Prioritizing Native Breast Skin Preservation or Scar Symmetry in Autologous Breast Reconstruction? Using...

Area of Science:

• Plastic Surgery
• Aesthetic Medicine
• Microsurgery

Background:

• Patient satisfaction in plastic surgery is influenced by public beauty standards.
• Previous studies indicate scar symmetry and skin paddle size are key factors in autologous breast reconstruction preferences.
• The relative importance of scar symmetry versus native skin preservation requires further investigation.

Purpose of the Study:

• To evaluate laypeople's aesthetic preferences for bilateral autologous breast reconstructions.
• To determine the importance of scar symmetry, skin paddle size, and native skin preservation.
• To utilize a novel crowdsourcing method to assess public opinion on reconstruction aesthetics.

Main Methods:

• A crowdsourcing approach using Amazon's Mechanical Turk.
• Participants ranked digitally modified images of 4 reconstruction types: immediate (IR), delayed symmetric (DS), delayed asymmetric (DA), and mixed (MR).
• Aesthetic evaluations included overall appearance, skin quality, scar visibility/position, and breast symmetry, shape, and position.

Main Results:

• Delayed symmetric (DS) reconstructions were ranked most favorably, followed by immediate (IR), delayed asymmetric (DA), and mixed (MR).
• Statistically significant differences were found between all 4 reconstruction types.
• Immediate (IR) reconstructions received higher ratings than delayed asymmetric (DA) for skin quality, scar characteristics, and breast aesthetics. Nipple-areolar-complex reconstruction improved all aesthetic factors.

Conclusions:

• Symmetric breast scars are rated more aesthetically pleasing than asymmetric ones.
• Maintenance of scar symmetry is preferred over preservation of native breast skin.
• Crowdsourcing is a viable method for understanding public aesthetic preferences in plastic surgery.