title: Quantifying the aesthetic outcomes of breast cancer treatment: assessment of surgical scars from clinical photographs.
abstract: BACKGROUND
  Accurate assessment of the degree of scaring that results from surgical intervention for breast cancer would enable more effective pre-operative counselling. The resultant scar that accompanies an open surgical intervention may be characterized by variance in thickness, colour and contour. These factors significantly impact the overall appearance of the breast. A number of studies have addressed the mechanical and pathologic aspects of scarring. The majority of these investigations have focused on the physiologic process of scar formation and means to improve the qualities of a scar. Few studies have focused on quantifying the visual impact of scars.
  
  
  METHODS
  This manuscript critically reviews current methods used to assess scars in terms of overall satisfaction after surgery. We introduce objective, quantitative measures for assessing linear breast surgical scars using digital photography. These new measurements of breast surgical scars are based on calculations of contrast and area.
  
  
  CONCLUSIONS
  We demonstrate, using the intra-class correlation coefficient, that the new measures are robust to observer variability in annotating the scar region on clinical photographs. As an example of the utility of the new measures, we use them to quantify the aesthetic differences of reconstruction following skin-sparing mastectomy vs. conventional mastectomy.
authors.affiliation: Department of Health Management and Informatics, University of Missouri School of Medicine, Columbia, Missouri, USA.
authors.forename: Min Soon
authors.initials: MS
authors.lastname: Kim
authors.forename: William N
authors.initials: WN
authors.lastname: Rodney
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Reece
authors.forename: Elisabeth K
authors.initials: EK
authors.lastname: Beahm
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Crosby
authors.forename: Mia K
authors.initials: MK
authors.lastname: Markey
mesh_terms: D001940:Breast; D001943:Breast Neoplasms / Q000601:surgery*; D002921:Cicatrix / Q000473:pathology*; D004954:Esthetics; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016462:Mammaplasty / Q000009:adverse effects* / Q000379:methods; D008408:Mastectomy / Q000009:adverse effects* / Q000379:methods; D015588:Observer Variation; D010781:Photography; D012189:Retrospective Studies