Keloids are benign fibroproliferative lesions resulting from abnormal wound healing, forming at sites of cutaneous injury or surgical incisions, not infrequently occurring following breast surgery. Five patients with keloid scars on their breasts, who underwent subsequent breast MRIs following breast surgery are described. Details on breast imaging studies, clinical course, pathology findings and therapeutic interventions were abstracted from the electronic medical records. Enhancement on MRI was qualitatively, not quantitively, determined on peak phase sequences. Regression of enhancement corresponding to the clinical attenuation of a hypertrophic scar was observed in one case three years postoperatively. This study demonstrates that breast keloid surgical scars are associated with exuberant neovascularisation.

We investigate how vibrotactile wrist feedback can enhance spatial guidance for handheld tool movement in optical see-through augmented reality (AR). While AR overlays are widely used to support surgical tasks, visual occlusion, lighting conditions, and interface ambiguity can compromise precision and confidence. To address these challenges, we designed a multimodal system combining AR visuals with a custom wrist-worn haptic device delivering directional and state-based cues. A formative study with experienced surgeons and residents identified key tool maneuvers and preferences for reference mappings, guiding our cue design. In a cue identification experiment (N = 21), participants accurately recognized five vibration patterns under visual load, with higher recognition for full-actuator states than spatial direction cues. In a guidance task (N = 27), participants using both AR and haptics achieved significantly higher spatial precision (5.8 mm) and usability (SUS = 88.1) than those using either modality alone, albeit with modest increases in task time. Participants reported that haptic cues provided reassuring confirmation and reduced cognitive effort during alignment. Our results highlight the promise of integrating wrist-based haptics into AR systems for high-precision, visually complex tasks such as surgical guidance. We discuss design implications for multimodal interfaces supporting confident, efficient tool manipulation.

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique that uses magnetic pulses to safely modulate neural activity in specific brain regions, with particular use in the treatment of major depressive disorder. However, effective treatment protocols require multiple sessions over time and accurate targeting. Current neuronavigation systems can improve pulse delivery compared to standard scalp and measuring tape methods, but are costly and have time-intensive setups for recurring sessions. Wepresent an augmented reality neuronavigation system (AR-NS) that overcomes these limitations. The AR-NS is functionally similar to other neuronavigation systems but can operate entirely within a head-mounted display. Unlike traditional 2D navigation systems that require mentally fusing screen information with real-world actions, the AR interface allows operators to perform the procedure with reduced cognitive and hand-eye coordination demands. We measured the functional targeting accuracy of the AR-NS and the Localite TMSNavigator, a commercial neuronavigation system, using a TMS phantom we developed embedded with Hall effect sensors at four different sites. We determined the coil placement for each site that maximized the sensor response to a magnetic pulse using co-registered X-ray computed tomography and structured light scanner scans. A MagVenture C-B60 coil was placed and fired at each site 30 times in a randomized order according to each neuronavigation system. We measured the resulting magnetic pulse amplitudes. A non-inferiority test with a 5 mT margin and 97.5% confidence intervals indicated that the AR-NS demonstrated similar functional targeting accuracy as the Localite TMS Navigator across all but one stimulation site, indicating that augmented reality neuronavigation systems may offer more accessible delivery of TMS stimulation without sacrificing functional accuracy compared to current systems.

The use of Augmented Reality (AR) devices for surgical guidance has gained increasing traction in the medical field. Traditional registration methods often rely on external fiducial markers to achieve high accuracy and real-time performance. However, these markers introduce cumbersome calibration procedures and can be challenging to deploy in clinical settings. While commercial solutions have attempted real-time markerless tracking using the native RGB cameras of AR devices, their accuracy remains questionable for medical guidance, primarily due to occlusions and significant outliers between the live sensor data and the preoperative target anatomy point cloud derived from MRI or CT scans. In this work, we present a markerless framework that relies only on the depth sensor of AR devices and consists of two modules: a registration module for high-precision, outlier-robust target anatomy localization, and a tracking module for real-time pose estimation. The registration module integrates depth sensor error correction, a human-in-the-loop region filtering technique, and a robust global alignment with curvature-aware feature sampling, followed by local ICP refinement, for markerless alignment of preoperative models with patient anatomy. The tracking module employs a fast and robust registration algorithm that uses the initial pose from the registration module to estimate the target pose in real-time. We comprehensively evaluated the performance of both modules through simulation and real-world measurements. The results indicate that our markerless system achieves superior performance for registration and comparable performance for tracking to industrial solutions. The two-module design makes our system a one-stop solution for surgical procedures where the target anatomy moves or stays static during surgery.

In this paper, we develop and clinically evaluate a depth-only, markerless augmented reality (AR) registration pipeline on a head-mounted display, and assess accuracy across small, or low-curvature anatomies in real-life operative settings. In HoloLens 2, we align Articulated HAnd Tracking (AHAT) depth to Computed Tomography (CT)-derived skin meshes via (i) depth-bias correction, (ii) brief human-in-the-loop initialization, (iii) global and local registration. We validated the surface-tracing error metric by comparing “skin-to-bone” relative distances to CT ground truth on leg and foot models, using an AR tracked tool. We then performed seven intraoperative target trials (feet × 2, ear × 3, leg × 2) during the initial stage of fibula free-flap harvest and mandibular reconstruction surgery, and collected 500+ data per trial. Preclinical validation showed tight agreement between AR-traced and CT distances (leg: median |Δ d| 0.78 mm, RMSE 0.97 mm; feet: 0.80 mm, 1.20 mm). Clinically, per-point error had a median 3.9 mm. Median errors by anatomy were 3.2 mm (feet), 4.3 mm (ear), and 5.3 mm (lower leg), with 5 mm coverage 92–95 Δ median ≈ 1.1 mm; p<0.001 ) A depth-only, markerless AR pipeline on HMDs achieved ∼ 3–4 mm median error across feet, ear, and lower leg in live surgical settings without fiducials, approaching typical clinical error thresholds for moderate-risk tasks. Human-guided initialization plus global-to-local registration enabled accurate alignment on small or low-curvature targets , improving the clinical readiness of markerless AR guidance.

OBJECTIVE:Supine positioning for breast magnetic resonance imaging (MRI) may increase patient comfort, shorten exam times, improve co-registration with other modalities, and provide better guidance for surgical planning. The objective of this study was to assess the clinical quality of a breath-held T1-weighted sequence as a feasible approach for supine contrast-enhanced breast MRI. METHODS:At 3T, in 19 supine-positioned female breast cancer patients, we acquired a 3D T1-weighted Dixon gradient recalled echo sequence (LAVA), within ≤19s breath-hold to reduce respiratory motion, using a high-density body-conforming coil. The same subjects also underwent prone-positioned 3D T1-weighted Dixon breast MRI. Image quality was assessed by three radiologists, specifically regarding coverage, signal-to-noise, sharpness, and presence of artifacts. Reader scores were analyzed per reader with a proportion analysis. RESULTS:Supine LAVA images showed sufficient quality to be interpretable, with 97% 'diagnostic' scores, compared to also 97% for prone images. A high parallel imaging factor (12×) was necessary to achieve adequate combined bilateral breast and axillary lymph node coverage. CONCLUSION:The proposed sequence presents a viable option to acquire diagnostic quality supine-positioned contrast-enhanced T1-weighted bilateral breast images.

Augmented reality guidance in microsurgery is challenged by depth ambiguity, occlusion, and limited situational awareness under the operating microscope. Digital twins, dynamic virtual models of physical systems, can provide the contextual geometric data needed to mitigate these limitations. We introduce a perception-first digital twin framework that uses real-time surgical state to drive depth-, occlusion-, and proximity-aware augmented reality visualization for guidance in otologic surgery. We formulate a hand–eye calibration refinement as a joint SE(3) optimization with a bias term and robust weighting to ensure accurate alignment between physical and virtual entities. Our framework integrates this optimized calibration with high-precision optical tracking of key surgical elements and real-time simulation, enabling dynamic updates of the digital twin from the evolving surgical state. In turn, the updated virtual replica is used to compute perceptual fields that drive the augmented reality overlays on the live stereoscopic microscope feed of a 3D-printed anatomical model. We evaluated the accuracy of the optimized calibration on both calibration and evaluation datasets. The optimized workflow achieved a median translational error of 1.06 mm and 1.19 mm and a median rotational error of 0.46^∘ and 0.28^∘ , respectively. In addition, the digital twin was used to derive and overlay perceptual cues onto the microscope video of a 3D-printed temporal bone. An AR-guided microsurgical use case demonstrated how the dynamically updated cues convey spatial relationships between critical structures and the evolving surgical cavity. We present a perception-first digital twin framework for augmented reality guidance in microsurgery. As surgical alteration of anatomy progresses, the digital twin is continuously updated and used to drive perception-aware augmented reality cues. Our framework enables enhanced spatial understanding while preserving visibility of the operative field.

Purpose Supine breast MRI has the potential to improve patient comfort compared to prone breast MRI, in addition to providing images in the same position as subsequent treatment protocols. Novel flexible coil arrays have enabled high SNR and parallel imaging in supine breast imaging, but the combined effect of coil and patient positioning on SNR has yet to be investigated. The aim of this study is to use a tissue-independent metric to account for tissue deformation to compare SNR between prone and supine positions, using appropriate coils for each. Methods Relative SNR (rSNR) metric is proposed as the ratio of SNR between a breast coil and a body coil. This metric is demonstrated to be tissue-independent, allowing for easier SNR comparisons in cases of tissue deformation. We scanned 10 female subjects and compared the rSNR in segmented regions consisting of breast tissue, chest wall, and axilla between prone and supine breast imaging. Results The rSNR was significantly higher in the breast tissue and chest wall in the supine position for all cases. The axilla rSNR was significantly higher in supine for four cases, with another four significantly higher in prone, and two showing no statistical difference. Using a distance-from-coil analysis, we found that the tissue is closer to the coil in supine, and that the supine coil provided higher SNR at distances closer than 4cm. Conclusion Our results show that using a surface array coil in the supine position can provide higher SNR than a standard setup in most subjects for most relevant regions of breast MRI.

Chinese acupuncture practitioners primarily depend on muscle memory and tactile feedback to insert needles and accurately target acupuncture points, as the current workflow lacks imaging modalities and visual aids. Consequently, new practitioners often learn through trial and error, requiring years of experience to become proficient and earn the trust of patients. Medical students face similar challenges in mastering this skill. To address these challenges, we developed an innovative system, MRUCT, that integrates ultrasonic computed tomography (UCT) with mixed reality (MR) technology to visualize acupuncture points in real-time. This system offers offline image registration and real-time guidance during needle insertion, enabling them to accurately position needles based on anatomical structures such as bones, muscles, and auto-generated reference points, with the potential for clinical implementation. In this paper, we outline the non-rigid registration methods used to reconstruct anatomical structures from UCT data, as well as the key design considerations of the MR system. We evaluated two different 3D user interface (3DUI) designs and compared the performance of our system to traditional workflows for both new practitioners and medical students. The results highlight the potential of MR to enhance therapeutic medical practices and demonstrate the effectiveness of the system we developed.

Optical see-through augmented reality (OST-AR) systems like Microsoft HoloLens 2 hold promise for arm's distance guidance (e.g., surgery), but depth perception of the hologram and occlusion of real instruments remain challenging. We present an evaluation of how visualizing the target object with different transparencies and visualizing a tracked tool (virtual proxy vs. real tool vs. no tool tracking) affects depth perception and system usability. Ten participants performed two experiments on HoloLens 2. In Experiment 1, we compared high-transparency vs. low-transparency target rendering in a depth matching task at arm's length. In Experiment 2, participants performed a simulated surgical pinpoint task on a frontal bone target under six visualization conditions (2 × 3: two target transparencies and three tool visualization modes: virtual tool hologram, real tool, or no tool tracking). We collected data on depth matching error, target localization error, system usability, task workload, and qualitative feedback. Results show that a more opaque target yields significantly lower depth estimation error than a highly transparent target at arm's distance. Moreover, showing the real tool (occluding the virtual target) led to the highest accuracy and usability with the lowest workload, while not tracking the tool yielded the worst performance and user ratings. However, making the target highly transparent, while allowing the real tool to remain visible, slightly impaired depth cues and did not improve usability. Our findings underscore that correct occlusion cues, rendering virtual content opaque and occluding it with real tools in real time, are critical for depth perception and precision in OST-AR. Designers of arm-distance AR systems should prioritize robust tool tracking and occlusion handling; if unavailable, cautiously use transparency to balance depth perception and tool visibility.

Background and purpose Radiotherapy (RT) response in gynecologic cancers varies widely and is influenced by several factors. We evaluated whether fibrosis detected with inversion-recovery ultrashort-echo-time (IR-UTE) MRI (magnetic-resonance-imaging) signal-intensity (SI) could serve as noninvasive biomarkers of treatment response in patients imaged serially during external-beam RT (EBRT) and brachytherapy (BT). Materials and methods Patients: Fifteen patients with gynecologic cancer were included. Five participants underwent seven MRIs: pre-RT, weeks 1 (RTwk1), 2 (RTwk2), and 3 (RTwk3) of EBRT, post-EBRT, 1-week post-BT, and 12 weeks post-BT. Ten participants did not receive MRI in RTwk1, RTwk2, or 1-week post-BT. Imaging: T2-weighted, diffusion-weighted images, and dynamic-contrast-enhanced MR images were acquired to segment the remnant-tumor-volume. Diffuse-fibrosis (FDiffuse) was imaged with non-contrast dual-echo IR research application, only retaining the ultrashort-(50 µs)-echo SI. Dense-fibrosis (FDense) imaging utilized Late-Gadolinium-Enhanced IR-UTE, acquired ∼ 15 min post-Gadavist. Analysis: R2* (apparent transverse relaxation rate) maps, indicative of hypoxia, were generated using R2* MRI. The mean FDiffuse SI, FDense SI, and R2* within the remnant-tumor-volume were determined and compared over the course of RT. Results Changes in FDiffuse SI and FDense SI were observed after 14 Gy. Across all patients, FDiffuse SI peaked during RTwk2 and FDense SI peaked during RTwk3. FDense SI was higher during RTwk3 than pre-RT (p < 0.05). Minor changes in FDense SI were observed post-BT week-12 (p > 0.05). Remnant-tumor R2* correlated with FDense SI (p = 0.03). Conclusions The largest increase in FDense occurred early during EBRT. Elevated FDense correlated with elevated R2* in the remnant-tumor, suggesting that fibrosis is an early indicator of radiation-resistant hypoxic regions.

Sentinel lymph node biopsy (SLNB) helps stage melanoma. Pre-surgical single-photon emission computed tomography/computed tomography (SPECT/CT) visualizes draining lymph nodes, but intraoperative gamma probe detection only estimates SLN location. This study evaluates augmented reality (AR) for projecting pre-surgical SLN imaging onto patients to aid precise localization and extraction. Molecular sieves (8 mm) incubated in fluorine-18 simulated lymph nodes and were implanted in the head and neck region of cadavers. Positron emission tomography/magnetic resonance imaging (PET/MRI) replaced SPECT/CT due to institutional restriction on cadavers. Virtual PET/MRI renderings were projected using the HoloLens 2 and custom software. Five cadavers underwent surgeries with standard, AR, and AR with head movement compensation methods. AR achieved a mean surface localization error of 2.5±2.0 mm (range, 0–8 mm) and a depth error of 2.3±1.7 mm (range, 1–7 mm), both within PET voxel resolution. For more challenging level V nodes, the mean surface error slightly increased to 2.9 mm. Compared to manual surface marking, which had an average error of 18.6±13.0 mm (range, 6–62 mm), the AR system significantly reduced errors both in the head-straight and rotated positions (p <.001). Additionally, the AR system reduced the task completion time by 74

Meta Quest Store: https://www.meta.com/experiences/stanford-mri-simulator/8205539289482347/ Magnetic Resonance Imaging (MRI) can be a stressful experience for pediatric patients due to the loud acoustic environment, enclosed scanner bore, and a prolonged requirement to remain still. While sedation is commonly used to manage anxiety and motion, it carries clinical risks and logistical burdens. Traditional preparatory approaches, such as instructional videos and mock scans, often lack engagement for older children and adolescents. In this study, we present a comparative evaluation of four MRI preparation modalities: (1) a gamified virtual reality (VR) simulation that trains stillness through real-time feedback; (2) a passive VR experience replicating the MRI environment without interactivity; (3) a 360° first-person video of a real MRI procedure; and (4) a standard 2D educational video. Using a within-subjects design (N = 11, ages 10-16), we assess each method's impact on head motion data, anxiety reduction, procedural preparedness, usability, cognitive workload, and subjective preference. Results show that the gamified VR condition has significantly lower head motion (p < 0.001) and yielded the highest preparedness scores (p < 0.05). Head motion data were significantly correlated with learning outcomes (p < 0.01), suggesting that behavioral performance in VR strongly indicates procedural readiness. While all modalities reduced anxiety and were rated usable, interactive VR was preferred by most participants and demonstrated unique advantages in promoting engagement and behavioral rehearsal. We conclude with design recommendations for designing immersive simulations and integrating VR training into pediatric imaging workflows.

PURPOSE:Supine breast MRI has the potential to improve over standard prone breast magnetic resonance imaging (MRI) in terms of efficiency and image quality, image alignment with diagnostic and treatment procedures, and overall accessibility. This study aims to characterize potential technical challenges of imaging in the supine position: (i) B 0 $$ {\mathrm{B}}_0 $$  field inhomogeneities, (ii) B 1 + $$ {\mathrm{B}}_1^{+} $$  variations, (iii) respiratory-induced breast motion, and (iv) supine breast geometry. METHODS:Ten healthy subjects were scanned at 3T in both prone and supine positions to quantify and compare (i) and (ii) between both positions, and to assess (iii) in the supine position. Breast image volumes from a wider population (N = 40, healthy volunteers and patients) were analyzed to obtain breast shape metrics to characterize (iv). RESULTS:B 0 $$ {\mathrm{B}}_0 $$  field inhomogeneity increased from prone positioning (2SD: 122 Hz ± 25 Hz $$ 122\kern0.2em \mathrm{Hz}\pm 25\kern0.2em \mathrm{Hz} $$ ) to supine positioning (2SD: 152 Hz ± 15 Hz $$ 152\kern0.2em \mathrm{Hz}\pm 15\kern0.2em \mathrm{Hz} $$ ), and B 1 + $$ {\mathrm{B}}_1^{+} $$  flip angle variations (from prescribed 30 ∘ $$ {30}^{\circ } $$ ) were greater in the supine position (2SD ranging 7 ∘ $$ {7}^{\circ } $$ to 13 ∘ $$ {13}^{\circ } $$ ) than in the prone position (2SD ranging 6 ∘ $$ {6}^{\circ } $$ to 8 ∘ $$ {8}^{\circ } $$ ). Breast tissue displacement (median [IQR] across all analyzed locations and subjects) was similar along A-P (1.4 [0.5] mm) and R-L (1.9 [1.5] mm) directions. Breast geometry varied greatly, with the outer breast perimeter ranging from 34 to 68 cm, and maximum breast tissue thickness ranging from 2 to 9 cm. CONCLUSION:Supine positioning for breast MRI may lead to greater B 0 $$ {\mathrm{B}}_0 $$  inhomogeneities and greater B 1 + $$ {\mathrm{B}}_1^{+} $$  variations when compared to prone positioning, and breast motion can be substantial. Breast geometry varies greatly among the female population, and shape metrics can inform supine-dedicated coil development.

Deep Inferior Epigastric Artery perforator flaps (DIEP flaps) have become the gold standard in autologous breast reconstruction; yet they remain complex procedures due to highly individual perforator anatomy. Increasingly, computed tomography (CT) angiography is used for preoperative planning but is conventionally viewed on 2D screens in black and white. With the rise of Virtual and Mixed Reality, early case studies have demonstrated the utility of 3D-Mixed Reality headsets for DIEP flap planning by immersively exploring projections of perforator anatomy. However, thus far, only segmentation- and volume rendering-based approaches have been used clinically. These techniques lack photorealism and do not ideally depict soft-tissue or high-resolution vascular detail. We describe a new holographic photorealistic rendering workflow on Mixed Reality headsets using Cinematic Anatomy that allows more accurate depth perception and, thus, a better understanding of perforator anatomy. Using hand-gestures to interact with a hologram derived by CT angiography, the surgeon can modify the rendering in real-time and interactively dissect parts of the Rectus Abdominis Muscle to get a more nuanced understanding of the sub- and intramuscular course of the vascular tree. Using different visualization settings, the spatial relationship of perforators to surrounding anatomical structures-especially the subcutaneous tissue and the Rectus Abdominis Muscle-can be understood more intuitively. Our technique can be performed by surgeons independently with a laptop and a Microsoft HoloLens, making CT angiography data more accessible and practical for use in plastic surgery. We demonstrate the first use of photorealistic rendering in Mixed Reality to explore perforator anatomy.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

BACKGROUND:We present a novel method for accurately measuring skin-surface distances using standard smartphone photos and Photoshop, validated on 3D-printed DIEP-flap models and on calibration grid-patterns. MATERIALS AND METHODS:Distance measurements are acquired in Photoshop in a calibration plane between dots on a grid-pattern as well as between perforators on photos of 3D-printed models and compared against ground-truth. Margins of errors are calculated from fitted linear models. RESULTS:Submillimeter accuracy can be achieved within errors of ±0.45 mm (80% probability) and ±0.8 mm (95% probability) for measuring distances on the dot-grid. On the 3D-printed DIEP-models, distance measurements are accurate within ±1.75 mm (80% probability) and ±3.1 mm (95% probability). CONCLUSIONS:We introduce a simple yet highly accurate technique to measure skin-surface distances using normal photos. Depending on the scenario, submillimeter or conservatively very low millimetre errors can be achieved, sufficiently accurate for clinical use, whilst maintaining topographic relationships of the measurements.

Preoperative vascular imaging has become standard practice in the planning of microsurgical breast reconstruction. Currently, translating perforator locations from radiological findings to a patient's abdomen is often not easy or intuitive. Techniques using three-dimensional printing or patient-specific guides have been introduced to superimpose anatomy onto the abdomen for reference. Augmented and mixed reality is currently actively investigated for perforator mapping by superimposing virtual models directly onto the patient. Most techniques have found only limited adoption due to complexity and price. Additionally, a critical step is aligning virtual models to patients. We propose repurposing suture packaging as an image tracking marker. Tracking markers allow quick and easy alignment of virtual models to the individual patient's anatomy. Current techniques are often complicated or expensive and limit intraoperative use of augmented reality models. Suture packs are sterile, readily available, and can be used to align abdominal models on the patients. Using an iPad, the augmented reality models automatically align in the correct position by using a suture pack as a tracking marker. Given the ubiquity of iPads, the combination of these devices with readily available suture packs will predictably lower the barrier to entry and utilization of this technology. Here, our workflow is presented along with its intraoperative utilization. Additionally, we investigated the accuracy of this technology.

OBJECTIVE:The Food and Drug Administration approved the MRI-compatible wireless SCOUT localization system in April 2022. The purpose of this study was to evaluate feasibility of SCOUT localization under MRI guidance. We present our initial experience adopting MRI-guided SCOUT localization and compare it to MRI-guided wire localization. METHODS:Electronic medical records and imaging were retrospectively reviewed for all patients who underwent MRI-guided SCOUT or wire localization at our institution between October 2022 and July 2023. Statistical analysis was performed using 2-sample proportion and Wilcoxon rank-sum tests. RESULTS:There were 14 MRI-guided SCOUT and 23 MRI-guided wire localization cases during the study period. All SCOUTs were placed without complication and were considered to be in adequate proximity to the target. There was no significant difference in complication rate (P = .25) or days lapsed from MRI-detected abnormality to surgery (P = .82) between SCOUT and wire cases. SCOUT was placed at time of biopsy for 71% (10/14) of cases. 57% (8/14) of SCOUT cases were used for breast conservation surgery (BCS) compared to 100% (23/23) of wire cases (P <.01), with all 6 SCOUTs not used for BCS placed at time of biopsy. CONCLUSION:MRI-guided SCOUT localization is feasible and offers an alternative to MRI-guided wire localization, with no SCOUT complications reported. SCOUT placement at time of biopsy obviates the need for an additional procedure, but predicting appropriateness is challenging, with 60% (6/10) of SCOUTs placed at time of MRI-guided biopsy not used for subsequent localization surgery.

Plastic surgeons routinely use 3D-models in their clinical practice, from 3D-photography and surface imaging to 3D-segmentations from radiological scans. However, these models continue to be viewed on flattened 2D screens that do not enable an intuitive understanding of 3D-relationships and cause challenges regarding collaboration with colleagues. The Metaverse has been proposed as a new age of applications building on modern Mixed Reality headset technology that allows remote collaboration on virtual 3D-models in a shared physical-virtual space in real-time. We demonstrate the first use of the Metaverse in the context of reconstructive surgery, focusing on preoperative planning discussions and trainee education. Using a HoloLens headset with the Microsoft Mesh application, we performed planning sessions for 4 DIEP-flaps in our reconstructive metaverse on virtual patient-models segmented from routine CT angiography. In these sessions, surgeons discuss perforator anatomy and perforator selection strategies whilst comprehensively assessing the respective models. We demonstrate the workflow for a one-on-one interaction between an attending surgeon and a trainee in a video featuring both viewpoints as seen through the headset. We believe the Metaverse will provide novel opportunities to use the 3D-models that are already created in everyday plastic surgery practice in a more collaborative, immersive, accessible, and educational manner.