The cosmetic outcome of breast reconstruction: reproducibility of different methods assessed by different professionals

Abstract

Objetivo: Comparar a reprodutibilidade de métodos diferentes de avaliação dos resultados estéticos de cirurgias reconstrutivas da mama, por avaliadores distintos. Métodos: Foram incluídas fotografias de 270 pacientes portadoras de neoplasia da mama que passaram por cirurgias reconstrutivas da mama. As notas da avaliação foram dadas por um cirurgião plástico, um residente em cirurgia plástica, dois mastologistas, dois residentes em mastologia e dois psicólogos. Foram utilizadas as escalas de Harvard e Garbay modificada e a nota objetiva do programa BCCT.core. Foram calculados os índice Kappa de concordância interobservador e de correlação de Spearman. Resultados: A média de idade das pacientes foi de 55,7 anos (±11,1). No geral, 145 (53,7%) mulheres foram submetidas a tratamento conservador com cirurgia oncoplástica e 125 (46,3%) passaram por mastectomia e reconstrução total. A média de tempo de seguimento foi de 63,7±45,6 meses. Para a escala de Harvard, houve uma reprodutibilidade interobservador razoável para os diferentes profissionais, enquanto na escala de Garbay, a reprodutibilidade foi pobre entre os profissionais. De forma geral, a nota dada pelo programa BCCT.core correlacionou-se moderadamente com a escala de Harvard e a de Garbay modificada. Conclusão: As escalas de Harvard e de Garbay modificada correlacionam-se igualmente de forma moderada com o teste objetivo (BCCT.core). A escala de Harvard tem menor variabilidade interobservador, se comparada com a escala de Garbay.PALAVRAS-CHAVE: neoplasias da mama; procedimentos cirúrgicos reconstrutivos; cirurgia plástica. RESUMO ABSTRACTObjective: To compare the reproducibility of different methods for assessing the cosmetic outcome of breast reconstruction, which was assessed by different health professionals. Methods: Photographs of 270 breast cancer patients who had been submitted to breast reconstruction of some type were included. A plastic surgeon, a resident in plastic surgery, two mastologists, two residents in mastology, and two psychologists performed the evaluation. The modified Garbay and Harvard scales and the objective BCCT. core software program were used. Cohen's Kappa and Spearman correlation coefficients were calculated. Results: The mean age of the patients was 55.7 (±11.1) years. Overall, 145 women (53.7%) underwent partial breast reconstruction and 125 (46.3%), total breast reconstruction. The mean follow-up time was 63.7±45.6 months. By applying the Harvard scale, the interobserver reproducibility among the different professionals was minimal; whereas the Garbay scale had no agreement. The correlations between the BCCT.core software program and the Harvard and modified Garbay scales were moderate. Conclusion: Correlations between both the modified Garbay scale and the Harvard scale and the objective (BCCT.core) test were moderate. There was less interobserver variability with the Harvard scale compared to the modified Garbay scale.

Dermoglandular advancement-rotation flap for conservative treatment of breast cancer – description of technique, objective and subjective assessments

“…All patients were assessed using photographs taken in the pre-operative, initial post-operative (6-15 days after surgery) and late post-operative (at least 30 days after the end of radiotherapy) stages. The aesthetic results particularly with regards to symmetry were assessed by two mastologists and a plastic surgeon, and rated by them using the Harvard scale in Excelent: when the operated breast is very similiar to the contralateral breast, Good: when the operated breast presents small differences compared to the contralateral breast, Fair: when the operated breast presentes a clear difference, but without serious distortion or Poor: when the operated breast presentes serious distortions when compared with contralateral breast ( 17 ). Patients were also requested to rate their results using the same scale.…”

Patient satisfaction among patients who underwent mastectomy and immediate breast reconstruction with silicone implants in an oncology hospital

“…Validated questionnaires are considered as appropriate methods to study outcome satisfaction after a treatment. International analyses with questionnaires and platforms have been developed to assess the acceptance and level of satisfaction of breast reconstructive surgeries, both from the functional and selfesteem points of view 2,6 .…”