An essential part of aesthetic and reconstructive breast surgery is a meticulous analysis of the outcomes. However, the reliable evaluation of breast attractiveness, the primary determinant of treatment, is challenging.1,2 Over the years, many methods of breast aesthetics evaluation have been proposed. Most of the studies are based on subjective analysis, utilizing either various scales or questionnaires.1–3 The quantitative evaluation mainly includes indirect anthropometric analysis of breast photographs.2,4 Unfortunately, the numeric measurements cannot be clearly translated into clinical conclusions, especially the breast shape and contour definition.1 There are two significant limitations of publications on breast surgery outcomes. First, they contain numeric data tables, which poorly represent the aesthetic value and underrepresent the shape.1,4 Second, publications show photographs of only a few patients at most.1–4 The inability to visually present all evaluated individuals’ outcomes is a common problem in plastic surgery in general. To overcome these limitations, we created a new evaluation technique called Averaged Body Contours, or ABC, which summarizes quantitative morphometric data and shapes of numerous breasts in the form of a single figure (Fig. 1).Fig. 1.: The graphical summarization of 20 female individuals’ breast analysis in the frontal view as an Averaged Body Contours parameter.The whole process is integrated with our Analyze It Doc software (A.I.D.; Pietruski & Majak, Warsaw, Poland) and consists of two steps.5 First, photogrammetric analysis of breast photographs in frontal and lateral views is performed. The semiautomatization of this process makes it easy and time efficient, taking fewer than 4 minutes per individual. The surgeon’s role is to label specific landmarks and contours according to the system’s instructions. The process requires metric calibration by marking the known distance on the photograph. For this purpose, we use an adhesive skin marker, but any measurement, such as intramammary distance, can be used. The second step is fully automated. The software algorithm instantly generates a set of hundreds of linear, angular, and surface area measurements as well as an averaged body contour. The latter is a graphical summarization of averaged values of obtained numeric parameters, which can be subdivided into specific contours if needed (Fig. 2).Fig. 2.: A view of the A.I.D. software generator with exemplary averaged body contours of 20 females’ breasts in lateral projection. Display of various breast contours, landmarks, reference lines, and standard deviations is possible.The conducted validation study confirmed our novel method’s effectiveness and reliability. The Averaged Body Contours technique generates an average shape and morphometry of multiple individuals’ breasts that complies with their quantitative anthropometric analysis results. In other words, the Averaged Body Contours technique translates numeric data into shape, something that, according to our knowledge, was not possible for photogrammetric-based outcomes evaluation, until now. Due to the deep analytic insight it provides, the Averaged Body Contours parameter has vast potential in breast surgery. Its application may redefine the form of aesthetic results presentation. Graphical summarization of entire group contours increases the comprehension of numeric measurements and reduces the tables’ role to supplementary material. Our analytic tool enables clear visualization of the shapes and tracking of their changes with time, enhancing both research and young surgeon development. The Averaged Body Contours technique may also be used to create the breast’s populational normative data for a specific age or ethnicity group, thus providing a visual aesthetic template that could improve preoperative consultations. We encourage all interested researchers and clinicians to test our analytic tool, which is distributed free of charge, and provide the feedback needed for further improvements. ACKNOWLEDGMENTS The development of the A.I.D. system is a private, nonprofit initiative of both authors. Their goal is to provide a free analytic tool for plastic surgery researchers and clinicians. The software, when ready, will be distributed free of charge (apply at http://analyzeitdoc.com). DISCLOSURE Neither author has a financial interest in any of the products or devices mentioned in this article. No funding was received for this article. The A.I.D. software discussed in this article, which both authors developed, is distributed free of charge.
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