A Novel Validated Breast Aesthetic Scale. Issue 6 (29th March 2022)

• Record Type: Journal Article
• Authors: Duraes, Eliana F. R.; Durand, Paul; Morisada, Megan; Scomacao, Isis; Duraes, Leonardo C.; de Sousa, Joao Batista; Abedi, Nasim; Djohan, Risal S.; Bernard, Steven; Moreira, Andrea; Schwarz, Graham S.
• Is Part Of: Plastic and reconstructive surgery. Volume 149:Issue 6(2022)
• Page Start: 1297
• Page End: 1308
• Publication Date: 2022-03-29
• Subjects: Surgery, Plastic -- Periodicals; 617.95205
• DOI: 10.1097/PRS.0000000000009156
• Languages: English
• ISSNs: 0032-1052

Abstract

Abstract : Background: Breast aesthetics impacts patients' quality of life after breast reconstruction, but patients and surgeons frequently disagree on the final aesthetic evaluation. The need for a comprehensive, validated tool to evaluate breast aesthetics independently from the patient motivated this study. Methods: The 13-item Validated Breast Aesthetic Scale was developed after several internal meetings, and worded to be understood by a nonspecialist. Three items are common for both breasts, with the remaining being side-specific. To test the internal consistency of the scale subitems, postoperative photographs after different breast reconstruction techniques were graded by a six-member panel. To test interrater and intrarater correlation across time, four physicians evaluated the results of abdominally based breast reconstructions following nipple-sparing mastectomies. Results: Graded aesthetic outcomes of 53 patients showed that the Cronbach alpha of the subitems of the scale was 0.926, with no single item that, if excluded, would increase it. Twenty-two patients underwent aesthetic outcomes grading at four different time points. The mean overall appearance was 3.71 ± 0.62. The mean grade for overall nipple appearance was 4.0 ± 0.57. The coefficient alpha of the panel overall aesthetic grade across different time points was 0.957; whereas intragrader reliability for graders 1 through 4 individually showed alpha coefficients of 0.894, 0.9, 0.898, and 0.688, respectively. Similar results were found for the other items of the scale. Conclusions: The proposed aesthetic scale evaluates different aspects of the breast reconstruction aesthetic result with excellent internal consistency among its subitems. Grading by a gender-balanced, diverse four-member panel using postoperative photographs showed higher reliability and reproducibility compared to single graders.