[Reconstructing, but how to evaluate? A critical review of aesthetic tools in breast reconstruction]

This systematic review aims to evaluate the various tools used to clinically assess aesthetic outcomes following breast reconstruction (BR) after mastectomy. It builds upon the most recent synthesis published in 2015, in a context where post-breast cancer quality of life, particularly with regard to aesthetic results, has become a major concern.

The review was conducted following the PRISMA-COSMIN guidelines. A comprehensive search was carried out across PubMed, Elsevier, Web of Science, Springer, and Google Scholar databases for studies published between 2015 and 2025. Only studies focusing on objective tools used to evaluate aesthetic outcomes after breast reconstruction were included. The analysis was based on established methodological criteria, including conceptual framework, reliability, validity, interpretability, responsiveness, user burden, and concordance with patient perceptions.

Six articles met the inclusion criteria. While some tools demonstrated good reliability or convergent validity, none fully satisfied all methodological standards. Key aspects such as validity, responsiveness, and user burden were seldom assessed, and only a few tools showed strong concordance between professional assessments and patient-reported outcomes. The highest score among the tools reviewed was 4 out of 7.

Since 2015, several evaluation scales have been developed, but none meet all the essential criteria for optimal clinical application. There remains a need for a more rigorous, reliable, and patient-aligned tool for assessing aesthetic outcomes after mastectomy. Such a tool would facilitate more meaningful comparisons between surgical techniques and support shared decision-making focused on patient expectations.