Print-to-patient: a novel 3D printing technique for autologous breast reconstruction

Résumé fourni par la source

Autologous breast reconstruction is technically demanding, and intraoperative shaping of the tissue flap into a three-dimensional breast remains a time-consuming step that requires simultaneous consideration of tissue volume, vascular pedicle preservation, and symmetry with the contralateral breast. Patient-specific templates may streamline this step, particularly in unilateral reconstruction where symmetry is a primary aesthetic goal. We describe a proof-of-concept “print-to-patient” workflow using smartphone-based three-dimensional scanning and in-house 3D printing to generate sterilizable intraoperative shaping templates. Smartphone surface-capture accuracy was validated against DSLR photogrammetry using a 3D-printed breast phantom; reconstructed meshes were rigidly registered to the reference STL and compared using per-vertex deviation and root-mean-square error. Three prospectively enrolled patients undergoing post-mastectomy autologous breast reconstruction were then 3D-scanned preoperatively with smartphone application ScandyPro. Native-breast surface models were mirrored, printed in flexible resin on a Form 3B+ printer, sterilized, and used intraoperatively as patient-specific flap-shaping templates. Scanning accuracy was first validated against a reference breast model, where smartphone scans achieved more precise vertex alignment with the reference model than DSLR photogrammetry. Three patients planned for post-mastectomy autologous reconstruction were prospectively scanned using the smartphone application ScandyPro during a preoperative clinic visit; scans were mirrored to represent the contralateral pre-mastectomy breast, printed in a flexible resin, and autoclaved for intraoperative use as shaping templates. All three patients had previously undergone unilateral mastectomy; two underwent unilateral bipedicled deep inferior epigastric perforator flap reconstruction, and one underwent bilateral profunda artery perforator flap reconstruction, with a mastectomy of the remaining breast immediately prior to the reconstruction. Templates aided intraoperative visualization of the breast footprint and contour and were used to approximate contralateral symmetry. In one patient with a smaller flap, the template guided shaping despite limited tissue, and the re-sterilized template subsequently guided implant placement during a revision procedure to improve projection. A smartphone-based, in-house print-to-patient workflow is feasible and can generate patient-specific intraoperative templates that may aid flap shaping and symmetry planning in autologous breast reconstruction. The approach is best suited to unilateral reconstruction in patients with sufficient donor tissue and may be adapted for stacked-flap or hybrid approaches when volume is limited. Further studies can be conducted to define the impact on operative efficiency and aesthetic outcomes.

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