“After the surgery, I felt much lighter. The recovery was exceptionally fast. I could walk on my own the next day”, said Ms. Tang, a patient with macromastia, who was recently discharged after receiving a bilateral breast reduction surgery at the West Campus of PUMCH. The surgery, aided by the photon-counting CT + augmented reality (AR) mapping system, demonstrated significant improvements in efficiency, accuracy, and safety over traditional CT angiography (CTA) techniques.

Macromastia is a condition in which excessive proliferation of breast tissue leads to abnormal enlargement of the breasts in women. Patients often experience symptoms such as neck and back pain, under-breast intertrigo, and discomfort from breast compression. It also affects their daily activities and decreases their quality of life. Breast reduction surgery is an effective treatment that renders patients’ breasts proportionate to their body shape. However, the greater the amount of breast tissues removed, the higher the risk of postoperative blood supply impairment and even necrosis due to the greater damage to the breast blood supply. Additionally, vascular variation is commonly observed. Therefore, precise pre-operative evaluation of blood supply and accurate marking of vascular patterns on the body surface are crucial for patients’ postoperative recovery.

Chief Technician Wang Yun from the Department of Radiology at PUMCH, has led a team to dive into fine-grained arteriole imaging by photon-counting CT since 2021. After two years of relentless efforts, they have successfully customized the entire examination process for patients with macromastia in perfect alignment with the preoperative planning required for plastic surgery. Aided by NAEOTOM Alpha, the world’s first photon-counting CT scanner with excellent spatial resolution and precision energy imaging, doctors performed a specialized preoperative CTA examination for Ms. Tang. Dr. Zeng Ang, Deputy Director of the Department of Plastic Surgery, utilized CT holographic reconstructed imaging combined with the AR mapping system to obtain high-precision preoperative CTA data that was accurately mapped 1:1 onto the patient’s body surface. This enabled precise preoperative localization and provided a more intuitive and three-dimensional observation of vascular patterns.

During the surgery, Dr. Zeng Ang’s team performed thinning of the superomedial pedicle of the patient. The overall thickness of the skin flap was less than 1 centimeter, with the thinnest part measuring less than 0.5 centimeter. ICG (indocyanine green) imaging confirmed good blood supply to the nipple-areolar complex (NAC). A total of 1.6 kilograms of breast glandular tissue was removed. On the third day after surgery, Ms. Tang had her drainage tube removed; with good blood supply in the breasts, she was discharged.

This is a successful exploration of applying the world’s first photon-counting CT scanner combined with AR to breast plastic surgery. By applying CT holographic reconstructed imaging in conjunction with the AR mapping system, doctors can improve surgical outcomes with precision preoperative planning and also significantly enhance safety with the visualized marking of blood vessels.

The arteriole imaging team and the Department of Plastic Surgery have collaborated in multiple successful practices, establishing a comprehensive protocol for personalized examinations. Moving forward, they will further improve their know-how to aid a wider range of plastic surgeries with AR, benefiting more patients.

Written and photographed by Zhang Wenchao, Zhang Chao, Liu Qiuyun, Wang Yun and Zeng Ang

Edited by Hong Chengwei and Chen Xiao

Translated by Liu Haiyan

Reviewed by Yu Nanze and Wang Yao