Objective assessment of aesthetic outcomes of breast cancer treatment: quantifying aesthetic factors after breast reconstruction

Breast cancer is the most common cancer among American women. One in eight women will be diagnosed with breast cancer during her lifetime. Essentially all breast cancer treatment involves surgery. The two most generally performed surgical treatments for breast cancer are breast conservation therapy and mastectomy followed by breast reconstruction. Breast reconstructive surgery is an important component of the breast cancer treatment process. The aesthetic outcome of breast cancer treatment is a critical factor in breast cancer survivors' quality of life. Aesthetics is a general term that refers to physical characteristics such as symmetry and proportion. Currently, physicians, patients, or other observers evaluate breast aesthetics in a subjective, qualitative manner. However, such assessments are typically based on vaguely defined rating scales that have low intra- and inter-observer agreement. Their qualitative nature also restricts the analyses that can be performed. Quantitative, objective measures with high reliability are needed to meaningfully relate patient and surgical variables to aesthetic outcomes and to compare the outcomes of different kinds of breast cancer treatments (e.g., reconstruction procedures). I postulated that quantitative measures of breast aesthetic properties can be designed using clinical photographs. In this dissertation, I have designed algorithms to compute objective, quantitative, reproducible measures of breast aesthetics. I have evaluated the algorithms for computing objective measures of breast aesthetic properties such as ptosis and surgical scars from clinical photographs. A preliminary observer rating scale of 11 symmetry ratings items, 14 individual breast ratings items, and a global rating on overall appearance before and after the entire rating items was proposed. Eye-tracking technology was used to understand how plastic surgeons assess breast aesthetics by recording their gaze path while they rate breast anatomy on clinical photographs. In addition to these design and evaluation tasks, I also have used the objective measures to conduct a preliminary comparison of the aesthetic outcomes of different reconstruction procedures.