# Crowdsourced Comparison of Aesthetic Outcomes of Traditional Transverse Versus Skin-Reducing Mastectomy Incision Patterns Following Implant-Based Breast Reconstruction

## TL;DR

This study compares the public's preference for two types of mastectomy incisions after breast reconstruction, finding that skin-reducing patterns are more aesthetically favored.

## Contribution

The study introduces a crowdsourced method to assess aesthetic outcomes of mastectomy incision patterns post-reconstruction.

## Key findings

- Skin-reducing mastectomy (SRM) incisions were rated more favorably than traditional transverse incisions across all categories.
- SRM patterns were particularly preferred in cases involving nipple-areolar complex reconstruction.
- Preferences were consistent regardless of respondents' age, gender, or healthcare experience.

## Abstract

Introduction

Advancements in reconstructive breast surgery have made postoperative cosmesis and patient satisfaction critical outcome measures. Skin-sparing mastectomy (SSM) incision patterns may be classified into the traditional transverse incision, or skin-reducing patterns. The aim of this study is to identify preferential trends among the public regarding aesthetic outcomes between incision patterns following implant-based breast reconstruction (IBBR).

Methods

Twelve patients who underwent IBBR following SSM were included, six with a transverse incision pattern, and six with skin-reducing mastectomy (SRM) patterns. Patients were matched for age, body mass index (BMI), American Society of Anesthesiology (ASA) physical status classification system, comorbidities, Regnault ptosis grade, and chemotherapy/radiation status. A survey was created via the Research Electronic Data Capture (RedCap) database to assess outcomes in seven categories: symmetry, volume, projection, shape, skin quality, scar pattern, and overall aesthetic rating. The survey was distributed via social media and the Amazon MTurk crowdsourcing platform.

Results

The survey collected 1,194 responses, predominantly from females under 40 years of age, with a balanced distribution of respondents with and without healthcare experience. Across all assessed categories, SRM patterns were rated more favorably than transverse incisions (p < 0.001). Notably, SRM patterns were preferred in scenarios involving nipple-areolar complex (NAC) reconstruction.

Conclusions

The SRM was found to be more aesthetically pleasing to the general public regardless of age, gender, or healthcare experience. These results should be considered when planning incision patterns for patients undergoing mastectomy.