Discussion
breasts, breast cancer
REGRESSION, PTOSIS, SCAR, BREAST CANCER
This study was conducted to compare aesthetic outcome scores of implant-based reconstructions (IBR) with autologous fat transfer (AFT) breast reconstructions.Our results showed breast cancer patients and plastic surgeons did not report different aesthetic scores for AFT and IBR. In line with previous studies, laymen were the lowest scorers. Additionally, this was the only group reporting significantly lower scores for the AFT group. Former studies evaluating subjective aesthetic outcomes argue that scores given by laymen are unreliably low due to their lack of experience with consequences of breast cancer, or achievable results with breast reconstruction post-mastectomy [Furthermore, it is stated that agreement between plastic surgeons is higher compared with inexperienced assessors [Aesthetic outcome is a keystone of breast reconstruction for both patients and plastic surgeons [Since our population included a variety of patients, e.g., presence of mamilla, laterality of reconstruction and age, a regression analysis was performed to determine possible factors influencing scoring. Interestingly, we found higher scores were given when a bilateral reconstruction was performed. This is a result that can be expected given the fact that symmetry is a key issue for the personal experience of aesthetics [An important rationale for lower scores reported for AFT reconstructions could be due to clinical differences. Although no statistical baseline differences were found between IBR and AFT group, there were six more patients with a mamilla in the IBR group and four more patients with a bilateral reconstruction in the IBR group. As shown by regression analysis, these clinical characteristics were predictors for higher scores. Hence, these differences in patient characteristics could have led to higher reported scores for the IBR group, since this group comprised more patients with positive clinical predictors.Although we hypothesize aesthetic judgement is personal, research has shown social media to have significant impact on perceptions of ideal body image and aesthetic consults are often prompted by unrealistic images shown in pornographic magazines [As with the majority of studies, our study suffered from limitations. First, subjects included varied in characteristics such as age, laterality of reconstruction and presence of mamilla. Analyses showed these characteristics influence scoring and thus more identical subjects could have corrected for differences in agreement. Furthermore, more evaluators per group are necessary to evaluate effect sizes. However, in reality, this setting is difficult to achieve. Additionally, 3D images were used for evaluation. Even though the quality of these images is superior to 2D images, positioning is not ideal. Arms of subjects are raised, possibly affecting shape of the breasts. A superior way, yet difficult setup, would be to include 3D video imaging.Lastly, an overall score was examined, not questioning specific patient characteristics such as mastectomy scar, inframammary fold, ptosis grade, symmetry or shape. Implementing these subscales could identify important factors influencing scoring and lead us to a better understanding on how different individuals observe and judge breast contours [Our results show aesthetic agreement is low within all evaluating groups and therefore a very subjective measurement that is difficult to measure. Seen as laymen gave the lowest scores and that this is probably due to their lack of experience with breast reconstructions, it could be that thorough patient counseling discussing achievable reconstruction results could alter satisfaction with outcome. These claims are supported by Ho et al. stating that patients’ satisfaction with breasts and overall outcome is dependent on preoperative information and interaction with plastic surgeon [