title: Subjective versus objective assessment of breast reconstruction.
abstract: BACKGROUND
  To date breast assessment has been conducted mainly subjectively. However lately validated objective three-dimensional (3D) imaging was developed. The study aimed to assess breast reconstruction subjectively and objectively and conduct a comparison.
  
  
  METHODS
  In forty-four patients after immediate unilateral breast reconstruction with solely the extended latissimus dorsi flap the breast was captured by validated 3D imaging method and standardized 2D photography. Breast symmetry was subjectively evaluated by six experts who applied the Harris score giving a mark of 1-4 for a poor to excellent result. An error study was conducted by examination of the intra and inter-observer agreement and agreement on controls. By Procrustes analysis an objective asymmetry score was obtained and compared to the subjective assessment.
  
  
  RESULTS
  The subjective assessment showed that the inter-observer agreement was good or substantial (p-value: <0.0001). There was moderate agreement on the controls (p-value: <0.0001) and fair (p-values: 0.159, 0.134, 0.099) to substantial (p-value: 0.005) intra-observer agreement. The objective assessment revealed that the reconstructed breast showed a significantly smaller volume compared to the opposite side and that the average asymmetry score was 0.052, ranging from 0.019 to 0.136. When comparing the subjective and objective method the relationship between the two scores was highly significant.
  
  
  CONCLUSIONS
  Subjective breast assessment lacked accuracy and reproducibility. This was the first error study of subjective breast assessment versus an objective validated 3D imaging method based on true 3D parameters. The substantial agreement between established subjective breast assessment and new validated objective method supported the value of the later and we expect its future role to expand.
authors: Biotechnology and Craniofacial Sciences Research Group, Glasgow University, UK. h.henseler@btinternet.com
authors: Helga
authors: H
authors: Henseler
authors: Joanna
authors: J
authors: Smith
authors: Adrian
authors: A
authors: Bowman
authors: Balvinder S
authors: BS
authors: Khambay
authors: Xiangyang
authors: X
authors: Ju
authors: Ashraf
authors: A
authors: Ayoub
authors: Arup K
authors: AK
authors: Ray
mesh_terms: D001940:Breast / Q000601:surgery*; D004867:Equipment Design; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D016462:Mammaplasty / Q000379:methods*; D010781:Photography / Q000295:instrumentation*; D015203:Reproducibility of Results; D013524:Surgical Flaps