Thesis. Development and Usability Testing of a Custom Positioning Surgical Guide for Soft Tissue Breast Reconstruction. JR Joury.

Date: August 2019.
Source: ERA: Education and Research Archive, University of Alberta.
Abstract: Breast cancer is the most common cancer in women with more than two thousand new cases diagnosed every year in Alberta [1]. Women endure both physical and psychological hardship from the disease and treatment. Surgical treatment often includes a mastectomy that removes the entire breast. Breast reconstruction surgery, either immediate or delayed, is considered to improve the rehabilitation process. Despite advancements in surgical reconstruction, the current methods to pre-operatively plan for a symmetrical outcome are limited, and the final result is a subjective assessment done by the surgeon intraoperatively. Other factors effect the surgical outcome such as how well the tissue heals, and how much fat resorbs over time. The challenge in precisely predicting the postoperative result comes from the nature of soft tissue and its surgical manipulation. Therefore, revisional surgery following breast reconstruction is common. The purpose of this project is to improve the understanding of surgical design and simulation in breast reconstruction and its applications benefits in a soft tissue manipulation. This is explored within two main objectives. The first objective is to develop a process for designing and fabricating a patient-specific surgical guide. The second objective is to evaluate the guide’s usability in a guide fitting session. A single case feasibility study was conducted. The participants included a patient with a unilateral mastectomy and a plastic surgeon. An interview with the surgeon was done to determine the design criteria of the surgical guide. A surface scan of the patient’s torso was taken. A custom surgical guide was designed and fabricated. The guide’s usability was tested in a guide fitting session. The results of this study include: 1) a design decision matrix determining the required design criteria, 2) the design workflow created to develop the patient-specific surgical guide, 3) the surgical guide both as a physical component and the numerical measure of volume estimate, 4) seven themes from the thematic analysis of the guide fitting session: 4.1) comparison of design techniques, 4.2) location of the inframammary fold, 4.3) positioning landmarks, 4.4) posture , 4.5) changes in weight affecting soft tissue, 4.6) imaging technique, 4.7) materials. This approach of evaluating the use of virtual planning to improve surgical outcome is inspired by the well-established 3D digital planning protocols for jaw reconstruction at the Institute for Reconstructive Sciences in Medicine (iRSM).

Thesis: Development and Usability Testing of a Custom Positioning Surgical Guide for Soft Tissue Breast Reconstruction.
Author: Jumana Rajae Joury

Thesis. Master of Science in Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta