COSMETIC

Surface Area Measurement of the Female Breast:

Phase I. Validation of a Novel Optical Technique
J. Grant Thomson, M.D.,
Background: Breast shape is largely determined by the volume of tissue and
M.Sc. surface area of the skin envelope. Values for breast surface area have never been
Yuen-Jong Liu, B.A. published in the literature. The investigators have developed an inexpensive,
Richard J. Restifo, M.D. noninvasive optical method to objectively measure breast volume and surface
Brian D. Rinker, M.D. area, and its accuracy is determined.
Andrew Reis, M.D. Methods: An optical grid is projected onto the breast, and two images are
New Haven, Conn. captured to create a computerized three-dimensional model from which vol-
ume, surface area, and maximum vertical projection are calculated.
Results: To assess accuracy, simple geometric shapes (n ⫽ 22) were analyzed,
and the actual volume, surface area, and maximum vertical projection were
compared with the imaged values using least-squares linear regression. There
was excellent correlation in all three parameters (r ⬎ 0.995, p ⬍ 10⫺14). The
mean differences in volume, surface area, and maximum vertical projection
were 28 ⫾ 28 ml (mean ⫾ SD), 2 ⫾ 9 cm, and 0.4 ⫾ 0.5 cm, respectively. Female
breasts (n ⫽ 14) were then analyzed, and the actual volume and surface area
were measured using plaster casts. Based on least-squares linear regression, there
was excellent correlation between the imaged values and actual values (r ⬎
0.992, p ⬍ 10⫺11), and the mean differences in volume and surface area were
32 ⫾ 22 ml and 3 ⫾ 11 cm2, respectively.
Conclusions: For the first time, an optical method has been demonstrated to
measure volume and surface area with accuracy. When the method is applied
to the breast, measurement errors are small and clinically insignificant. The
ability to facilitate quantitative breast surgery will be investigated in future phases
of this experiment. (Plast. Reconstr. Surg. 123: 1588, 2009.)

“Many surgeons only use their eyes and digital ship between volume of tissue and surface area of
estimations in a mammaplastic procedure.” skin envelope. The importance of the surface area
–-Gustave Aufricht, M.D., 1949 component of this equation has been under-
scored since the early history of breast surgery,

T
he goal of cosmetic and reconstructive breast
surgery is to provide symmetric breasts with an
aesthetically acceptable shape, incorporating
considerations of volume, ptosis, and glandular con-
figuration. Investigators have attempted to define
these criteria both subjectively and quantitatively.1,2
Breast shape is largely determined by the relation-
when the concept of the “skin brassiere” was in-
troduced by Aufricht in 1949.3 In fact, most sur-
geons today use a technique of breast reduction
that includes a skin envelope design originally
based on a pattern used by brassiere makers.4,5
Despite the importance of surface area in the de-
termination of the shape of the breast following

From the Section of Plastic Surgery, Yale University School of

Medicine.
Received for publication August 22, 2008; accepted October
20, 2008.
Presented in part at the annual meetings of the Plastic
Surgery Research Council (poster), in New York, New York,
May of 1995, the New England Society of Plastic and Re-
constructive Surgeons, in Boston, Massachusetts, June of
1995, and the Northeastern Society of Plastic Surgeons, in
Boston, Massachusetts, November of 1995.
Copyright ©2009 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0b013e3181a076ad
Disclosure: This research was supported by an
Ohse Research Grant from the Department of Sur-
gery, Yale University, School of Medicine. Addi-
tional support came from a Yale University School of
Medicine Medical Student Research Fellowship and
James G. Hirsch, M.D., Endowed Medical Student
Research Fellowships. The authors have no other
financial information to disclose.

1588 www.PRSJournal.com
Volume 123, Number 5 • Breast Surface Area
cosmetic or reconstructive surgery, the correct re-
lationship between volume and surface area is still
poorly understood, and currently, breast opera-
tions are usually performed with only a visual es-
timation of volume and no measurement or esti-
mation of the surface area of overlying skin. Most
publications continue to stress the importance of
an adequate skin envelope,6 –10 but surprisingly,
there is no quantitative information to guide the
surgeon in the design of the skin pattern. Values
for breast surface area have never been published
in the plastic surgery literature.
Several investigators have reported measure-
ments of breast volume and other anthropomor-
phic values in normal and “aesthetically perfect”
women.1,2,11,12 Plaster casts have been filled with
sand, and breast volume has been calculated from
the weight of the sand.2,13–15 This technique should
be considered the accepted standard of volume
measurement to which all other techniques be
compared. While it is useful experimentally, there
are significant drawbacks that limit its routine clin-
ical use, including that it is messy and uncomfort-
able for the patient and may furthermore be dif-
ficult or impossible to use on pendulous breasts.
Most previous methods of breast volume assessment
have relied on measurement of water volume dis-
placed by immersing the breasts or some other vari-
ation of Archimedes’ principle.16 –21 These methods
involve contact with the breast and distortion
thereof. Others have purposely distorted the breasts
to aid in volume measurement22–24 with questionable
validity.15,25 Noncontact methods, such as magnetic
resonance imaging,26,27 stereo photography,11,12,28 –31
and laser scanning,27 are limited by expense and the
need for a precise geometric apparatus. Further-
more, surface area measurement either has not
been possible or has not been attempted with any
previously described technique. Because breasts
with different volumes can have equally aestheti-
cally pleasing shapes, volume measurement alone
is insufficient to classify their aesthetic value.
The investigators have developed a simple, in-
expensive, noninvasive optical method that does
not require complicated geometric alignment and
provides quantitative measurements of volume
and surface area without contact or distortion.
Because of the need to visualize the entire breast
surface, the subjects must be analyzed while prone.
When the subject is upright, ptosis may occlude
full visualization of the inferior surface of the
breast. In the prone position, the breast retracts
from the chest wall by hanging from gravity, and
the entire skin surface may be visualized. Before
using this method to answer clinical questions, it
was necessary to obtain information about its ac-
curacy in measuring the parameters of interest,
namely, volume, surface area, and maximum ver-
tical projection. If the technique proves to be ac-
curate in the measurement of these parameters in
geometric solids, then the second goal is to de-
termine whether measurement of these parame-
ters in the female breast in the prone position
accurately corresponds to values in the upright
position.
The goal of this study was to validate this new
imaging method for measuring volume and surface
area. This was achieved in a two-part approach, by
measuring (1) geometric solids and (2) actual fe-
male breasts in the prone and upright positions.
MATERIALS AND METHODS
Breast Imaging
Each breast is imaged separately. While the
subject lies prone on an examining table, one
breast is allowed to project dependently to gravity
through an opening in the table (Fig. 1). A slide
projector projects a lattice grid of light onto the
breast at a right angle after reflecting off a mirror
below the table. The projector is adjusted so that
each edge of the grid is 1 cm, where it intersects
the undersurface of the table. The grid is distorted
by the curvature of the breast, and this informa-
tion is captured by two video cameras positioned
cranially and caudally. Any viewing angle apart
from 90 degrees will provide information about
the depth of breast tissue at each vertex of the grid.
An angle of 45 degrees is usually approximated.
Positioning and alignment of the cameras and the
subject are not crucial as image analysis automat-
ically compensates.
The images are transferred through an an-
alog-to-digital converter (Computer Eyes/RT
SCSI Video Frame Grabber by Digital Vision, Inc.,
Hong Kong) to an ordinary personal computer
(Apple Macintosh PowerBook, Cupertino, Calif.)
as PICT files. The total time to image four images
of two breasts is approximately 1 minute, includ-
ing the time used to position the subject.
Computerized Three-Dimensional Model
The PICT files are imported into graphical
analysis software (NIH Image v1.52, public do-
main software from the National Institutes of
Health, Bethesda, Md.), where first the images are
scaled from pixels to centimeters such that each
edge measures 1 cm and then vertices of the grid
are labeled. The viewing angles of each video cam-
1589
 Plastic and Reconstructive Surgery • May 2009

Fig. 1. The imagingapparatusconsistsofatablewithanopening,throughwhichone

breast is allowed to project dependently. The image of a lattice grid is projected hor-
izontallyuntilitisreflectedoffamirrorunderthetable,whenceitilluminatesthebreast.
The magnification of the grid is adjusted so that each edge measures 1 cm on the
undersurface of the table. The grid is distorted by the irregular surface of the breast.
Two video cameras capture images directly into a computer. Analysis of the digitized
image provides the vertical projection of each grid coordinate.

era are calculated from three coordinates along
one side of the lattice grid. In Equations 1 to 3, the
actual vertical projection zij of the vertex at the i-th
row and j-th column (i,j ⑀{1, 2, . . ., 25}, rows enu-
merated from bottom to top and columns from
left to right) is calculated from the angle of ele-
vation of the video camera ␪ and vertical distance
within the image zi,j=
between the vertex and the
first row. Here, distances are measured in milli-
meters and f is an intermediate value in the cal-
culation.
␪ ⫽ sin ⫺1 共 =
z25,1 兲 2
v1.00E1 (Redmond, Wash., for Apple Macintosh
computers) to transform the vertices into a com-
puterized three-dimensional model of the breast
and chest wall. The boundary between breast
mound and chest wall is identified by comparing
the digital images and photographs, and grid
squares within the boundary are highlighted on
the model to be measured for breast volume, sur-
face area, and maximum vertical projection (Fig.
2). The position of the underlying chest wall can-
not be determined exactly without computerized
radiography. Therefore, the chest wall contour is

(1) approximated by connecting the grid lines at the

480共z25,1
=
⫺ z13,1
=
兲 superior and inferior limits of the previously de-

f ⫽
共z25,1
=
⫺ z13,1
=
兲 · 240 cos ␪ (2)
termined breast boundary, and the height of the
contour is subtracted from the height of the
=
2z13,1 ⫺ z25,1
=
model to yield the vertical projection of each ver-

冉=
zi,j ⫺
=
z25,1
2 冊冉
· 1 ⫹
icos ␪
f 冊 tex from the chest wall. The maximum vertical
projection is recorded. In Equation 4, the volume

冉 冊
over each grid square is calculated by considering
240共z25,1 ⫺ z13,1
= =
兲 sin ␪ it as a square prism with an uneven top, where the
⫺ i ⫺ = length of each side of the base is b and h1, h2, h3,
z25,1

冉 冊
zi,j ⫽ (3) and h4 are the heights at the lower left, lower right,
=
z25,1 upper left, and upper right corners, respectively.

冉 冊
z ⫺
=
i,j sin ␪
2 1 1 1 1
cos␪ ⫹ V ⫽ b2 h1 ⫹ h2 ⫹
h4 h3 ⫹
(4)
f 3 6 3 6
Using these equations, the investigators have writ- In Equation 5, the surface area is calculated
ten computer programs in Microsoft QuickBASIC by dividing each grid square into two triangles,

1590
Volume 123, Number 5 • Breast Surface Area

Fig. 2. Description of subject 31. Left breast total surface area is 263 cm2, total volume
is 429 ml, and maximum projection is 5.97 cm. A sample of the computer analysis of the
images showing the digital model, which can be rotated in two planes, and the quan-
titative analysis. In this view, the head of the subject is to the lower left. The shaded area
is defined by the investigator during the data analysis by visualizing the boundary of
the breast on the digitized image. It represents the part of the model from which
surface area and volume are measured. The actual surface area measured from the
plaster cast of this breast is 263 cm2, and the volume is 404 ml.

the area of which can be calculated from the
length of the three sides, a, b, and c, and their
a⫹b⫹c
average s ⫽ , using Hero’s formula.
2 compared with plaster cast measurements taken in
A ⫽ 兹s共s ⫺ a兲 共s ⫺ b兲 共s ⫺ c兲
The total volume and the total surface area are
recorded. The total cost of the examining table,
video cameras, and digital interface was less than
$2000 in 1993, and the total cost for an equivalent
setup using today’s technology is expected not to
exceed $500.
Validation by Geometric Solids
The optical method and subsequent computer
image processing were applied to geometric solids,
including hemispheres, cones, and truncated cones,
whose volume, surface area, and maximum vertical
projection could also be calculated exactly by math-
ematical formulas. Hemispheres were made from
hemisected styrofoam balls. Cones were made from
cardboard, and truncated cones were constructed to
be a closer approximation of the shape of a breast.
Height, base diameter, and apex diameter were var-
ied to generate a range of sizes and shapes.
Human Female Subjects
Under an institutional review board-approved
protocol, volunteers were recruited through clas-
sified advertisements for breast surface imaging.
Those whose breast geometry allowed application
of plaster casts were recruited for the second stage
of validation of the optical method. Imaging mea-
surements were taken in the prone position and
(5) the upright position. Casts were made according
to previously published techniques.13 In brief, a
thick layer of petroleum jelly was applied to the
skin to prevent adherence of the plaster. As the
patient stood, three to four layers of 4-inch plaster
strips were applied, diligently avoiding excess pres-
sure that would cause distortion. Once the plaster
had hardened, the cast was removed, and the
breast boundary was outlined on the inside surface
of the plaster cast. Volume was initially measured by
filling the casts with sand and weighing the sample.
The sand, however, could be compacted to varying
degrees, and therefore, its density did not remain
constant. Modeling clay (Play-Doh from Tonka Cor-
poration, Playskool, Inc., Pawtucket, R.I.) was found
to be noncompactable and better suited volume
measurement. The clay was pressed into the mold
following the chest wall contour. The weight of the
sample was then divided by the density (D ⫽ 1.30
g/ml) to obtain the volume.
Surface area of the plaster casts was measured
by a tiled method. The entire inner surface was
divided into small triangles. After the sides of all
the triangles had been measured, the total surface
area was calculated from repeated use of Hero’s
formula, as in Equation 5.

1591

Anterior projection was not measured from
the plaster casts because this is a conceptually dif-
ferent parameter from vertical projection in the
prone position. Statistical analysis was performed
using least-squares linear regression analysis.
Repeatability
One volunteer was imaged on multiple sepa-
rate occasions to demonstrate repeatability of the
measuring instrument under the same procedure
and conditions.
RESULTS
Geometric Solids
Twenty-two objects (four hemispheres, three
cones, and 15 truncated cones) with volumes rang-
ing from 50 to 1300 ml (mean, 414 ml), surface
areas ranging from 70 to 600 cm2 (mean, 230 cm2),
and vertical projections ranging from 1.5 to 20 cm
(mean, 8.7 cm) were imaged using the novel op-
tical method. There was excellent correlation of
all three measured parameters with the calculated
values for each geometric shape (r ⬎ 0.995, p ⬍
10⫺14) (Fig. 3). The mean errors (optical-actual) in
volume, surface area, and maximum vertical pro-
jection were ⫺28 ⫾ 28 ml (mean ⫾ SD), 2 ⫾ 9 cm2,
and ⫺0.4 ⫾ 0.5 cm, respectively. Thus, the optical
method tended to underestimate volume, overes-
timate surface area, and underestimate maximum
vertical projection. The largest errors were seen in
the vertical projections of the pointed cones
(mean difference, 1.3 ⫾ 0.5 cm, n ⫽ 3), as the grid
did not always align with the point of the cone.
Human Female Subjects
Seven volunteers were recruited for plaster cast-
ing of 14 breasts, and the volumes and surface areas
of the casts were compared with optical measure-
ments using linear regression analysis. Surface areas
Fig. 3. There was strong correlation between the imaged and actual parameters for geometric objects of varied shapes and sizes.
The straight lines were calculated by linear regression (r ⬎ 0.995, p ⬍ 10⫺15, n ⫽ 22).
1592
Plastic and Reconstructive Surgery • May 2009
ranged from 100 to 350 cm2 (mean, 213 cm2), and
volumes ranged from 80 to 600 ml (mean, 271 ml).
There was excellent correlation between measure-
ments by the optical method and by plaster casting
(r ⬎ 0.992, p ⬍ 10⫺11) (Fig. 4), and the mean errors
(optical-actual) in volume and surface area were
32 ⫾ 22 ml (mean ⫾ SD) and ⫺3 ⫾ 11 cm2,
respectively. No subjects complained of any dis-
comfort during the procedure.
Repeatability
To assess the precision of the optical method,
measurements of volume and surface area were
repeated on one subject under the same proce-
dure, instrument, observer, conditions, and loca-
tion. As shown in Table 1, measurements of vol-
ume, surface area, and maximum vertical projection
are within 5, 3, and 9 percent of the mean, respec-
tively. The standard deviation of the error in mea-
surements of volume, surface area, and maximum
vertical projection are 4, 2, and 6 percent, respec-
tively, which are clinically insignificant. In a female
patient with 36C breasts measuring 1000 ml in
volume, 500 cm2 in surface area, and 10 cm in
maximum vertical projection, the optical method
can be expected to vary ⫾50 ml, ⫾15 cm2, and
⫾0.9 cm between measurements.
DISCUSSION
Previous attempts at quantification of breast
surgery have focused primarily on nipple position
and volume measurement. An evaluation of 20
“aesthetically perfect” female models published in
1955 attempted to determine the “ideal” relation-
ship of the breast to the chest wall.1 More recently,
anthropomorphic measurements and volume
have been collected in “normal” women.2,11,12 Other
investigators have attempted to improve the re-
sults of breast surgery using various techniques of
Volume 123, Number 5 • Breast Surface Area

Fig. 4. There was excellent correlation between the imaged and plaster cast measurements. The straight
lines were calculated by linear regression (r ⬎ 0.992, p ⬍ 10⫺11, n ⫽ 14).

Table 1. Repeated Measurements of the Same Subject’s Left and Right Breasts*
Left Breast Right Breast

Volume Surface Vertical Volume Surface Vertical

(ml) Area (cm2) Projection (cm) (ml) Area (cm2) Projection (cm)
Measurement 1 118 (⫹4.73%) 142 (⫺1.84%) 5.52 (⫺6.65%) 116 (⫺4.13%) 150 (⫺2.39%) 6.26 (⫹3.47%)
Measurement 2 110 (⫺2.37%) 146 (⫹0.92%) 6.09 (⫹2.99%) 122 (⫹0.83%) 157 (⫹2.17%) 6.33 (⫹4.63%)
Measurement 3 110 (⫺2.37%) 146 (⫹0.92%) 6.13 (⫹3.66%) 125 (⫹3.31%) 154 (⫹0.22%) 5.56 (⫺8.10%)
*Under the same procedure, instrument, observer, conditions, and location, repeated measurements were taken of the same subject’s left and
right breasts. Percent deviation from the mean measurement is shown in parentheses.

breast volume measurement.20,21,32,33 The draw-
backs of previous techniques include distortion
causing variable results and equipment complex-
ity and expense. Although it is well recognized that
skin surface area is an important parameter in the
determination of breast symmetry and shape,
there are no quantitative data in the plastic surgery
literature documenting normal or abnormal val-
ues. Indeed, until now, there has been no method
available to measure these two parameters simul-
taneously without breast contact or distortion. The
authors have described an optical method of
breast volume and surface area analysis that is
simple to perform and is associated with minimal
patient discomfort and inconvenience. The appa-
ratus can be assembled from components that are
readily available, can be kept in a physician’s of-
fice, and are relatively inexpensive. These are ad-
vantages over other surface imaging systems that
have been developed with specialized cameras and
computer equipment for facial analysis.34 The sig-
nificantly higher cost of this technology can be
expected to limit widespread clinical availability.
Furthermore, although this and other stereopho-
tographic systems are available for breast imaging
and analysis and they are provided with sophisti-
cated software for image display and manipula-
tion, no scientific reports of their use have been
published. The reason may be that imaging us-
ing these systems is performed with the subject
positioned upright, limiting their use to non-
ptotic breasts. To the authors’ knowledge, none
of these systems has been programmed to mea-
sure surface area, although it should be techni-
cally feasible to do so.
This experiment has shown that the optical
method is accurate in the analysis of simple geo-
metric shapes. The accuracy is limited by the use
of a grid for imaging which, through random
alignment, does not always coincide with surface
landmarks, with the result that sharp projections
are poorly imaged. Natural breast shape is not
acutely pointed, more closely resembling a trun-
cated cone, for which the vertical projection mea-
sured in this study was accurate to within several
millimeters. Despite this limitation, the errors be-
tween optical values and actual parameters were
small and clinically insignificant.
It is natural to believe that breast volume and
surface area may change with positioning of the

1593

breast in the upright or prone position. As the sur-
geon is primarily interested in the shape of the
breast in the upright position, one could argue
that all measurements should be performed up-
right. Unfortunately, optical analysis of the up-
right breast is usually impossible secondary to pto-
sis. The inferior surface can be hidden by close
proximity to the chest wall. Previous investigators
have shown that volume measurements performed
in both positions are identical.13 The results of this
study have confirmed these findings by comparing
prone optical imaging with upright plaster cast-
ing. Moreover, it has been shown for the first time
that the differences between surface area mea-
surements performed in the two positions are
small and within the measured accuracy of the
technique.
Therefore, it has been demonstrated that it is
possible to accurately measure breast volume and
surface area in the prone position and that this
information is clinically relevant. A few obstacles
remain, however, to full clinical implementation.
First, the data analysis is cumbersome, requiring
significant time-consuming human intervention.
Future improvements will allow fully automated
data analysis after image capture. Furthermore,
even though it is now possible to measure breast
surface area, the clinical meaning of variations in
this parameter is yet poorly understood and will be
elucidated in subsequent experiments using this
optical method.
Under many circumstances, breast surgery can
be performed successfully without preoperative
quantitative analysis, but there are several clinical
situations in which surface area measurement may
improve the results of breast surgery. An imbal-
ance between volume and surface area can result
in an unacceptable cosmetic appearance, leading
to a ptotic or a constricted breast. The proper
relationship between volume and surface area
needed to obviate these deformities is currently
unknown. Phase II of the experiment aims to cor-
relate subjective aesthetic features with objective
breast measurements. Knowledge of the “ideal”
relationship between volume and surface area may
yield improved results following breast operations
such as mastopexy, reduction mammaplasty, con-
stricted breast reconstruction, or reconstruction
following mastectomy.
A significant problem following breast recon-
struction is that 40 percent of patients may have an
asymmetry of breast shape, and 23 percent may
have an asymmetry in size.35 Imaging of the mas-
tectomy site and the contralateral normal breast
before reconstruction with an autologous flap or
1594
Plastic and Reconstructive Surgery • May 2009
a tissue expander may provide data that will allow
construction of a flap or insertion of an expander
with the proper dimensions to improve symmetry
of size and shape.
Postoperative breast asymmetry is one of the
more common problems following reduction
mammaplasty.32 During breast reduction for gi-
gantomastia, a small volume difference may go
unrecognized without quantitative analysis, and if
the same volume is removed from each breast, the
volume difference may become clinically signifi-
cant at the smaller revised volume. For example,
the difference between 1500- and 1700-g breasts
may not be subjectively obvious, but once each
breast has been reduced by the same amount, the
difference between the final volumes of 600 and
800 gm may be clinically significant. Preoperative
volume measurement may alert the surgeon to
such differences so that the surgery can be ad-
justed appropriately.
In the planning of an augmentation mamma-
plasty, surface imaging is important for two reasons.
First, patient satisfaction of postoperative breast size
may be more easily attained through quantitative
knowledge of preoperative volume integrated with
the patient’s desired size. Second, if the “ideal”
relationship between breast volume and surface
area is known, then knowledge of the preaugmen-
tation skin surface area may allow determination
of the volume required to provide an aesthetic
breast shape. Thus, quantitative analysis should
improve the surgeon’s ability to perform a breast
augmentation that satisfies the patient’s and sur-
geon’s concepts of postoperative size and shape.
During surgical planning to correct breast
asymmetry, knowledge of the volume and surface
area differences can yield improved postoperative
results. If quantitative values for both volume and
surface area are known for each breast, then it will
be possible to alter these two parameters to
achieve identical values. It is hoped that the op-
tical method will thus improve symmetry not only
in volume but also in shape.
Current programming displays a three-dimen-
sional digital model of the subject’s breast. Future
improvements may allow alteration on the fly by
changing volume and surface area. This feature
may aid in preoperative planning, patient educa-
tion, and management of patient expectations.
In phase II of the experiment, nonoperative
normal volunteers and preoperative and postop-
erative patients undergoing breast surgery for
asymmetry, augmentation, reduction, and recon-
struction have been quantitatively assessed by the
optical method, deriving objective measurements
Volume 123, Number 5 • Breast Surface Area
as well as subjective aesthetic ratings. This manu-
script is being prepared for publication.
Quantitative surface area measurement was
originally conceived by the investigators to be use-
ful for breast imaging. It has become obvious,
however, that there are other areas of the body
where it may be valuable. For example, imaging of
a skin defect requiring tissue expansion can quan-
tify the amount of surface area needed. Imaging
of the expanding tissue will yield volume that pro-
vides the appropriate amount of skin, thus mini-
mizing overexpansion or underexpansion. The
optical method can also be used to quantitate
facial surface changes following craniofacial sur-
gery and to correlate these changes with skeletal
alterations.
SUMMARY
A new optical method to measure the surface
area and volume of simple convex shapes is de-
scribed. It is simple to use, inexpensive, noninva-
sive, and accurate. Measurement errors are small
and clinically insignificant. Breast volume and sur-
face area can be accurately measured in the prone
position using this technique.
J. Grant Thomson, M.D., M.Sc.
Section of Plastic and Reconstructive Surgery
Yale University School of Medicine
P.O. Box 208041
New Haven, Conn. 06520-8041
grant.thomson@yale.edu
ACKNOWLEDGMENTS
The authors thank Dana Reiver, M.D., Liane Phil-
potts, M.D., Pia Ali-Salaam, M.D., Maureen Lynch,
Elena Barnard, Denise Ferraiuolo, and Yuen-Joyce Liu
for their assistance with this project.
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