A Novel Validated Breast Aesthetic Scale
by 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.
Plastic and Reconstructive Surgery: June 2022 -
Volume 149 - Issue 6 - p 1297-1308
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.
