Previous studies have pointed out that better communication between the patient and physician is needed for breast cancer surgical decisions , as approximately half of Japanese women with early breast cancer reported some regret regarding the treatment decision–making process . In this regard, improving the patients’ satisfaction with the preoperative explanation has been an issue. In order to solve this problem, we explained the postoperative morphology after BCS using 3D breast imaging in addition to the conventional methods such as oral explanations and handwritten drawings by a doctor and postoperative photos of other patients. Our study surveyed patient satisfaction with this explanation method and found that many patients were satisfied with this explanation method, and that the patients found 3D breast imaging to be particularly useful among the various preoperative explanation methods.
Three-dimensional imaging has begun to be applied clinically in the field of plastic surgery such as breast augmentation or breast reconstruction. Efforts are being made to improve the decision-making process and improve patient satisfaction by showing preoperative simulations using 3D imaging [9–11]. Two studies of breast augmentation showed that 3D imaging was useful in envisaging breast augmentation  and choosing an implant . Another study on breast reconstructive surgery reported that 3D imaging is an effective method for enhancing patient preparedness prior to surgery . In the field of BCS, there have been reports on the use of 3D imaging as a method for assessing postoperative morphology [12, 13], but only a few studies have examined its use in preoperative morphological prediction [14, 15].
Our results are consistent with the findings of previous studies on plastic surgery, where 3D imaging was reported to be useful as a preoperative explanation. More patients answered that 3D imaging was useful than those who answered conventional methods such as oral explanations and handwritten drawings by a doctor or postoperative photos of other patients were useful. The advantage of 3D imaging is that the patients can visually recognize the individual shape of their breast, and the tumor position and size. The patients’ opinion that a more accurate understanding of the postoperative breast morphology helped them to prepare for BCS and, conversely, that they decided to undergo breast reconstruction after finding the deformity unacceptable suggests that 3D breast imaging may be useful as a decision making tool.
When patients who actually underwent BCS were asked about the degree of postoperative deformation, 85.2% answered it was comparable or better than what they had imagined. Although it is necessary to take into consideration that this survey was conducted at approximately one month postoperatively, the fact that only a few patients felt that their morphology after BCS was more deformed than what they had preoperatively imagined suggests that they had been adequately prepared for the postoperative breast morphology.
The 3D breast imaging used in this study produces a predictive postoperative morphology by inputting the preoperative breast morphology, tumor location, and its size. Because scanned photographs of the patient were not used, the skin tones and textures may not be reproduced satisfactorily, as noted in some of the survey responses. However, since this 3D breast imaging setup is not time consuming, it can be performed on many patients in a limited time during outpatient care. From this point of view, this tool is easily applicable in actual daily clinical practice.
A limitation of this study is that it was not a randomized control trial. Although the impact of 3D breast imaging may not have been directly assessed, we chose this study design because 3D breast imaging is noninvasive, yet it is likely to be beneficial based on the results of previous studies in the field of plastic surgery. We believe that the results of this study sufficiently demonstrate that 3D breast imaging is beneficial to breast cancer patients.
In conclusion, our study suggests that our preoperative explanation method using 3D breast imaging is useful for shared decision making. We think that 3D breast imaging can help patients to visualize the individual shape of their breast as well as the tumor position and size. Further studies are needed to confirm the long-time patient satisfaction to widely translate this explanation method into daily clinical practice.