A scoring system for 3D surface images of breast reconstruction developed using the Delphi consensus process

Amy R Godden, Simon H Wood, Stuart E James, Fiona A MacNeill, Jennifer E Rusby, Amy R Godden, Simon H Wood, Stuart E James, Fiona A MacNeill, Jennifer E Rusby

Abstract

Introduction: Evaluation of aesthetics after breast reconstruction is challenging. In the absence of an objective measurement, panel assessment is widely adopted. Heterogeneity of scales and poor internal consistency make comparison difficult. Development and validation of an expert panel scale using a Delphi consensus process is described. It was designed specifically for use as the gold standard for development of an objective evaluation tool using 3-Dimensional Surface Imaging (3D-SI).

Materials and methods: 20 items relating to aesthetic assessment were identified for consideration in the Delphi consensus process. Items were selected for inclusion in the definitive panel scale by iterative rounds of voting according to importance, consensus discussion, and a final vote. The Delphi-derived scale was tested on a clinical research series for intra- and inter-panellist, and intra-panel reliability, and correlation with Patient Reported Outcome Measures (PROMs).

Results: 61 surgeons participated in the Delphi process. Oncoplastic and plastic surgeons were represented. The Delphi-derived scale included symmetry, volume, shape, position of breast mound, nipple position, and a global score. Intra-panellist reliability ranged from poor to almost perfect (wκ<0to0.86), inter-rater reliability was fair (ICC range 0.4-0.5) for individual items and good (ICC0.6) for the global score, intra-panel reliability was moderate to substantial (wκ0.4-0.7), and correlation with PROMs was moderate (r = 0.5p < 0.01).

Conclusions: The Delphi-derived panel evaluation is at least as good as other scales in the literature and has been developed specifically to provide expert evaluation of aesthetics after breast reconstruction. The logistical constraints of panel assessment remain, reinforcing the need to develop an objective evaluation method.

Trial registration: ClinicalTrials.gov NCT03203252.

Keywords: Aesthetic/reconstruction/breast/cancer.

Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.

Figures

Fig. 1
Fig. 1
Standardised views of 3D-SIs viewed by the panel including Antero-posterior (AP), Oblique (left and right), Lateral (left and right), cranial, and caudal.
Fig. 2
Fig. 2
The Delphi consensus process.

References

    1. Al-Ghazal S.K., Sully L., Fallowfield L., Blamey R.W. The psychological impact of immediate rather than delayed breast reconstruction. Eur J Surg Oncol. 2000;26(1):17–19.
    1. Waljee J.F., Hu E.S., Ubel P.A., Smith D.M., Newman L.A., Alderman A.K. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26(20):3331–3337.
    1. Evans A.A., Straker V.F., Rainsbury R.M. Breast reconstruction at a district general hospital. J R Soc Med. 1993;86(11):630–633.
    1. Ringberg A., Tengrup I., Aspegren K., Palmer B. Immediate breast reconstruction after mastectomy for cancer. Eur J Surg Oncol. 1999;25(5):470–476.
    1. Reaby L.L., Hort L.K., Vandervord J. Body image, self concept, and self-esteem in women who had a mastectomy and either wore an external breast prosthesis or had breast reconstruction and women who had not experienced mastectomy. Health Care Women Int. 1994;15:361–375.
    1. Kim M.K., Kim T., Moon H.G. Effect of cosmetic outcome on quality of life after breast cancer surgery. Eur J Surg Oncol : J. Eur. Soc. Surg Oncol. Br. Assoc. Surg Oncol. 2015;41(3):426–432.
    1. Kim K.-D., Kim Z., Kuk J.C. Long-term results of oncoplastic breast surgery with latissimus dorsi flap reconstruction: a pilot study of the objective cosmetic results and patient reported outcome. Ann. Surg. Treat. Res. 2016;90(3):117–123.
    1. Jeevan R., Cromwell D.A., Browne J.P. Findings of a national comparative audit of mastectomy and breast reconstruction surgery in England. J Plast Reconstr Aesthetic Surg. 2014;67(10):1333–1344.
    1. Cancer Research Uk Breast cancer incidence statistics. Available at:
    1. National Institute for Clinical Excellence . 2002. Guidance on cancer services. Improving outcomes in breast cancer emanual update.
    1. Mennie J.C., Mohanna P.N., O'Donoghue J.M., Rainsbury R., Cromwell D.A. National trends in immediate and delayed post-mastectomy reconstruction procedures in England: a seven-year population-based cohort study. Eur J Surg Oncol. 2017;43(1):52–61.
    1. Maass S.W., Bagher S., Hofer S.O., Baxter N.N., Zhong T. Systematic review: aesthetic assessment of breast reconstruction outcomes by healthcare professionals. Ann Surg Oncol. 2015;22(13):4305–4316.
    1. Potter S., Harcourt D., Cawthorn S. Assessment of cosmesis after breast reconstruction surgery: a systematic review. Ann Surg Oncol. 2011;18(3):813–823.
    1. O'Connell R.L., Di Micco R., Khabra K. Comparison of immediate versus delayed DIEP flap reconstruction in women who require postmastectomy radiotherapy. Plast Reconstr Surg. 2018;142(3):594–605.
    1. O'Connell R.L., DiMicco R., Khabra K. Initial experience of the BREAST-Q breast-conserving therapy module. Breast Canc Res Treat. 2016;160(1):79–89.
    1. O'Connell R.L., Stevens R.J., Harris P.A., Rusby J.E. Review of three-dimensional (3D) surface imaging for oncoplastic, reconstructive and aesthetic breast surgery. Breast. 2015;24(4):331–342.
    1. Heil J., Dahlkamp J., Golatta M. Aesthetics in breast conserving therapy: do objectively measured results match patients' evaluations? Ann Surg Oncol. 2011;18(1):134–138.
    1. Merie R., Browne L., Cardoso J.S. Proposal for a gold standard for cosmetic evaluation after breast conserving therapy: results from the St George and Wollongong Breast Boost trial. Journal of medical imaging and radiation oncology. 2017;61(6):819–825.
    1. Boyages J., Barraclough B., Middledorp J., Gorman D., Langlands A.O. Early breast cancer: cosmetic and functional results after treatment by conservative techniques. Aust N Z J Surg. 1988;58(2):111–121.
    1. Beesley H, Ullmer H Fau - Holcombe C, Holcombe C Fau - Salmon P, Salmon P. How patients evaluate breast reconstruction after mastectomy, and why their evaluation often differs from that of their clinicians. (1878-0539 (Electronic)).
    1. Hirst A, Philippou Y, Blazeby J, et al. No surgical innovation without evaluation: evolution and further development of the IDEAL framework and recommendations. (1528-1140 (Electronic)).
    1. McCulloch P., Altman D.G., Campbell W.B. No surgical innovation without evaluation: the IDEAL recommendations. Lancet. 2009;374(9695):1105–1112.
    1. Mylvaganam S., Conroy E.J., Williamson P.R. Adherence to best practice consensus guidelines for implant-based breast reconstruction: results from the iBRA national practice questionnaire survey. Eur J Surg Oncol : J. Eur. Soc. Surg Oncol. Br. Assoc. Surg Oncol. 2018;44(5):708–716.
    1. Hasson F., Keeney S., McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000;32(4):1008–1015.
    1. Cicchetti D. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instrument in psychology. Psychol Assess. 1994;6:284–290.
    1. Cortina J.M. What is coefficient alpha? An examination of theory and applications. J Appl Psychol. 1993;78:98–104.
    1. Hinkle D.E., Wiersma W., Jurs S.G. fifth ed. Houghton Mifflin; Boston: 2003. Applied statistics for the behavioral sciences.
    1. Visser N.J., Damen T.H., Timman R., Hofer S.O., Mureau M.A. Surgical results, aesthetic outcome, and patient satisfaction after microsurgical autologous breast reconstruction following failed implant reconstruction. Plast Reconstr Surg. 2010;126(1):26–36.
    1. Vrieling C., Collette L., Bartelink E. Validation of the methods of cosmetic assessment after breast-conserving therapy in the EORTC "boost versus no boost" trial. EORTC radiotherapy and breast cancer cooperative groups. European organization for research and treatment of cancer. Int J Radiat Oncol Biol Phys. 1999;45(3):667–676.
    1. Potter S., Thomson H.J., Beresford M. Evaluating the cosmetic outcome of breast reconstruction: a comparison of patients' and healthcare professionals' views and their associations with patient satisfaction and quality of life. Canc Res. 2009;69(2)
    1. Haekens CM, Enajat M Fau - Keymeulen K., Keymeulen K Fau - Van der Hulst RRWJ, Van der Hulst RR. Self-esteem and patients' satisfaction after deep inferior epigastric perforator flap breast reconstruction. (1550-1841 (Electronic)).
    1. Ramon Y., Ullmann Y., Moscona R. Aesthetic results and patient satisfaction with immediate breast reconstruction using tissue expansion: a follow-up study. Plast Reconstr Surg. 1997;99(3):686–691.

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