title: The Rainbow Scale for Assessing Breast Ptosis: Validation of Three Different Views.
abstract: BACKGROUND
  Photographic scales have become an increasingly used tool in objectively assessing outcomes in aesthetic surgery. However, no online photographic scale for assessing breast ptosis has been developed yet that is readily available.
  
  
  OBJECTIVE
  This study was designed to validate the online Rainbow Scale for the assessment of breast ptosis for the anterior-posterior (AP), lateral, and oblique views.
  
  
  METHODS
  For the five grades of the Rainbow Scale format, standardized reference photographs were selected. Six plastic surgeons rated 15 photographs for each view three times. Intra- and inter-observer agreements were calculated by using the weighted kappa coefficient and differences in intra- and inter-observer agreements between the three views were assessed for statistical significance using the Kruskal-Wallis test.
  
  
  RESULTS
  The mean intra-observer agreements were 0.91 (range, 0.82-0.98) for the AP view, 0.88 (range, 0.77-1.00) for the oblique view, and 0.86 (range, 0.74-0.97) for the lateral view and did not vary significantly between all three views. The mean inter-observer agreements were 0.88 (range, 0.77-0.95) for the AP view, 0.84 (range, 0.72-0.94) for the oblique view, and 0.82 (range, 0.58-0.95) for the lateral view. The mean inter-observer agreements of the AP view varied significantly from the oblique view (P = .012) and the lateral view (P = .001).
  
  
  CONCLUSIONS
  The Rainbow Scale for breast ptosis has been validated for the AP view, the lateral view, and the oblique view and is reproducible and reliable for the assessment of breast ptosis in three different views in an online setup.
  
  
  METHODS
  4 Diagnostic.
authors.affiliation: Mr Eyck is a Student at the Faculty of Medicine, Erasmus University Rotterdam, the Netherlands. Mr van Dongen is a PhD candidate, Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands. Dr Athanassopoulos is a Locum Consultant Plastic Surgeon, Department of Burns and Plastic Surgery, University Hospitals of South Manchester, Manchester, UK. Dr Bastos Martins is a plastic surgeon in private practice, Lisbon, Portugal. Dr Stevens is a plastic surgeon in private practice, The Hague, the Netherlands.
authors.forename: Ben M
authors.initials: BM
authors.lastname: Eyck
authors.affiliation: Mr Eyck is a Student at the Faculty of Medicine, Erasmus University Rotterdam, the Netherlands. Mr van Dongen is a PhD candidate, Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands. Dr Athanassopoulos is a Locum Consultant Plastic Surgeon, Department of Burns and Plastic Surgery, University Hospitals of South Manchester, Manchester, UK. Dr Bastos Martins is a plastic surgeon in private practice, Lisbon, Portugal. Dr Stevens is a plastic surgeon in private practice, The Hague, the Netherlands.
authors.forename: Joris A
authors.initials: JA
authors.lastname: van Dongen
authors.affiliation: Mr Eyck is a Student at the Faculty of Medicine, Erasmus University Rotterdam, the Netherlands. Mr van Dongen is a PhD candidate, Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands. Dr Athanassopoulos is a Locum Consultant Plastic Surgeon, Department of Burns and Plastic Surgery, University Hospitals of South Manchester, Manchester, UK. Dr Bastos Martins is a plastic surgeon in private practice, Lisbon, Portugal. Dr Stevens is a plastic surgeon in private practice, The Hague, the Netherlands.
authors.forename: Thanassi
authors.initials: T
authors.lastname: Athanassopoulos
authors.affiliation: Mr Eyck is a Student at the Faculty of Medicine, Erasmus University Rotterdam, the Netherlands. Mr van Dongen is a PhD candidate, Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands. Dr Athanassopoulos is a Locum Consultant Plastic Surgeon, Department of Burns and Plastic Surgery, University Hospitals of South Manchester, Manchester, UK. Dr Bastos Martins is a plastic surgeon in private practice, Lisbon, Portugal. Dr Stevens is a plastic surgeon in private practice, The Hague, the Netherlands.
authors.forename: João
authors.initials: J
authors.lastname: Bastos Martins
authors.affiliation: Mr Eyck is a Student at the Faculty of Medicine, Erasmus University Rotterdam, the Netherlands. Mr van Dongen is a PhD candidate, Department of Plastic Surgery, University of Groningen and University Medical Centre Groningen, Groningen, the Netherlands. Dr Athanassopoulos is a Locum Consultant Plastic Surgeon, Department of Burns and Plastic Surgery, University Hospitals of South Manchester, Manchester, UK. Dr Bastos Martins is a plastic surgeon in private practice, Lisbon, Portugal. Dr Stevens is a plastic surgeon in private practice, The Hague, the Netherlands.
authors.forename: Hieronymus P
authors.initials: HP
authors.lastname: Stevens
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D010781:Photography