The literature provides limited predictive factors for an expected favourable cosmetic outcome in breast cancer patients opting for BCS. To objectively device a tailor-made treatment plan this study makes use of a prediction model [
10]. This study aims to provide level 1B evidence for the use of a preoperative prediction model for clinical decision making to improve cosmetic results in patients opting for BCS.
Following the inclusion of the first 30 patients (10%) the patients’ experiences tell us that the study is well accepted and appreciated. It is however of great importance that the study is discussed by the treating surgeon at the first or second consultation at the outpatient clinic. By the start of inclusion up to 40% of the approached patients declined participation. This was mainly based on too much burdening in the preoperative phase and an inadequate introduction of the study. If the treating surgeon introduces the study and explains the importance of the study in the preoperative phase the acceptance for participation is higher. With the allocation of multiple including centre’s in the region of Rotterdam the inclusion rate has adequately improved with an ongoing high acceptance of participating patients.
Preoperative assessment of patients’ quality of life and satisfaction with their breast is currently lacking in the literature available. Only few trials have combined postoperative cosmetic outcome measurements by panel or software with patient reported outcome measures (PROMs) [
21‐
23]. Especially an evaluation of cosmetic outcome through time following breast surgery is scarce [
21]. By preoperatively collecting aesthetics and PROMs a reliable understanding of the relationship between cosmetic results and self-image or quality of life is gained. Comparing overall health-related quality of life (EORTC-QLQ-C30/B23 and EQ-5D-5 L) and treatment- or surgery specific outcomes (BREAST-Q) gives a better understanding between overall and disease-specific quality of life [
16,
24,
25]. With this knowledge, future treatment decision making and cosmetic outcome evaluation can possibly be based on PROMs. To adequately study cosmetic outcome and their relationship to PROM’s, standardized, reproducible and easily available tools are needed [
18,
26]. Comparing two different panel evaluations within 68 patients following BCS our group found almost perfect inter- and intra-observer agreement. Interclass correlation coefficient showed
R = 0.93,
R = 0.9 respectively for the inter- and intra-observer agreement [unpublished data]. When comparing trials differences in panel evaluations found are based on panel size and the use of layperson versus experts [
23,
27,
28]. Moreover multiple and unstandardized questionnaires are used to obtain cosmetic outcome; making a comparison between different trials difficult. Based on previous recommendations of Cardoso et al. our current study uses a questionnaire concerning the different aspect of cosmetic outcome when evaluating the breast by panel members [
17]. The BCCT.core software is known to evaluate asymmetry, skin colour difference(s) and scar features based on the situation of two identical breasts [
29‐
31]. In line with previous literature our group found a moderate agreement (unpublished data) between panel and BCCT core evaluation [
22,
23]. An independent 6-member panel will therefore assess cosmetic outcome as our primary outcome. In summary this study aims to improve cosmetic outcome and quality of life through the implementation of a preoperative prediction model for breast cancer patients opting for BCS.