Enhanced Biomechanical Modeling of the Breast for Womens Health

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As biomechanical modeling of the breast is integral to predicting tumor location across multimodal diagnostic imaging and during surgery, surgical planning, generating simulations for physician and patient education, and brassiere and clothing design for optimal breast support, advances in model accuracy have the potential to significantly improve women's health and quality of life. Despite the growing use of breast biomechanical models for different applications, there are persistent knowledge gaps in both the anatomical and biomechanical literature that prevent an accurate model from being developed and deployed to patient-specific applications. Accurate biomechanical models are needed for tracking cancer in diagnostic imaging and surgery. However, the accuracy of biomechanical models is sensitive to the geometrical and structural features used to describe the anatomical features and the constitutive parameters used to describe the behavior of the tissues. For example, small alterations in the stiffness of the various breast tissue properties can displace tissues by more than 10 mm. Thus, thorough characterization of the constitutive properties of individual breast structures are necessary to obtain precise predictions of tissue motion. Furthermore, in the absence of precise knowledge of anatomical geometrical and structural features, biomechanical models have placed an overemphasis on the constitutive parameters of the breast tissue. The long-term goal of our research is to develop an accurate biomechanical model of the breast that transforms the applications of breast modeling for both population models and patient-specific applications. Our vision is to improve the model so that it becomes a reliable and useful tool in the diagnosis and management of breast cancer, surgeon education and training, patient education for better shared decision making, and clothing design, especially in the post mastectomy recovery period. Our present human breast tissue biomechanical model represents the state of the art, as it is based on actual 3D analyses. However, it represents a first step, as clinical translation remains limited by insufficient information about the structural and biomechanical characteristics of the fascial support system and its relationship to the adipose and glandular breast structures in the broader population. Thus, we hypothesize that the accuracy of the biomechanical model may be improved by determining the anatomical and biomechanical characteristics of the fascial support system of the breast, understanding the sensitivity of the patient-specific parameters across the population, and validating the translation of these models, with their inherent uncertainties, into the patient-specific setting. Our multi-disciplinary team of breast reconstructive surgeons, engineers, medical physicists, and pathologists are uniquely poised to perform this innovative research leading to the development of a high-fidelity biomechanical model of the human breast that is capable of reproducing its behavior, both in general and in a patient specific sense.