Comparing Breast Aesthetics Using a Novel Validated Breast Aesthetic Scale: Standard Breast-Conserving Surgery Versus Oncoplastic Techniques.

BACKGROUND AND METHODS: Oncoplastic breast surgery (BCS) has been associated with improved patient-reported satisfaction; however, objective comparisons with standard breast-conserving surgery remain limited. This study compared overall and domain-level aesthetic outcomes among standard lumpectomy, volume displacement, and volume replacement techniques using a validated observer-based Breast Aesthetic Scale. Standardized postoperative photographs from 12 patients were evaluated by 74 independent student observers across 13 domains. Mixed-effects regression modelled surgical technique as a fixed effect with rater as a random intercept. Šidák-adjusted pairwise comparisons and nonparametric tests were performed as sensitivity analyses. RESULTS: Surgical technique significantly influenced overall aesthetic outcomes (p < 0.001). Volume displacement demonstrated higher overall scores compared with partial mastectomy (mean difference +0.35, 95% CI: 0.30-0.40) and volume replacement (+0.15, 95% CI: 0.10-0.19). Volume replacement outperformed partial mastectomy (+0.20, 95% CI: 0.16-0.25); all p < 0.001. Domain analyses showed volume displacement scored highest in breast symmetry, nipple symmetry, and overall appearance, while lumpectomy scored highest in scar appearance. CONCLUSIONS: Volume displacement was associated with higher observer-rated aesthetic scores following BCS. DISCUSSION: Observer-based assessment may inform technique-specific counselling and future outcomes research.