Natrelle style 115 (two patients). The mean MRI-
based breast volume was 333.36 ± 144.56 mm3 (range
108.61–692.20) preoperatively, and mean resected breast
tissue weight was 329.47 ± 154.83 g (range 140–769) in-
traoperatively. The mean interval time from tissue expander
insertion to removal was 7.46 ± 3.49 months. Mean final
tissue expander inflation volume was 381.83 ± 76.02 mL
(range 230–550), whereas mean implant volume used on the
ipsilateral side was 343.80 ± 72.89 mL (range 167–480).
Between them, there were two cases that needed additional
fat injection on the ipsilateral side. The first case was 20 mL
fat injection with breast reduction (165 g) and liposuction
(77 mL) on the contralateral side. The other case was fat

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Table 3 Correlation of volumetry data and intraoperative data of DIEP patients

CTV MRIV MWt FWt

CTV 1
373.89 ± 128.80 mm3
MRIV 0.888 1
391.51 ± 148.43 mm3 (p = 0.001)
MWt 0.782 0.928 1
371.63 ± 171.32 g (p = 0.001) (p = 0.001)
IFWt 0.873 0.959 0.930 1
381.60 ± 135.39 g (p = 0.001) (p = 0.001) (p = 0.001)
CTV breast volume measure with CT (mm3), MRIV breast volume measure with MRI (mm3), MWt mastectomy specimen weights (g), FWt final
flap weights (g)

injection of 47 mL without any modification on the con- Discussion

tralateral side. There were 11 cases that received contralat-
eral breast augmentation with implant simultaneously. The
mean implant volume used on the contralateral side was
208.64 ± 36.48 mL (range 170–270). Net implanted vol-
ume was calculated by adding ipsilateral fat injection vol-
ume, adding contralateral liposuction/reduction, or
subtracting contralateral side augmentation volume. Mean
net implanted volume was 277.60 ± 126.71 mL (range
75–592). The breast volume measured by MRI correlated
closely with the actual mean weight of resected breast spe-
cimens (Pearson correlation coefficient 0.937; p = 0.001)
(Fig 3). Mean net implanted volume was more closely re-
lated to mean estimated breast volume using MRI, than to
mean resected breast tissue weight during mastectomy
(Pearson correlation coefficient 0.893 and 0.880; p = 0.001)
(Table 4).
Fig. 3 Breast volume (mm3) measured with MRI and breast weight
(g) measured intraoperatively. Pearson correlation coefficient was
0.937 (p = 0.001). Pearson’s correlation reflects the degree of linear
relationship between the two variables
The purpose of this study was to report our experience with
recycling MRI data by calculating breast volume for a
series of immediate breast reconstruction procedures.
Breast MRI has repeatedly been shown to detect occult
cancer in patients with newly diagnosed breast cancer, and
the modality has increasingly been used in the initial
evaluation of patients with the disease. Breast MRI
theoretically provides an improved ability to localize dis-
ease and avoids reexcision. For these reasons, the use of
breast MRI has become almost routine in the evaluation of
patients with newly diagnosed breast cancer [10]. The
American Cancer Society published an update of guideli-
nes in 2007 that recommend routine use of MRI in patients
with a 20–25 % lifetime risk of breast cancer [11]. We
evaluated the benefit of MRI in breast reconstruction,
especially in predicting the replacement breast volume
needed. The accuracy of breast MRI in cancer staging and
cancer extent estimation has been established. Recently,
Yoo et al. reported the MRI-based volumetric analysis and
its relationship to actual breast weight focused on volume
and density of breast tissue based on mammography and
MRI data [12]. They derived a new model for estimating
breast volume considering both fibroglandular tissue vol-
ume and fat tissue volume. In contrast, the current study
was designed to establish the accuracy of MRI-based vol-
umetry by comparing many other parameters (i.e., breast
volume measure with CT, mastectomy specimen weights,
final flap weights, implant volume, and final expander
volume).
Ideally, a matching volume to restore breast volumetric
symmetry should replace the volume of the resected breast.
Accurate information of breast volume is useful in deter-
mining autologous tissue amount or implant volume that
will be needed. Various methods of breast volume mea-
surements have been reported including mammography,
thermoplastic cast, Archimedes principle, CT, MRI,

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Table 4 Correlation of volumetry data and intraoperative data of implant-based patients
MRIV MWt
MRIV 1
333.36 ± 144.56 mm3
MWt 0.937 1
329.47 ± 154.83 g (p = 0.001)
NV 0.893 0.880
277.60 ± 126.71 mL (p = 0.001) (p = 0.001)
IV 0.340 0.330
343.80 ± 72.89 mL (p = 0.066) (p = 0.075)
FEV 0.682 0.688
381.83 ± 76.02 mL (p = 0.001) (p = 0.001)
MRIV breast volume measure with MRI (mm3), MWt mastectomy specimen weights (g), NV net implanted volume (mL), IV implant volume
(mL), FEV final expander volume (mL)
anatomical and anthropomorphic measurements with for-
mula, and three-dimensional scanners [1–8]. A previous
study assessed routine CT of the chest using a three-di-
mensional device; the calculation was accurate enough to
have a significant clinical benefit in planning reconstructive
breast surgery [13]. Cil et al. demonstrated that CT is able
to quantify noninvasively the adipose and glandular com-
ponent distribution at gynecomastica tissue sites preop-
eratively [14]. The present study suggests the suitability of
CT-based breast volumetry associated with the weight of
resected breast tissue and final flap intraoperatively (Pear-
son correlation coefficient 0.782 and 0.873; p = 0.001).
CT had a high correlation in estimating the volume needed
for DIEP breast reconstruction. The cost of preoperative
computed tomographic angiography of both donor and
recipient sites in this study was the same as the cost for
conventional CT for donor sites. Despite the proven ben-
efits of CT, exposure to radiation is a drawback and addi-
tional financial obligation to the patient is inevitable [1,
15]. Besides, the results suggested that MRI may provide a
more significant estimation to actual resected breast tissue
weight and final flap weight than CT. MRI-based vol-
umetry showed a higher correlation to mastectomy speci-
men weights than CT-based volumetry (Pearson correlation
coefficient 0.928 and 0.782; p = 0.001). MRI-based vol-
umetry also showed a higher correlation to final flap weight
than CT-based volumetry (Pearson correlation coefficient
0.959 and 0.873; p = 0.001). The correlation coefficient of
CT-based volumetry to mastectomy specimen weight
(0.922, p = 0.001) is reportedly higher than the correlation
coefficient of the present study (0.782, p = 0.001) [1]. To
our knowledge, this is the first study comparing the accu-
racy between CT and MRI in predicting the autologous
tissue volume needed in DIEP flap. The reason that CT-
based volumetry is less accurate and has a more inconsis-
tent outcome than MRI-based volumetry is that, unlike
375
NV IV FEV
1
0.351 1
(p = 0.057)
0.562 0.642 1
(p = 0.001) (p = 0.001)
MRI which is conducted in a prone position, CT is con-
ducted in at supine position, which makes it harder to de-
fine the boundary of the breast and to reflect the shape of
breast. Moreover, most women undergoing breast MRI for
cancer staging and screening found it to be a comfortable
test and perceived it had a positive impact on their care.
Breast cancer patients perceived the clinical impact of their
breast MRI examination to be significantly more positive
than when assessed objectively [16]. MRI was acceptable
with high levels of satisfaction (96.3 %) and low levels of
psychological morbidity throughout [17].
In previous publications, the density of the breast sub-
cutaneous tissue was found to be close to 1 g/mL, so that
weight measurement of the breast in grams intraoperatively
generally equals the volume in milliliters [18, 19]. By de-
termining the volume of the breast, surgeons can estimate
how much of the abdominal flap needs to be utilized to
achieve an acceptable symmetry. This volumetric infor-
mation can also expedite the DIEP flap trimming during
insetting. This method also can guide the surgeon to choose
the most appropriate implant preoperatively. We found that
estimated breast volume preoperatively measured using
MRI-based volumetry closely correlated with the actual
resected breast tissue weight measured, final flap weight,
and also net implanted volume inserted intraoperatively.
MRI-based volumetry showed a higher correlation to
mastectomy specimen weights and net implanted volume
in implant-based patients (Pearson correlation coefficient
0.937 and 0.893; p = 0.001). As expected, final expander
volume revealed a lower correlation to breast volume
measure with MRI and mastectomy specimen weight
(Pearson correlation coefficient 0.682 and 0.688;
p = 0.001). Additionally, correlations between implant
volume and other parameters (i.e., breast volume measure
with MRI, mastectomy specimen weights, net implanted
volume) were not statistically significant (Pearson
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correlation coefficient 0.340, 0.330, and 0.351). Preop-
erative breast volume is one of most important factors that
affect the decision on implant size. However, breast width,
chest wall width, breast shape (ptotic or tubular breast), and
the depth of soft tissue envelope are also important in de-
ciding the implant size. Further study on these parameters
is required.
We could obtain the reliable volumetric measurements
with MRI to determine both the breast implant volume and
the autologous tissue required to optimize symmetry, one
of the main goals of breast reconstruction. MRI is more
accurate than CT in estimating breast volume. By using a
preoperative breast MRI performed routinely for oncologic
evaluation, we could predict the breast volume needed
before breast reconstruction. The timing of the MRI in
radiated patients relative to surgery could potentially affect
an accurate correlation between the calculated volume and
the intraoperative mastectomy specimen weight.
The mean for the hospital stay was 15.39 ± 3.03 days
(range 11–21). It is optimal and possible that maintaining the
length of stay could be in the 4–5 day range. In South Korea,
however, National Health Insurance Corporation covers all
charges for hospital accommodation regardless of the length
of stay. Most of the patients want to stay until the pathology
results are confirmed. This was a retrospective study that was
also limited due to the small sample size. A larger, well-
controlled cohort study would be ideal to draw more solid
conclusions. Further research with long-term follow-up and
detailed evaluation of clinical outcomes and patient satis-
faction is needed to validate the feasibility of MRI-based
volumetry on immediate breast reconstruction.
Conclusion
The findings in this paper suggest that breast volumetry
achieved from preoperative MRI for breast staging could
be an effective way to recycle data and predict appropriate
breast volumes in breast reconstruction. This method is
cost-effective and precise in estimating either autologous
tissue volume or implant volume needed, compared to CT.
Its utility needs to be considered in the planning of breast
reconstruction to achieve symmetry and patient
convenience.
Conflict of interest The authors declare that they have no conflicts
of interest to disclose.
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Aesth Plast Surg (2015) 39:369–376
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