Implant volume estimation in direct-to-implant breast reconstruction after nipple-sparing mastectomy

Background: Nipple-sparing mastectomy (NSM) is an increasingly popular alternative to more traditional mastectomy approaches. However, estimating the implant volume during direct-to-implant (DTI) reconstruction following NSM is difficult for surgeons with little-to-moderate experience. We aimed to provide a fast, easy to use, and accurate method to aid in the estimation of implant size for DTI reconstruction using the specimen weight and breast volume. Methods: A retrospective analysis was performed using data from 145 NSM patients with specific implant types. Standard two-dimensional digital mammograms were obtained in 118 of the patients. Breastmorphological factors (specimen weight, mammographic breast density and volume, and implant size and type) were recorded. Curve-fitting and linear regression models were used to develop formulas predicting the implant volume, and the prediction performance of the obtained formulas was evaluated using the prospective data set. Results: Two formulas to estimate the implant size were obtained, one using the specimen weight and one using the breast volume. The coefficients of correlation (R-2) in these formulas were over 0.98 and the root mean squared errors were approximately 13. Conclusions: These implant volume estimate formulas benefit surgeons by providing a preoperative implant volume assessment in DTI reconstruction using the breast volume and an intraoperative assessment using the specimen weight. The implant size estimation formulas obtained in the present study may be applied in a majority of patients. (C) 2018 The Authors. Published by Elsevier Inc.