An updated systematic review of esthetic grading tools in postmastectomy breast reconstruction
Carrie Stern and Leslie N. Kim contributed equally and should be viewed as cofirst authors.
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.
CONFLICTS OF INTEREST
Joseph Dayan, MD, is a paid consultant for Stryker and the Director of Welwaze Medical Corporation. The remaining authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The author has provided the required Data Availability Statement, and if applicable, included functional and accurate links to said data therein. The data that support the findings of this study are available from the corresponding author upon reasonable request.
