BREAST SPECIAL TOPIC Patient Self-Assessment of the Cosmetic Results of Breast Reconstruction William N. Andrade, M.D., Ph.D. John L. Semple, M.D., M.Sc. Toronto, Ontario, Canada Background: In a previous study, the authors evaluated factors that contribute to patient satisfaction with breast reconstruction, using a comprehensive chart review and questionnaire. The results of part of this questionnaire, regarding patients’ rating of the cosmetic result of their breast reconstruction, are presented in this article. Methods: The questionnaire was mailed to 267 patients, 214 questionnaires (80.1 percent) were returned, and 200 contained a response to the question rating the overall cosmetic outcome of breast reconstruction (Fig. 1). To conduct a statistical analysis, the data were collapsed into two smaller groups. An “excellent” or “good” result was considered a “favorable” outcome, while lower responses were “unfavor- able” outcomes. Results: The outcome was rated as excellent by 82 patients, good by 76 patients, fair by 31 patients, and poor by 11 patients. A significant association was found between overall cosmesis and breast size, shape, or scars. Conclusion: It should not be assumed that patients’ responses regarding satisfac- tion with reconstruction will reflect their specific feelings regarding cosmetic results. (Plast. Reconstr. Surg. 117: 44, 2006.) I n a previous study, 1 the authors evaluated factors that contribute to patient satisfaction with breast reconstruction, using a comprehensive chart re- view and questionnaire. Part of this questionnaire, which contained information regarding the patients’ rating of the cosmetic result of their breast recon- struction (Fig. 1), had not yet been published. With increasing involvement of patients in the decision- making process regarding breast reconstruction, it is important to understand the various factors that in- fluence cosmetic outcomes from the patient’s per- spective. Several studies have used self-reported over- all satisfaction with breast surgery as a surrogate measure of cosmesis, 2– 4 which may not be valid. Other investigations have had a relatively small sam- ple size or no statistical analysis, making firm conclu- sions difficult. 4–8 Details regarding the design of this study are pub- lished elsewhere. 1 The questions pertaining to breast cosmesis were derived from a previous investigation. 9 The questionnaire was mailed to 267 patients, 214 questionnaires (80.1 percent) were returned, and 200 contained a response to the question rating the overall cosmetic outcome of breast reconstruction (Fig. 1). The outcome was rated as excellent by 82 patients, good by 76 patients, fair by 31 patients, and poor by 11 patients. To conduct a statistical analysis, the data were collapsed into two smaller groups. An “excellent” or “good” result was considered a “favor- able” outcome, while lower responses were “unfavor- able” outcomes. Details of the statistical analysis are published elsewhere. 1 Briefly, for the statistical analy- sis of interval data, Student’s unpaired, two-sided t test was used. Contingency tables were constructed for the analysis of nominal data. Fisher’s exact test or the chi-square test was used. Infrequently, a question- naire had one or more unanswered questions, and certain questions did not pertain to all patients. For example, patients who never received nipple-areola reconstruction would have answered “not applicable” to questions regarding this aspect of their reconstruc- tion. In these cases, the results were tabulated based on the remaining data. As outlined in Table 1, the only clinical variables associated with cosmetic outcome were postoperative complications ( p = 0.007) and whether nipple-areola reconstruction was performed ( p = 0.005). A signif- icant association was found between overall cosmesis and breast size, shape, or scars (Fig. 2; p  0.0001). In contrast, there did not appear to be an association From the Division of Plastic Surgery, University of Toronto. Received for publication September 3, 2004; revised Novem- ber 10, 2004. Presented at the Annual Meeting of the Canadian Society of Plastic Surgeons, in Whistler, British Columbia, Canada, June 25 to 28, 2003. Copyright ©2005 by the American Society of Plastic Surgeons DOI: 10.1097/01.prs.0000186534.50094.ab www.plasreconsurg.org 44