Standardizing Aesthetic Outcomes in Breast Reconstruction: Applicability of a Validated Scale in Mexico

Breast reconstruction after mastectomy is a key component of the physical and emotional rehabilitation of breast cancer patients. Objective assessment of aesthetic outcomes is essential to determine the quality of reconstructive procedures. The aim of this study was to evaluate the aesthetic outcomes of patients undergoing breast reconstruction using the Validated Breast Aesthetic Scale and to analyze their association with clinical and surgical variables.

An observational, retrospective, cross-sectional study was conducted at the Specialty Hospital No. 71 of the Mexican Social Security Institute (IMSS) including patients who underwent breast reconstruction between 2019 and 2023. A total of 30 reconstructions in 28 patients were assessed using the 13-item Validated Breast Aesthetic Scale. Evaluations were performed by two board-certified plastic surgeons and one senior resident. Clinical and surgical variables were analyzed, and interobserver reliability was calculated using the intraclass correlation coefficient (ICC).

The median overall aesthetic score was 54 (IQR 48-56), with most items scoring ≥ 4. The highest scores were obtained for breast volume and position, whereas the lowest score corresponded to nipple-areola complex color. The ICC exceeded 0.8 for most items, indicating high interobserver reliability. The TRAM flap was the most frequently used technique (42.9%), and 96.4% of reconstructions were performed in the delayed setting.

The validated aesthetic scale proved to be a useful and reliable tool for objectively assessing outcomes in breast reconstruction. Overall favorable aesthetic results were observed, particularly in reconstructions with abdominal flaps. Systematic implementation of this tool may contribute to standardizing aesthetic evaluation and guiding improved outcomes in surgical practice.

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