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.
Conflicts of Interest
Babak J. Mehrara is a consultant for PureTech Health and receives research funding from Regeneron. The other authors declare no conflicts of interest.
Open Research
Data Availability Statement
Data supporting the findings of this study are available from the corresponding author upon reasonable request.