A comparison of different methods of assessing cosmetic outcome following breast-conserving surgery and factors influencing cosmetic outcome

Abstract

Methods to assess cosmesis following breast-conserving surgery are varied and assumed to yield similar results. The aim of this study was to compare three different methods of cosmetic assessment following breast-conserving surgery and to assess the impact of certain factors on cosmetic outcome. One hundred and fifteen patients undergoing breast-conserving surgery had 3 view digital photographs taken for assessment of cosmesis at one year postsurgery. Subjective cosmetic assessment was performed by a 5 member panel and objective assessment by Breast Retraction Assessment (BRA) and Nipple Deviation (ND). Factors including tumour size, percentage breast volume excised, location of tumour and number of breast operations performed was correlated with final cosmetic outcome. The majority of patients undergoing breast-conserving surgery demonstrated satisfactory cosmetic results. Inter-observer variation assessed using a kappa statistic for panel assessment gave a value of 0.42 with a 95% confidence interval (CI) of 0.37 to 0.47, indicating moderate agreement between observers. The kappa statistic for agreement between the three methods used for assessing cosmesis was -0.23 with 95% CI of -0.35, -0.11 indicating poor concordance between the three methods used. These methods however, may be complementary to each other and therefore these observations merit further investigation. Tumour location, tumour size and the number of operations performed did not influence cosmetic outcome. However, cosmetic outcome was related to percentage breast volume excised.