Methods: A 9-item instrument was developed with emphasis on those criteria that are specifically affected by the particular procedure performed. The criteria include vertical positioning, horizontal positioning, defects, projection, shape, inframammary fold, medial contour, overall appearance, and overall satisfaction. The instrument utilized a 4- to 7-point scale on each sub-item. Thirty-six patients who had previously undergone autologous breast reconstruction completed the instrument on two occasions, one month apart.

Results: Test-retest reliability analysis demonstrated a "good to excellent" range for each criterion (weighted kappa 0.53 - 0.87) and a lower reproducibility for the overall satisfaction item (weighted kappa of 0.46). The instrument's internal consistency was high when assessed both for the entire nine-item scale (Chronbach's alpha=0.92). Most individual criteria correlated well with the overall appearance score (Spearman's rho 0.61 - 0.80), with slightly lower correlations for the vertical and horizontal positioning and the inframammary fold items (rho 0.55 - 0.58). Correlations between individual criteria and patient satisfaction were weaker for horizontal positioning, defects, projection, and inframammary fold (rho 0.47 - 0.59), and good for vertical positioning, shape, and medial contour (rho 0.64 - 0.80). High correlation was found between the and overall appearance and overall satisfaction (rho=0.81).

Conclusions: We have developed a reproducible and internally consistent scale that can be used by patients to assess the subtle and specific aspects of their own reconstruction appearance. The survey instrument shows good to excellent test-retest reliability as well as correlation between the individual criteria and the patient's overall satisfaction and judgement of overall appearance. Application of this instrument to a large cohort of patients will allow a prioritization of the criteria. By learning which criteria are most important in determining overall patient satisfaction, surgeons will then be able to choose the reconstructive procedures most likely to positively impact these criteria.