title: Breast Augmentation and Breast Reconstruction Demonstrate Equivalent Aesthetic Outcomes.
abstract: BACKGROUND
  There is a perception that cosmetic breast surgery has more favorable aesthetic outcomes than reconstructive breast surgery. We tested this hypothesis by comparing aesthetic outcomes after breast augmentation and reconstruction.
  
  
  METHODS
  Postoperative images of 10 patients (cosmetic, n = 4; reconstructive, n = 6; mean follow-up, 27 months) were presented anonymously to participants who were blinded to clinical details. Participants were asked if they believed cosmetic or reconstructive surgery had been performed. Aesthetic outcome measures were quantified: (1) natural appearance, (2) size, (3) contour, (4) symmetry, (5) position of breasts, (6) position of nipples, (7) scars (1 = poor and 4 = excellent). Images were ranked from 1 (most aesthetic) to 10 (least aesthetic). Analyses included two-tailed t tests, Mann-Whitney U tests, and χ(2) tests.
  
  
  RESULTS
  One thousand eighty-five images were quantified from 110 surveys (99% response rate). The accuracy of identifying cosmetic or reconstructive surgery was 55% and 59%, respectively (P = 0.18). Significantly more of the top 3 aesthetic cases were reconstructive (51% vs 49%; P = 0.03). Despite this, cases perceived to be reconstructive were ranked significantly lower (5.9 vs 5.0; P < 0.0001). Mean aesthetic outcomes were equivalent regardless of surgery for 5 categories (P > 0.05), with the exception of breast position that improved after reconstruction (2.9 vs 2.7; P = 0.009) and scars that were more favorable after augmentation (2.9 vs 3.1; P < 0.0001). Age and nipple position (R (2) = 0.04; P = 0.03) was the only association between a demographic factor and aesthetic outcome.
  
  
  CONCLUSIONS
  Aesthetic outcomes after cosmetic and reconstructive breast surgery are broadly equivalent, though preconceptions influence aesthetic opinion. Plastic surgeons' mutually inclusive-reconstructive and aesthetic skill set maximizes aesthetic outcomes.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, Calif.; and Division of Plastic and Reconstructive Surgery, Royal Free Hospital NHS Trust, London, United Kingdom.
authors.forename: Danielle H
authors.initials: DH
authors.lastname: Rochlin
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, Calif.; and Division of Plastic and Reconstructive Surgery, Royal Free Hospital NHS Trust, London, United Kingdom.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Davis
authors.affiliation: Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Palo Alto, Calif.; and Division of Plastic and Reconstructive Surgery, Royal Free Hospital NHS Trust, London, United Kingdom.
authors.forename: Dung H
authors.initials: DH
authors.lastname: Nguyen