Measuring breast volume in hypertrophy: laser scanning or water displacement?

Main Article Content

Tamara Crittenden
Daisy E Veitch
Maciej Henneberg
Karen Burford
Phillipa van Essen
Kaveeta Deut
Kalavani Zeitouneh
Elizabeth Lomax
Philip A Griffin
Nicola R Dean


breast volume, water displacement, 3D laser scan, breast hypertrophy, breast reduction


Background: The accurate determination of intact breast volume facilitates preoperative planning for a range of plastic surgical breast procedures. In women with breast hypertrophy, volumetric assessment assists in planning the amount of tissue to be removed during breast reduction surgery to achieve breast symmetry. Further, in jurisdictions where restrictive surgical guidelines exist, measurement of intact breast volume is essential in order to justify breast reduction surgery. Not all practitioners have access to magnetic resonance imaging (MRI) or three dimensional (3D) laser scanning facilities, so the purpose of this study was to determine whether water displacement of the intact breast is an effective substitute method of measurement in women with breast hypertrophy.

Methods: A prospective cohort study was undertaken to measure breast volume using water displacement and 3D laser scanning in breast hypertrophy patients. The volume of a total of 322 breasts were determined using both measurement techniques; 194 preoperatively and 128 at 12 months following breast reduction surgery. Pearson correlations, linear regression and Bland-Altman analyses were used to compare the methods of breast volume assessment.

Results: The mean breast volume according to 3D laser scan was 1440 millilitres (SD = 588 millilitres) and for water displacement was 1419 millilitres (SD = 811 millilitres). There was a strong linear association between breast volumes as measured using water displacement and 3D laser scanning using a Pearson correlation (r = 0.89, p < 0.001). However, using the Bland-Altman analysis, the two methods were found not to be in agreement, with water displacement values consistently larger than 3D scan values.

Conclusions: While a strong linear association was found between breast volume measurements made using the water displacement technique and 3D laser scanning, the two methods did not have a high level of equivalence. Water displacement of the intact breast is not an accurate enough tool to be used as a substitute for 3D laser scanning, and therefore not an optimal method of breast volume measurement in women with breast hypertrophy.


Download data is not yet available.
Abstract 200 | PDF Downloads 82 HTML Downloads 60


1. Kerrigan CL, Collins ED, Striplin D, Kim HM, Wilkins E, Cunningham B, Lowery J. The health burden of breast hypertrophy. Plast Reconstr Surg. 2001;108(6):1591–99. PMid:11711933
2. Singh KA, Losken A. Additional benefits of reduction mammaplasty: a systematic review of the literature. Plast Reconstr Surg. 2012;129(3):562–70. PMid:22090252
3. Collins ED, Kerrigan CL, Kim M, Lowery JC, Striplin DT, Cunningham B, Wilkins EG. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Plast Reconstr Surg. 2002;109(5):1556–66. PMid:11932597
4. Mello AA, Domingos NA, Miyazaki MC. Improvement in quality of life and self-esteem after breast reduction surgery. Aesthet Plast Surg. 2010;34(1):59–64. PMid:19768493
5. Blomqvist L, Eriksson A, Brandberg Y. Reduction mammaplasty provides long-term improvement in health status and quality of life. Plast Reconstr Surg. 2000;106(5):991–97. PMid:11039369
6. Krieger LM, Lesavoy MA. Managed care’s methods for determining coverage of plastic surgery procedures: the example of reduction mammaplasty. Plast Reconstr Surg. 2001;107(5):1234–40.
7. Klassen A, Fitzpatrick R, Jenkinson C, Goodacre T. Should breast reduction surgery be rationed? A comparison of the health status of patients before and after treatment: postal questionnaire survey. Brit Med J. 1996;313(7055):454–57. PMid:8776311
8. Koltz PF, Frey JD, Langstein HN. Insurance coverage and reduction mammaplasty: a systematic review of current health care policies. Plast Reconstr Surg. 2013;132(4):692e–3e. PMid:24076738
9. O’Blenes CAE, Delbridge CL, Miller BJ, Pantelis A, Morris SF. Prospective study of outcomes after reduction mammaplasty: Long-term follow-up. Plast Reconstr Surg. 2006;117(2):351–58. PMid:16462312
10. Seitchik MW. Reduction mammaplasty: criteria for insurance coverage. Plast Reconstr Surg. 1995;95(6):1029–032. PMid:7732111
11. Nguyen JT, Wheatley MJ, Schnur PL, Nguyen TA, Winn SR. Reduction mammaplasty: a review of managed care medical policy coverage criteria. Plast Reconstr Surg. 2008;121(4):1092–100. PMid:18349625
12. Schultz RC, Dolezal RF, Nolan J. Further applications of Archimedes’ principle in the correction of asymmetrical breasts. Ann Plast Surg. 1986;16(2):98–101. PMid:3273032
13. Smith DJ, J., Palin WE, J., Katch VL, Bennett JE. Breast volume and anthropomorphic measurements: normal values. Plast Reconstr Surg. 1986;78(3):331–35. PMid:3737757
14. Qiao Q, Zhou G, Ling Y. Breast volume measurement in young Chinese women and clinical applications. Aesthet Plast Surg. 1997;21(5):362–68.
15. Longo B, Farcomeni A, Ferri G, Campanale A, Sorotos M, Santanelli F. The BREAST-V: A unifying predictive formula for volume assessment in small, medium, and large breasts. Plast Reconstr Surg. 2013;132(1):1e–7e. PMid:23806950
16. Howes BH, Watson DI, Fosh B, Yip JM, Kleinig P, Dean NR. Magnetic resonance imaging versus 3-dimensional laser scanning for breast volume assessment after breast reconstruction. Ann Plast Surg. 2017;78(4):455–59. PMid:28273058
17. Lee WY, Kim MJ, Lew DH, Song SY, Lee DW. Three-dimensional surface imaging is an effective tool for measuring breast volume: a validation study. Arch Plast Surg. 2016;43(5):430–37. PMid:27689050 PMCid:PMC5040845
18. Bulstrode N, Bellamy E, Shrotria S. Breast volume assessment: comparing five different techniques. Breast. 2001;10(2):117–23. PMid:14965570
19. Sigurdson LJ, Kirkland SA. Breast volume determination in breast hypertrophy: an accurate method using two anthropomorphic measurements. Plast Reconstr Surg. 2006;118(2):313–20. PMid:16874195
20. Losken A, Seify H, Denson DD, Paredes AA, Jr., Carlson GW. Validating three-dimensional imaging of the breast. Ann Plast Surg. 2005;54(5):471–76; discussion 7–8. PMid:15838205
21. Kovacs L, Eder M, Hollweck R, Zimmermann A, Settles M, Schneider A, Endlich M, Mueller A, Schwenzer-Zimmerer K, Papadopulos NA, Biemer E. Comparison between breast volume measurement using 3D surface imaging and classical techniques. Breast. 2007;16(2):137–45. PMid:17029808
22. Yip JM, Mouratova N, Jeffery RM, Veitch DE, Woodman RJ, Dean NR. Accurate assessment of breast volume: a study comparing the volumetric gold standard (direct water displacement measurement of mastectomy specimen) with a 3D laser scanning technique. Ann Plast Surg. 2012;68(2):135–41. PMid:21587046
23. Choppin SB, Wheat JS, Gee M, Goyal A. The accuracy of breast volume measurement methods: A systematic review. Breast 2016;28:121–29. PMid:27288864
24. Bouman FG. Volumetric measurement of the human breast and breast tissue before and during mammaplasty. Br J Plast Surg. 1970;23(3):263–64.
25. Veitch D, Burford K, Dench P, Dean N, Griffin P. Measurement of breast volume using body scan technology (computer-aided anthropometry). Work. 2012;41 Suppl 1:4038–045. PMid:22317340
26. Bland JM, Altman DG. Comparing methods of measurement: why plotting difference against standard method is misleading. Lancet. 1995;346(8982):1085–087.
27. Eder M, Papadopulos NA, Kovacs L. Breast volume determination in breast hypertrophy. Plast Reconstr Surg. 2007;120(1):356–57. PMid:17572598
28. Kocak E, Carruthers KH, McMahan JD. A reliable method for the preoperative estimation of tissue to be removed during reduction mammaplasty. Plast Reconstr Surg. 2011;127(3):1059–064. PMid:21364407
29. Sommer NZ, Zook EG, Verhulst SJ. The prediction of breast reduction weight. Plast Reconstr Surg. 2002;109(2):506–11. PMid:11818828
30. Kececi Y, Sir E. Prediction of resection weight in reduction mammaplasty based on anthropometric measurements. Breast Care. 2014;9(1):41–45. PMid:24803886 PMCid:PMC3995377
31. Descamps MJ, Landau AG, Lazarus D, Hudson DA. A formula determining resection weights for reduction mammaplasty. Plast Reconstr Surg. 2008;121(2):397–400. PMid:18300955
32. JZ, Wendel JJ, Zellner EG, Hagan KF, Shack RB, Corlew DS. Association between preoperative measurements and resection weight in patients undergoing reduction mammaplasty. Ann Plast Surg. 2010;64(5):512–15. PMid:20354427
33. Yip JM, Watson DI, Tiggemann M, Hsia S, Smallman AE, Dean NR. Determinants of breast reconstruction outcome: how important is volume symmetry? J Plast Reconstr Aes. 2015;68(5):679–85. PMid:25731778
34. Liu C, Luan J, Mu L, Ji K. The role of three-dimensional scanning technique in evaluation of breast asymmetry in breast augmentation: a 100-case study. Plast Reconstr Surg. 2010;126(6):2125–132. PMid:21124152
35. Kovacs L, Zimmermann A, Brockmann G, Gühring M, Baurecht H, Papadopulos NA, Schwenzer-Zimmerer K, Sader R, Biemer E, Zeilhofer HF. Three-dimensional recording of the human face with a 3D laser scanner. J Plast Reconstr Aes. 2006;59(11):1193–202. PMid:17046629
36. Knoops PGM, Beaumont CAA, Borghi A, Rodriguez-Florez N, Breakey RWF, Rodgers W, Angullia F, Jeelani NU, Schievano S, Dunaway DJ. Comparison of three-dimensional scanner systems for craniomaxillofacial imaging. J Plast Reconstr Aes. 2017;70(4):441–49. PMid:28161205
37. Lekakis G, Claes P, Hamilton GS 3rd, Hellings PW. Three-dimensional surface imaging and the continuous evolution of preoperative and postoperative assessment in rhinoplasty. Facial Plast Surg. 2016;32(1):88–94. PMid:26862969
38. Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer Basic Clin Res. 2011;5:43–52. PMid:21494401 PMCid:PMC3076010
39. Tezel E, Numanoglu A. Practical do-it-yourself device for accurate volume measurement of breast. Plast Reconstr Surg. 2000;105(3):1019–023. PMid:10724264
40. Henseler H, Khambay BS, Bowman A, Smith J, Paul Siebert J, Oehler S, Ju X, Ayoub A, Ray AK. Investigation into accuracy and reproducibility of a 3D breast imaging system using multiple stereo cameras. J Plast Reconstr Aes. 2011;64(5):577–82. PMid:20947459
41. Brown N, White J, Milligan A, Risius D, Ayres B, Hedger W, Scurr J. The relationship between breast size and anthropometric characteristics. Am J Hum Biol. 2012;24(2):158–64. PMid:22287066

Most read articles by the same author(s)