A breast shape symmetry score for reconstructive surgery outcomes: The next gold standard?

Abstract

Breast shape symmetry is an important measure to evaluate the aesthetic result of breast reconstruction results. These evaluations are often based on subjective measurements. The aim of this study was to create a standardized, easy-to-interpret breast shape symmetry scoring model. A development (n=50) and validation dataset (n=36) of 3D breast images were used. Each image was scored three times. First an average breast shape symmetry (1-10) was scored by plastic surgeons as the reference. Two scores were computed through two image analysis modules: curvature and shape-deviation. The shape symmetry scoring model was developed using multiple linear regression to create a model with these two models that would approach the reference scores best. The performance was assessed with the validation dataset using the two-way mixed intraclass correlation coefficient. The absolute mixed model intraclass correlation coefficient between the model's symmetry scores and mean symmetry score of the plastic surgeons for the validation dataset was 0.825 (p<0.001). The consistency intraclass correlation coefficient was 0.850 (p<0.001). The symmetry scoring model seems suitable for the evaluation of breast reconstruction outcomes in clinical practice. A larger dataset for validation is required to test the robustness of the model and facilitate larger-scale implementation.