Improving the Evaluation of Aesthetic Outcomes in DIEP Flap Breast Reconstruction: Validation of the Aesthetic Grading Tool Journal Article
| Authors: | Stern, C. S.; Shammas, R. L.; Montes, E. S.; Boe, L. A.; Wang, J.; White, D.; Graziano, F. D.; Mehrara, B. J.; Allen, R. J.; Nelson, J. A. |
| Article Title: | Improving the Evaluation of Aesthetic Outcomes in DIEP Flap Breast Reconstruction: Validation of the Aesthetic Grading Tool |
| Abstract: | Introduction: This study aimed to develop and validate an aesthetic grading tool (AGT) for bilateral DIEP flap breast reconstruction and investigate the correlation of BREAST-Q scores with perceived aesthetic outcomes. Methods: The AGT utilized a Likert scale to rate aesthetic outcomes based on photographs of post-reconstruction breasts. The validation involved iterative testing with healthcare providers and patients. A two-way mixed effects model estimated the intraclass correlation coefficients (ICC) to assess intra-rater and inter-rater reliability. Pearson Correlation Coefficients explored the relationship between aesthetic ratings and BREAST-Q Satisfaction with Breasts scores. Results: The AGT demonstrated substantial intra-rater reliability (ICC = 0.74, 95% CI: 0.64–0.79) and moderate to very strong inter-rater reliability across respondents after iterative revisions (ICC = 0.75, 95% CI: 0.59–0.91). Pearson Correlation analysis revealed no significant relationship between AGT scores and BREAST-Q scores when surveying healthcare providers (mean = 0.145, 95% CI: [−0.35, 0.32], p = 0.94) (median = 0.06, 95% CI: [−0.28, 0.87], p = 0.73) or patients (mean = 0.15, 95% CI: [−0.19, 0.46], p = 0.41) (median = 0.17, 95% CI: [−0.17, 0.48], p = 0.32). Conclusion: The AGT provides a validated, reliable measure for assessing aesthetic outcomes in bilateral DIEP flap reconstruction. The lack of correlation with BREAST-Q scores indicates that BREAST-Q may not be a reliable proxy for assessing aesthetic outcomes. © 2024 Wiley Periodicals LLC. |
| Keywords: | adult; controlled study; major clinical study; breast reconstruction; correlation analysis; correlation coefficient; diagnosis; health care personnel; esthetics; deep inferior epigastric perforator flap; photography; interrater reliability; intrarater reliability; shared decision making; shared decision-making; scale; breast-q; human; female; article; likert scale; aesthetics; grading tool |
| Journal Title: | Journal of Surgical Oncology |
| Volume: | 131 |
| Issue: | 7 |
| ISSN: | 0022-4790 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2025-01-01 |
| Start Page: | 1407 |
| End Page: | 1412 |
| Language: | English |
| DOI: | 10.1002/jso.28066 |
| PUBMED: | 39737736 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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