An updated systematic review of esthetic grading tools in postmastectomy breast reconstruction Journal Article


Authors: Stern, C.; Kim, L. N.; Plotsker, E.; Boyce, L.; Dayan, J.; Nelson, J. A.
Article Title: An updated systematic review of esthetic grading tools in postmastectomy breast reconstruction
Abstract: Background and Objectives: We ascertained whether a validated esthetic grading tool for breast reconstruction had been developed and widely adopted since the last published systematic review on the topic from 2015. Methods: We performed a systematic review identifying all studies using a grading tool to assess breast reconstruction, using search terms associated with all types of breast surgery and outcomes research. Articles were assessed for patient number, validated scale use, assessor type and training, assessor blinding, assessment method, scoring system type, type and timing of reconstruction, and usage of corroborating scales. Results: Of 2809 articles screened, 148 met the criteria. Only 3 used a validated tool, the Esthetic Items Scale. Most used study-only tools (n = 111) or unvalidated tools (n = 28). The most used unvalidated tool was the Garbay/Lowery 5-subscale rubric. Unanchored Likert scales were the most common subjective tool; two-dimensional images were the most used medium. Surgeons, patients, and nurses were the most common assessors. Twenty percent of studies used corroborating scales. Conclusions: In the absence of a validated esthetic grading tool for breast reconstruction, researchers continue to rely on unvalidated scales. The only validated scale available is used infrequently and only validated among physicians. A validated, reliable, simple grading tool with clinical and scholastic relevance is needed. © 2023 Wiley Periodicals LLC.
Keywords: adult; outcome assessment; mastectomy; breast neoplasms; breast reconstruction; mammaplasty; systematic review; breast tumor; surgeon; scoring system; outcomes research; physician; esthetics; breast surgery; nurse; procedures; humans; human; male; female; article; likert scale; outcome assessment, health care; esthetic grading tool
Journal Title: Journal of Surgical Oncology
Volume: 127
Issue: 5
ISSN: 0022-4790
Publisher: Wiley Blackwell  
Date Published: 2023-04-01
Start Page: 782
End Page: 790
Language: English
DOI: 10.1002/jso.27186
PUBMED: 36594965
PROVIDER: scopus
PMCID: PMC10006367
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: Carrie Stern -- Source: Scopus
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MSK Authors
  1. Carrie Stern
    46 Stern
  2. Joseph Henry Dayan
    101 Dayan
  3. Lindsay Marie Boyce
    18 Boyce
  4. Leslie Narae Kim
    12 Kim