A systematic review of 3D printing in autologous breast reconstruction

Abstract

Aim: The use of three-dimensionally printed (3DP), patient-specific models in autologous breast reconstruction is gaining popularity, namely for their benefits in surgical planning and ability to aid in aesthetic outcomes. Furthermore, 3DP patient-specific models serve as a safe alternative to intraoperative surgical training and act as a useful tool for visualizing the intramuscular course of deep inferior epigastric perforator vessels. Despite demonstrated usefulness in other surgical specialties and areas of plastic surgery, there remains a significant gap in the literature exploring specific perioperative, preoperative, and intraoperative uses as well as the educational advantages of 3DP in autologous breast reconstruction. Methods: PubMed, MEDLINE, EMBASE, Scopus, and the Cochrane Central Register of Controlled Trials were searched for all English language articles using specific MeSH terms (3dp OR 3D-print* OR three dimension* print*) AND (breast reconstruction). Only studies discussing the use of 3DP for surgical planning or as an educational tool in autologous breast reconstruction were included. Studies using 3DP as interventions or implants were excluded. Results: A total of 168 articles were identified, 13 of which were selected for inclusion. Risk of bias was low for 8 articles and moderate for 5 articles. Seven (53.8%) articles discussed 3DP usage in preoperative planning. Most papers (12, 92.3%) focused on 3DP models as guides for intraoperative identification of anatomical landmarks and 3DP molds as tools to achieve desired breast volume, shape, and projection. Only 4 (30.7%) articles discussed patient outcomes. Of the 4 (30.7%) articles that discussed education, only one of these properly assessed trainees and faculty using pre- and post-intervention surveys. Conclusion: The majority of 3DP research as an intraoperative guide and educational tool is concentrated outside of autologous breast reconstruction. Studies that do discuss this have found significantly higher success rates in dissecting true DIEP flaps when 3DP vascular modeling is used and can result in improved confidence and competence in surgical training for microsurgical anastomosis. Although 3DP has been shown to aid microsurgeons in preoperative planning, most research concentrates on the aid of this novel technology in dynamic, intraoperative decision making. Existing research has identified five 3DP breast molds, but studies have yet to compare these molds in a controlled setting to assess for superiority in feasibility and outcomes. There is little investigation into the usefulness of 3DP as an educational tool, and more research should be conducted as this methodology expands to cover more forms of autologous breast reconstruction.