Advancing nipple volume measurement using Gaussian splatting: Achieving comparable accuracy to current standards

BACKGROUND: The rising incidence of breast cancer and increasing demand for esthetic breast reconstruction have led to a higher frequency of nipple reconstruction procedures. Methods for nipple reconstruction vary; however, the assessment of surgical outcomes through nipple volume measurement often relies on imprecise or inconsistent techniques. Conventional approaches can be time-consuming, uncomfortable for patients, and depend on expensive equipment. METHODS: We retrospectively analyzed 37 reconstructed nipples in 32 female patients aged >19 years who underwent evaluation at Chungnam National University Hospital between December 1, 2023, and May 30, 2025. Traditional measurement methods include mold-based water displacement using Archimedes' principle, and geometric calculations based on physical dimensions that serve as the reference standard. Computed tomography (CT) and Antera 3D®, two more recent modalities, were also used. In this study, we introduced a novel, noninvasive three-dimensional (3D) reconstruction method using the Gaussian splatting technique. RESULTS: The proposed method demonstrated a mean squared error of ±0.128 cc compared with ±0.023 cc for Antera 3D®. The 95% confidence interval for the difference between the methods (0.005-0.012 cc) remained within acceptable limits. Bland-Altman analysis confirmed agreement between both methods and the reference standard, with Antera 3D® showing narrower limits of agreement. CONCLUSION: The proposed Gaussian splatting method provides an accurate, low-cost, non-contact, and patient-friendly alternative to conventional nipple volume measurement techniques.