“The PERFECT breast”: Measuring cosmetic outcomes after breast-conserving therapy

Abstract Background Measuring cosmetic outcome following breast-conserving therapy (BCT) is difficult. However, it is crucial to have an easy-to-use and reproducible method to record this outcome of BCT. We argue that breast cosmesis can be divided into a set of key cosmetic components that are easy to observe and score individually, and the total score synthesised from these component scores can reflect the overall cosmesis. Additionally, this system would also indicate the cause for the aesthetic deficiency. We report our experience using a cosmetic score based on six determinants of breast aesthetics, namely breast size, breast contour, vertical nipple position, horizontal nipple position, breast skin appearance, and scar appearance. Materials and Methods In this prospective study, our assessors scored 112 patients who had undergone BCT six or more months previously, by using our Total Cosmetic Score (TCS) instrument. An Overall Cosmetic Grade (OCG) of the breast was then compared against the TCS. Results We found a very good agreement between total aesthetic score and overall cosmetic grade. Conclusion A simple subscale based cosmetic scoring system is a practical method of documenting and rating the cosmetic outcome of BCT.