BREAST+: An augmented reality interface that speeds up perforator marking for DIEAP flap reconstruction surgery.

Deep inferior epigastric artery perforator flap reconstruction is a common technique for breast reconstruction surgery in cancer patients. Preoperative planning typically depends on radiological reports and 2D images to help surgeons locate abdominal perforator vessels before surgery. Here, BREAST+, an augmented reality interface for the HoloLens 2, designed to facilitate accurate marking of perforator locations on the patients' skin and to seamlessly access relevant clinical data in the operating room is proposed. The system is evaluated in a controlled setting by conducting a user study with 27 medical students and 2 breast surgeons. Quantitative (marking error, task completion time, and number of task repetitions) and qualitative (perceived usability, perceived workload, user preference and user satisfaction) data are collected to assess BREAST+ performance during perforator marking. The average time taken to mark each perforator is 7.7 ± 6.5 s, with an average absolute error of 6.8 ± 2.6 mm and an estimated average deviation of 3.6 ± 1.4 mm. The results revealed non-negligeable biases in user estimates likely attributed to depth perception inaccuracies. Still, the study concluded that BREAST+ is both accurate and considerably more efficient (∼6 times faster) when compared to the conventional perforator marking approach.