The aesthetic implication of scar position in breast reconstruction

In these enlightened times of patient involvement in operative planning, the patient has a much greater input into procedure selection, especially where several options are available. Breast reconstruction is a prime example of combined decision making, although options are still limited by pre-existing scars and previous treatment. In this study we eliminated all variables of reconstruction except the resulting scar pattern in an attempt to discover what was most acceptable to the patient. Various postoperative results, such as single scars and flaps, were mimicked unilaterally and bilaterally by drawing them on the same live subject. These photographic images were then formulated into a questionnaire and distributed to various female groups for scoring. Results show a preference for single-line horizontal scars in unilateral and bilateral reconstructions; scars that encroached the upper medial quadrant scored less well. The preferred flap reconstruction is also positioned horizontally, but in the lower pole. Overall, the preferred reconstruction in all groups was a single unilateral horizontal scar.