title: Cosmetic evaluation methods adapted to asian patients after breast-conserving surgery and examination of the necessarily elements for cosmetic evaluation.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Nohara
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Hanamura
authors.affiliation: Department of Surgery, Nakagami Hospital, Okinawa, Japan.
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Zaha
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Kashikura
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Noro
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Imai
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Mai
authors.initials: M
authors.lastname: Shibusawa
authors.affiliation: Department of Breast Surgery, Mie University Hospital, Mie, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ogawa
keywords: Asian continental ancestry group; Esthetics; Outcome assessment; Segmental mastectomy
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