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Computer-aided methods in bespoke breast prosthesis design and fabrication

Around 38,000 women are diagnosed with breast cancer each year in the UK, resulting in around 19,000 breast removals. The majority of those who have had a mastectomy will be offered a brassiere-worn prosthesis as a temporary or permanent solution to restore body shape and posture. Despite the high case number, the vast majority of prostheses are not custom made to fit the wearers’ anatomical shape, resulting in a compromised and unsatisfactory fit. A new method of designing breast prostheses that are better matched to the shape and physical requirements of women who have undergone a mastectomy is demonstrated in this paper. The research was clinically led and informed by the Breast Care Nurse team at a local hospital. Techniques established through pioneering collaborative work in facial prosthetics with Morriston Hospital, Swansea, were applied to address the challenges of making prostheses custom contoured to individual patients. That is, the paper describes the introduction of three dimensional photogrammetry, haptic computer sculpting and Rapid Prototyping and manufacturing methods to produce bespoke breast prostheses. This process removed the need for impression taking, which is labour and material intensive, time consuming and intrusive for the patient. The technique provided a prosthesis that accurately fitted the defect chest wall of the post-mastectomy patient, providing a comfortable fit and improved retention over ‘off the shelf’ alternatives. By designing the prosthesis digitally, using the mirrored contour of the breast within the brassier, a better symmetry was achieved for the wearer. Literature on breast prostheses is extremely limited and the approach presented was the first address the challenges of custom design and fabrication. The research has provided the basis on which a clinically viable workflow can be developed to meet the needs of thousands of people per year.