Abstract
Accurate retrieval of post-surgical images plays a critical role in surgical planning for breast cancer patients. However, current content-based image retrieval methods face challenges related to limited interpretability, poor robustness to image noise, and reduced generalization across clinical settings. To address these limitations, we propose a multistage retrieval pipeline integrating saliency-based explainability, noise-reducing image pre-processing, and ensemble learning. Evaluated on a dataset of post-operative breast cancer patient images, our approach achieves contrastive accuracy of 77.67% for Excellent/Good and 84.98% for Fair/Poor outcomes, surpassing prior studies by 8.37% and 11.80%, respectively. Explainability analysis provided essential insight by showing that feature extractors often attend to irrelevant regions, thereby motivating targeted input refinement. Ablations show that expanded bounding box inputs improve performance over original images, with gains of 0.78% and 0.65% contrastive accuracy for Excellent/Good and Fair/Poor, respectively. In contrast, the use of segmented images leads to a performance drop (1.33% and 1.65%) due to the loss of contextual cues. Furthermore, ensemble learning yielded additional gains of 0.89% and 3.60% over the best-performing single-model baselines. These findings underscore the importance of targeted input refinement and ensemble integration for robust and generalizable image retrieval systems. © 2025 Elsevier B.V., All rights reserved.

Abstract
Breast segmentation has a critical role for objective pre and postoperative aesthetic evaluation but challenged by limited data (privacy concerns), class imbalance, and anatomical variability. As a response to the noted obstacles, we introduce an encoder–decoder framework with a Segment Anything Model (SAM) backbone, enhanced with synthetic depth maps and a multiterm loss combining weighted crossentropy, convexity, and depth alignment constraints. Evaluated on a 120patient dataset split into 70% training, 10% validation, and 20% testing, our approach achieves a balanced test dice score of 98.75%—a 4.5% improvement over prior methods—with dice of 95.5% (breast) and 89.2% (nipple). Ablations show depth injection reduces noise and focuses on anatomical regions, yielding dice gains of 0.47% (body) and 1.04% (breast). Geometric alignment increases convexity by almost 3% up to 99.86%, enhancing geometric plausibility of the nipple masks. Lastly, crossdataset evaluation on CINDERELLA samples demonstrates robust generalization, with small performance gain primarily attributable to differences in annotation styles. © 2025 Elsevier B.V., All rights reserved.

Abstract
Breast cancer treatments often affect patients' body image, making aesthetic outcome predictions vital. This study introduces a Deep Learning (DL) multimodal retrieval pipeline using a dataset of 2,193 instances combining clinical attributes and RGB images of patients' upper torsos. We evaluate four retrieval techniques: Weighted Euclidean Distance (WED) with various configurations and shallow Artificial Neural Network (ANN) for tabular data, pre-trained and fine-tuned Convolutional Neural Networks (CNNs) and Vision Transformers (ViTs), and a multimodal approach combining both data types. The dataset, categorised into Excellent/Good and Fair/Poor outcomes, is organised into over 20K triplets for training and testing. Results show fine-tuned multimodal ViTs notably enhance performance, achieving up to 73.85% accuracy and 80.62% Adjusted Discounted Cumulative Gain (ADCG). This framework not only aids in managing patient expectations by retrieving the most relevant post-surgical images but also promises broad applications in medical image analysis and retrieval. The main contributions of this paper are the development of a multimodal retrieval system for breast cancer patients based on post-surgery aesthetic outcome and the evaluation of different models on a new dataset annotated by clinicians for image retrieval.