title: Systematic Review: Aesthetic Assessment of Breast Reconstruction Outcomes by Healthcare Professionals.
abstract: BACKGROUND
  Achieving an aesthetic outcome following postmastectomy breast reconstruction is both an important goal for the patient and plastic surgeon. However, there is currently an absence of a widely accepted, standardized, and validated professional aesthetic assessment scale following postmastectomy breast reconstruction.
  
  
  METHODS
  A systematic review was performed to identify all articles that provided professional assessment of the aesthetic outcome following postmastectomy, implant- or autologous tissue-based breast reconstruction. A modified version of the Scientific Advisory Committee's Medical Outcomes Trust (MOT) criteria was used to evaluate all professional aesthetic assessment scales identified by our systematic review. The criteria included conceptual framework formation, reliability, validity, responsiveness, interpretability, burden, and correlation with patient-reported outcomes.
  
  
  RESULTS
  A total of 120 articles were identified: 52 described autologous breast reconstruction, 37 implant-based reconstruction, and 29 both. Of the 12 different professional aesthetic assessment scales that exist in the literature, the most commonly used scale was the four-point professional aesthetic assessment scale. The highest score on the modified MOT criteria was assigned to the ten-point professional aesthetic assessment scale. However, this scale has limited clinical usefulness due to its poor responsiveness to change, lack of interpretability, and wide range of intra- and inter-rater agreements (Veiga et al. in Ann Plast Surg 48(5):515-520, 2002).
  
  
  CONCLUSIONS
  A "gold standard" professional aesthetic assessment scale needs to be developed to enhance the comparability of breast reconstruction results across techniques, surgeons, and studies to aid with the selection of procedures that produce the best aesthetic results from both the perspectives of the surgeon and patients.
authors.affiliation: Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada.|Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Saskia W M C
authors.initials: SW
authors.lastname: Maass
authors.affiliation: Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada.|Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Shaghayegh
authors.initials: S
authors.lastname: Bagher
authors.affiliation: Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada.|Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Stefan O P
authors.initials: SO
authors.lastname: Hofer
authors.affiliation: Departments of Surgery and Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.|The Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.affiliation: Division of Plastic & Reconstructive Surgery, Department of Surgery and Surgical Oncology, University Health Network, Toronto, ON, Canada. toni.zhong@uhn.ca.|Division of Plastic & Reconstructive Surgery, University of Toronto, Toronto, ON, Canada. toni.zhong@uhn.ca.|Department of Surgery, University of Toronto, Toronto, ON, Canada. toni.zhong@uhn.ca.
authors.forename: Toni
authors.initials: T
authors.lastname: Zhong
mesh_terms: D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction