TY - JOUR A1 - Brébant, Vanessa A1 - Weiherer, Maximilian A1 - Noisser, Vivien A1 - Seitz, Stephan A1 - Prantl, Lukas A1 - Eigenberger, Andreas T1 - Implants Versus Lipograft: Analysis of Long-Term Results Following Congenital Breast Asymmetry Correction JF - Aesthetic Plastic Surgery N2 - Aims Congenital breast asymmetry represents a particular challenge to the classic techniques of plastic surgery given the young age of patients at presentation. This study reviews and compares the long-term results of traditional breast augmentation using silicone implants and the more innovative technique of lipografting. Methods To achieve this, we not only captured subjective parameters such as satisfaction with outcome and symmetry, but also objective parameters including breast vol-ume and anthropometric measurements. The objective examination was performed manually and by using the Vectra H2 photogrammetry scanning system. Results Differences between patients undergoing either implant augmentation or lipograft were revealed not to be significant with respect to patient satisfaction with surgical outcome (p= 0.55) and symmetry (p= 0.69). Furthermore, a breast symmetry of 93 % was reported in both groups. Likewise, no statistically significant volume difference between the left and right breasts was observed in both groups (p\0.41). However, lipograft patients needed on average 2.9 procedures to achieve the desired result, compared with 1.3 for implant augmentation. In contrast, patients treated with implant augmentation may require anumber of implant changes during their lifetime. Conclusion Both methods may be considered for patients presenting with congenital breast asymmetry. KW - Congenital Breast Asymmetry KW - 3D volumetry KW - Autologous fat injections KW - Three-dimensional imaging KW - Lipograft Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-32404 VL - 46 SP - 2228 EP - 2236 PB - Springer Nature ER - TY - JOUR A1 - Noisser, Vivien A1 - Eigenberger, Andreas A1 - Weiherer, Maximilian A1 - Seitz, Stephan A1 - Prantl, Lukas A1 - Brébant, Vanessa T1 - Surgery of congenital breast asymmetry - which objective parameter influences the subjective satisfaction with long-term results JF - Archives of Gynecology and Obstetrics N2 - Purpose Congenital breast asymmetry is a serious gynecological malformation for affected patients. The condition hits young women in puberty and is associated with socio-esthetic handicap, depression, and psychosexual problems. Surgical treatment is usually early in the patient's lifetime, so a long-term sustainable solution is important. Although postoperative outcome has been evaluated in several studies before, this study is the first to analyze which objective parameters have the greatest influence on subjective satisfaction with long-term results. Methods Thirty-four patients diagnosed with congenital breast asymmetry that underwent either lipofilling or implant therapy between the years of 2008 to 2019 were examined. On average, our collective comprised patients seven years after surgery. Data were mainly gathered through manual measurements, patient-reported outcome measures (Breast Q™), and breast volumetry based on 3D scans (Vectra® H2, Canfield Scientific). Results Among all analyzed parameters, only areolar diameter correlated significantly negatively with the subjective outcome satisfaction of the patient. Regarding the subjective assessment of postoperative satisfaction with similarity of the breasts, again the mean areolar diameter, but also the difference in areolar diameter and breast volume between the right and left breasts correlated significantly negatively. Conclusion Areolar diameter was revealed as being a significant factor influencing subjective long-term satisfaction in breast asymmetry patients. Moreover, 3D volumetry proves to be an effective tool to substantiate subjective patient assessments. Our findings may lead to further improvements to surgical planning and will be expanded in further studies. KW - Congenital breast asymmetry KW - Poland syndrome KW - Lipofilling KW - Silicone implant KW - 3D volumetry Y1 - 2021 U6 - https://doi.org/10.1007/s00404-021-06218-0 PB - Springer Nature ER - TY - JOUR A1 - Hartmann, Robin A1 - Weiherer, Maximilian A1 - Schiltz, Daniel A1 - Seitz, Stephan A1 - Lotter, Luisa A1 - Anker, Alexandra A1 - Palm, Christoph A1 - Prantl, Lukas A1 - Brébant, Vanessa T1 - A Novel Method of Outcome Assessment in Breast Reconstruction Surgery: Comparison of Autologous and Alloplastic Techniques Using Three-Dimensional Surface Imaging JF - Aesthetic Plastic Surgery N2 - Background Breast reconstruction is an important coping tool for patients undergoing a mastectomy. There are numerous surgical techniques in breast reconstruction surgery (BRS). Regardless of the technique used, creating a symmetric outcome is crucial for patients and plastic surgeons. Three-dimensional surface imaging enables surgeons and patients to assess the outcome’s symmetry in BRS. To discriminate between autologous and alloplastic techniques, we analyzed both techniques using objective optical computerized symmetry analysis. Software was developed that enables clinicians to assess optical breast symmetry using three-dimensional surface imaging. Methods Twenty-seven patients who had undergone autologous (n = 12) or alloplastic (n = 15) BRS received three-dimensional surface imaging. Anthropomorphic data were collected digitally using semiautomatic measurements and automatic measurements. Automatic measurements were taken using the newly developed software. To quantify symmetry, a Symmetry Index is proposed. Results Statistical analysis revealed that there is no dif- ference in the outcome symmetry between the two groups (t test for independent samples; p = 0.48, two-tailed). Conclusion This study’s findings provide a foundation for qualitative symmetry assessment in BRS using automatized digital anthropometry. In the present trial, no difference in the outcomes’ optical symmetry was detected between autologous and alloplastic approaches. KW - Breast reconstruction KW - Breast symmetry KW - Digital anthropometry KW - Mammoplastik KW - Dreidimensionale Bildverarbeitung KW - Autogene Transplantation KW - Alloplastik Y1 - 2020 U6 - https://doi.org/10.1007/s00266-020-01749-4 VL - 44 SP - 1980 EP - 1987 PB - Springer CY - Heidelberg ER - TY - JOUR A1 - Hartmann, Robin A1 - Weiherer, Maximilian A1 - Schiltz, Daniel A1 - Baringer, Magnus A1 - Noisser, Vivien A1 - Hösl, Vanessa A1 - Eigenberger, Andreas A1 - Seitz, Stefan A1 - Palm, Christoph A1 - Prantl, Lukas A1 - Brébant, Vanessa T1 - New aspects in digital breast assessment: further refinement of a method for automated digital anthropometry JF - Archives of Gynecology and Obstetrics N2 - Purpose: In this trial, we used a previously developed prototype software to assess aesthetic results after reconstructive surgery for congenital breast asymmetry using automated anthropometry. To prove the consensus between the manual and automatic digital measurements, we evaluated the software by comparing the manual and automatic measurements of 46 breasts. Methods: Twenty-three patients who underwent reconstructive surgery for congenital breast asymmetry at our institution were examined and underwent 3D surface imaging. Per patient, 14 manual and 14 computer-based anthropometric measurements were obtained according to a standardized protocol. Manual and automatic measurements, as well as the previously proposed Symmetry Index (SI), were compared. Results: The Wilcoxon signed-rank test revealed no significant differences in six of the seven measurements between the automatic and manual assessments. The SI showed robust agreement between the automatic and manual methods. Conclusion: The present trial validates our method for digital anthropometry. Despite the discrepancy in one measurement, all remaining measurements, including the SI, showed high agreement between the manual and automatic methods. The proposed data bring us one step closer to the long-term goal of establishing robust instruments to evaluate the results of breast surgery. KW - digital anthropometry KW - reconstructive surgery KW - 3D surface imaging Y1 - 2021 U6 - https://doi.org/10.1007/s00404-020-05862-2 SN - 1432-0711 VL - 303 SP - 721 EP - 728 PB - Springer Nature CY - Heidelberg ER - TY - JOUR A1 - Knoedler, Leonard A1 - Baecher, Helena A1 - Kauke-Navarro, Martin A1 - Prantl, Lukas A1 - Machens, Hans-Günther A1 - Scheuermann, Philipp A1 - Palm, Christoph A1 - Baumann, Raphael A1 - Kehrer, Andreas A1 - Panayi, Adriana C. A1 - Knoedler, Samuel T1 - Towards a Reliable and Rapid Automated Grading System in Facial Palsy Patients: Facial Palsy Surgery Meets Computer Science JF - Journal of Clinical Medicine N2 - Background: Reliable, time- and cost-effective, and clinician-friendly diagnostic tools are cornerstones in facial palsy (FP) patient management. Different automated FP grading systems have been developed but revealed persisting downsides such as insufficient accuracy and cost-intensive hardware. We aimed to overcome these barriers and programmed an automated grading system for FP patients utilizing the House and Brackmann scale (HBS). Methods: Image datasets of 86 patients seen at the Department of Plastic, Hand, and Reconstructive Surgery at the University Hospital Regensburg, Germany, between June 2017 and May 2021, were used to train the neural network and evaluate its accuracy. Nine facial poses per patient were analyzed by the algorithm. Results: The algorithm showed an accuracy of 100%. Oversampling did not result in altered outcomes, while the direct form displayed superior accuracy levels when compared to the modular classification form (n = 86; 100% vs. 99%). The Early Fusion technique was linked to improved accuracy outcomes in comparison to the Late Fusion and sequential method (n = 86; 100% vs. 96% vs. 97%). Conclusions: Our automated FP grading system combines high-level accuracy with cost- and time-effectiveness. Our algorithm may accelerate the grading process in FP patients and facilitate the FP surgeon’s workflow. Y1 - 2022 U6 - https://doi.org/10.3390/jcm11174998 VL - 11 IS - 17 PB - MDPI CY - Basel ER - TY - JOUR A1 - Ruewe, Marc A1 - Eigenberger, Andreas A1 - Klein, Silvan A1 - von Riedheim, Antonia A1 - Gugg, Christine A1 - Prantl, Lukas A1 - Palm, Christoph A1 - Weiherer, Maximilian A1 - Zeman, Florian A1 - Anker, Alexandra T1 - Precise Monitoring of Returning Sensation in Digital Nerve Lesions by 3-D Imaging: A Proof-of-Concept Study JF - Plastic and Reconstructive Surgery N2 - Digital nerve lesions result in a loss of tactile sensation reflected by an anesthetic area (AA) at the radial or ulnar aspect of the respective digit. Yet, available tools to monitor the recovery of tactile sense have been criticized for their lack of validity. However, the precise quantification of AA dynamics by three-dimensional (3-D) imaging could serve as an accurate surrogate to monitor recovery following digital nerve repair. For validation, AAs were marked on digits of healthy volunteers to simulate the AA of an impaired cutaneous innervation. Three dimensional models were composed from raw images that had been acquired with a 3-D camera (Vectra H2) to precisely quantify relative AA for each digit (3-D models, n= 80). Operator properties varied regarding individual experience in 3-D imaging and image processing. Additionally, the concept was applied in a clinical case study. Images taken by experienced photographers were rated better quality (p< 0.001) and needed less processing time (p= 0.020). Quantification of the relative AA was neither altered significantly by experience levels of the photographer (p= 0.425) nor the image assembler (p= 0.749). The proposed concept allows precise and reliable surface quantification of digits and can be performed consistently without relevant distortion by lack of examiner experience. Routine 3-D imaging of the AA has the great potential to provide visual evidence of various returning states of sensation and to convert sensory nerve recovery into a metric variable with high responsiveness to temporal progress. KW - 3D imaging Y1 - 2023 U6 - https://doi.org/10.1097/PRS.0000000000010456 SN - 1529-4242 VL - 152 IS - 4 SP - 670e EP - 674e PB - Lippincott Williams & Wilkins CY - Philadelphia, Pa. ER - TY - JOUR A1 - Weiherer, Maximilian A1 - Eigenberger, Andreas A1 - Egger, Bernhard A1 - Brébant, Vanessa A1 - Prantl, Lukas A1 - Palm, Christoph T1 - Learning the shape of female breasts: an open-access 3D statistical shape model of the female breast built from 110 breast scans JF - The Visual Computer N2 - We present the Regensburg Breast Shape Model (RBSM)—a 3D statistical shape model of the female breast built from 110 breast scans acquired in a standing position, and the first publicly available. Together with the model, a fully automated, pairwise surface registration pipeline used to establish dense correspondence among 3D breast scans is introduced. Our method is computationally efficient and requires only four landmarks to guide the registration process. A major challenge when modeling female breasts from surface-only 3D breast scans is the non-separability of breast and thorax. In order to weaken the strong coupling between breast and surrounding areas, we propose to minimize the variance outside the breast region as much as possible. To achieve this goal, a novel concept called breast probability masks (BPMs) is introduced. A BPM assigns probabilities to each point of a 3D breast scan, telling how likely it is that a particular point belongs to the breast area. During registration, we use BPMs to align the template to the target as accurately as possible inside the breast region and only roughly outside. This simple yet effective strategy significantly reduces the unwanted variance outside the breast region, leading to better statistical shape models in which breast shapes are quite well decoupled from the thorax. The RBSM is thus able to produce a variety of different breast shapes as independently as possible from the shape of the thorax. Our systematic experimental evaluation reveals a generalization ability of 0.17 mm and a specificity of 2.8 mm. To underline the expressiveness of the proposed model, we finally demonstrate in two showcase applications how the RBSM can be used for surgical outcome simulation and the prediction of a missing breast from the remaining one. Our model is available at https://www.rbsm.re-mic.de/. KW - Statistical shape model KW - Non-rigid surface registration KW - Breast imaging KW - Surgical outcome simulation KW - Breast reconstruction surgery Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-30506 N1 - Corresponding author: Christoph Palm N1 - Zugehörige arXiv-Publikation: https://opus4.kobv.de/opus4-oth-regensburg/frontdoor/index/index/docId/2023 VL - 39 IS - 4 SP - 1597 EP - 1616 PB - Springer Nature ER - TY - JOUR A1 - Hartmann, Robin A1 - Nieberle, Felix A1 - Palm, Christoph A1 - Brébant, Vanessa A1 - Prantl, Lukas A1 - Kuehle, Reinald A1 - Reichert, Torsten E. A1 - Taxis, Juergen A1 - Ettl, Tobias T1 - Utility of Smartphone-based Three-dimensional Surface Imaging for Digital Facial Anthropometry JF - JPRAS Open N2 - Background The utilization of three-dimensional (3D) surface imaging for facial anthropometry is a significant asset for patients undergoing maxillofacial surgery. Notably, there have been recent advancements in smartphone technology that enable 3D surface imaging. In this study, anthropometric assessments of the face were performed using a smartphone and a sophisticated 3D surface imaging system. Methods 30 healthy volunteers (15 females and 15 males) were included in the study. An iPhone 14 Pro (Apple Inc., USA) using the application 3D Scanner App (Laan Consulting Corp., USA) and the Vectra M5 (Canfield Scientific, USA) were employed to create 3D surface models. For each participant, 19 anthropometric measurements were conducted on the 3D surface models. Subsequently, the anthropometric measurements generated by the two approaches were compared. The statistical techniques employed included the paired t-test, paired Wilcoxon signed-rank test, Bland–Altman analysis, and calculation of the intraclass correlation coefficient (ICC). Results All measurements showed excellent agreement between smartphone-based and Vectra M5-based measurements (ICC between 0.85 and 0.97). Statistical analysis revealed no statistically significant differences in the central tendencies for 17 of the 19 linear measurements. Despite the excellent agreement found, Bland–Altman analysis revealed that the 95% limits of agreement between the two methods exceeded ±3 mm for the majority of measurements. Conclusion Digital facial anthropometry using smartphones can serve as a valuable supplementary tool for surgeons, enhancing their communication with patients. However, the proposed data suggest that digital facial anthropometry using smartphones may not yet be suitable for certain diagnostic purposes that require high accuracy. KW - Three-dimensional surface imaging KW - Stereophotogrammetry KW - Smartphone-based surface imaging KW - Digital anthropometry KW - Facial anthropometry Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:898-opus4-70348 VL - 39 SP - 330 EP - 343 PB - Elsevier ER - TY - JOUR A1 - Knoedler, Leonard A1 - Dean, Jillian A1 - Knoedler, Samuel A1 - Kauke-Navarro, Martin A1 - Hollmann, Katharina A1 - Alfertshofer, Michael A1 - Helm, Sabrina A1 - Prantl, Lukas A1 - Schliermann, Rainer T1 - Hard shell, soft core? Multi-disciplinary and multi-national insights into mental toughness among surgeons JF - Frontiers in Surgery N2 - Background: With the prevalence of burnout among surgeons posing a significant threat to healthcare outcomes, the mental toughness of medical professionals has come to the fore. Mental toughness is pivotal for surgical performance and patient safety, yet research into its dynamics within a global and multi-specialty context remains scarce. This study aims to elucidate the factors contributing to mental toughness among surgeons and to understand how it correlates with surgical outcomes and personal well-being. Methods: Utilizing a cross-sectional design, this study surveyed 104 surgeons from English and German-speaking countries using the Mental Toughness Questionnaire (MTQ-18) along with additional queries about their surgical practice and general life satisfaction. Descriptive and inferential statistical analyses were applied to investigate the variations in mental toughness across different surgical domains and its correlation with professional and personal factors. Results: The study found a statistically significant higher level of mental toughness in micro-surgeons compared to macro-surgeons and a positive correlation between mental toughness and surgeons' intent to continue their careers. A strong association was also observed between general life satisfaction and mental toughness. No significant correlations were found between the application of psychological skills and mental toughness. Conclusion: Mental toughness varies significantly among surgeons from different specialties and is influenced by professional dedication and personal life satisfaction. These findings suggest the need for targeted interventions to foster mental toughness in the surgical community, potentially enhancing surgical performance and reducing burnout. Future research should continue to explore these correlations, with an emphasis on longitudinal data and the development of resilience-building programs. KW - mental toughness KW - mental health KW - resilience KW - robustness KW - psychology KW - surgery Y1 - 2024 U6 - https://doi.org/10.3389/fsurg.2024.1361406 N1 - Correspondign author der OTH Regensburg: Rainer Schliermann (und Leonard Knoedler) VL - 11 PB - Frontiers ER -