Eliodoro Faiella, Domiziana Santucci, Donata Maria Antonia Assunta Vaccaro, Matteo Sammarra, Manuela Tommasiello, Stefania Tenna, Rosario Francesco Grasso and Bruno Beomonte Zobel
Aim: To evaluate the capability of non-enhanced breast MRI to assess flap volume variability in post-bariatric patients who underwent mastopexy in a reproducible way.
Materials and Methods: Ten bariatric patients, treated with mastopexy using anterior intercostal artery perforator (AICAP) flap for autologous tissue breast augmentation, were enrolled in this study. All patients performed a breast Magnetic Resonance (MR) exam after surgery, in a period ranged from 177 and 838 days. The real flap volume, measured before mastopexy, and the flap volume calculated from MRI segmentation, was compared. Two radiologists performed the segmentation of the flap and of the whole breast, manually drawing an area of interest on MR images. The process was repeated for each patient, each breast and each slice 5 times, on axial T2W-TIRM, axial T1W-3D FS and sagittal T1W-3D images. Then, the flap and the breast 3D volumes were automatically generated combining multiple segmentations. The reproducibility of the measurements was evaluated, analyzing inter-and intra-observer agreement, and the most accurate MRI sequence was identified.
Results: A significant difference between the mean flap volume before mastopexy and the mean MRI flap volume was detected, with an absolute mean decrease of 46,85% (105,89 cm3) (p<0.05). There was no significant difference among the measurements performed by the same reader and by the two readers. The lowest variability was identified on T1W-FS, evaluated as the best performing sequences.
Conclusion: MRI breast segmentation is an accurate and reproducible method for breast flap volume assessment and can provide important quantitative information to surgeons.