J Breast Cancer.  2015 Mar;18(1):80-86. 10.4048/jbc.2015.18.1.80.

Cosmetic Evaluation Methods Adapted to Asian Patients after Breast-Conserving Surgery and Examination of the Necessarily Elements for Cosmetic Evaluation

• Nohara Y
• Hanamura N
• Zaha H
• Kimura H
• Kashikura
• Nakamura T
• Noro A
• Imai N
• Shibusawa
• Ogawa T

• KMID: 2286341
• DOI: http://doi.org/10.4048/jbc.2015.18.1.80

Abstract

PURPOSE
Although various strategies have been reported, there are no defined criteria for cosmetic evaluation methods after breast-conserving surgery (BCS). Since Asians tend to have smaller breasts, indistinct inframammary folds, and conspicuous scars, differences in the cosmetic results are expected. So we examined two subjective methods and one objective method to determine the differences, and elements necessary for a cosmetic evaluation after BCS.
METHODS
Frontal photographs of 190 Japanese were evaluated using the Harris scale (Harris) and the evaluation method proposed by the Japanese Breast Cancer Society Sawai group (Sawai group) as the subjective methods, and the Breast Cancer Conservation Treatment cosmetic results (BCCT.core) as the objective method, respectively. In order to examine the necessary elements for developing a new ideal method, 100 out of 190 were selected and assessed separately by six raters using both the Harris and modified Sawai group methods in the observer assessment. The correlation between the two methods was examined using the Spearman rank-correlation coefficient.
RESULTS
The results of the BCCT.core and the other two methods were clearly different. In the observer assessment, the consensuses of the six raters were evaluated as follows: 27, 27, 26, and 20 cases were evaluated as "excellent," "good," "fair," and "poor," respectively. For the Spearman rank-correlation coefficient, values higher than 0.7 indicated a strong correlation, as seen by the values of 0.909 for the breast shape and 0.345 for the scar. The breast shape accounted for the most significant part of the evaluation, and the scar had very little correlation.
CONCLUSION
In this study, we recognized a clear difference between the subjective and objective evaluation methods, and identified the necessary elements for cosmetic evaluation. We would like to continue developing an ideal cosmetic evaluation that is similar to subjective one and is independent from raters.

Keyword

Asian continental ancestry group; Esthetics; Outcome assessment; Segmental mastectomy

MeSH Terms

Asian Continental Ancestry Group*
Breast
Breast Neoplasms
Cicatrix
Consensus
Esthetics
Humans
Mastectomy, Segmental*

Figure

• 

  Figure 1 Cosmetic result by Breast Cancer Conservative Treatment cosmetic results (BCCT.core). (A) BCCT.core evaluated better than the others. This case was evaluated as "excellent" in BCCT.core and "fair" or "poor" in two other methods. (B) BCCT.core evaluated worse than the others. This case was evaluated as "fair" in BCCT.core and "excellent" or "good" in two other methods. (C) A no retraction case evaluated as "fair." This case was evaluated as "fair" in BCCT.core and "fair" or "poor" in two other methods.

• 

  Figure 2 Relationship between scores rated by items of modified Sawai group and evaluation results obtained from the consensus. (A) Relationship between breast size and consensus. (B) Relationship between breast shape and consensus. (C) Relationship between scar and consensus. (D) Relationship between nipple and areola size/shape and consensus. (E) Relationship between nipple and areola color tone and consensus. (F) Relationship between nipple position and consensus. (G) Relationship between position of the maximum descent point and consensus.

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