title: Evaluation of outcome after immediate breast reconstruction: prospective comparison of four methods.
abstract: BACKGROUND
  Little is known about the association among different methods to assess outcome following breast reconstruction. The aim of this study was to comprehensively compare four distinct methods of outcome evaluation following immediate breast reconstruction.
  
  
  METHODS
  There were 102 women who were prospectively evaluated: 46 patients had submuscular implants, and 56 patients had implant-assisted latissimus dorsi breast reconstruction. The mean patient age at the time of operation was 46 years (range, 22 to 72 years), with a mean follow-up of 18 months (range, 12 to 24 months). All patients were evaluated using geometric measurements, photographs, linear analogue scores, and a quality-of-life questionnaire. The Wilcoxon signed rank test, Spearman's correlation, and factor analysis statistics were used.
  
  
  RESULTS
  Transverse breast width, vertical breast height, sternal notch-nipple, midclavicular line-nipple, nipple-inframammary crease, midline-nipple, internipple, and intermammary measurements were reproducible and reliable. Median differences of absolute vertical and horizontal differences were less than 1 cm and were associated with high levels of patient satisfaction. Assessors asked to score photographs without being specifically requested to consider shape, cleavage, or symmetry would focus mainly on vertical and horizontal differences. There was a high correlation between surgeon and patient linear analogue scores. Quality-of-life questionnaires provide valuable information on body image, physical effects, and continued cancer worry. Factor analyses failed to identify components to compress data fields to obtain equivalent information from fewer questions.
  
  
  CONCLUSIONS
  Evaluation of immediate breast reconstruction is complex. Cumbersome data collection has to be balanced against practical variables that individual units can collect to evaluate outcome for audit and research.
authors.affiliation: Academic Surgery, The Royal Marsden Hospital NHS Trust, London, United Kingdom. gerald.gui@rmh.nthames.nhs.uk
authors.forename: Gerald P H
authors.initials: GP
authors.lastname: Gui
authors.forename: Geeta
authors.initials: G
authors.lastname: Kadayaprath
authors.forename: Su-Ming
authors.initials: SM
authors.lastname: Tan
authors.forename: Eleni C
authors.initials: EC
authors.lastname: Faliakou
authors.forename: Christina
authors.initials: C
authors.lastname: Choy
authors.forename: Roger
authors.initials: R
authors.lastname: A'Hern
authors.forename: Ann
authors.initials: A
authors.lastname: Ward
mesh_terms: D000328:Adult; D000368:Aged; D019928:Breast Implantation; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000523:psychology; D008875:Middle Aged; D015588:Observer Variation; D017063:Outcome Assessment, Health Care / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life