Towards quantifying the aesthetic outcomes of breast cancer treatment: comparison of clinical photography and colorimetry

Abstract

Rationale, aims and objectives: Scarring is a significant cause of dissatisfaction for women who undergo breast surgery. Scar tissue may be clinically distinguished from normal skin by aberrant colour, rough surface texture, increased thickness (hypertrophy) and firmness. Colorimeters or spectrophotometers can be used to quantitatively assess scar colour, but they require direct patient interaction and can cost thousands of dollars. By comparison, digital photography is already in widespread use to document clinical outcomes and requires less patient interaction. Thus, assessment of scar coloration by digital photography is an attractive alternative. The goal of this study was to compare colour measurements obtained by digital photography and colorimetry.

Methods: Agreements between photographic and colorimetric measurements of colour were evaluated. Experimental conditions were controlled by performing measurements on artificial scars created by a make-up artist. The colorimetric measurements of the artificial scars were compared with those reported in the literature for real scars in order to confirm the validity of this approach. We assessed the agreement between the colorimetric and photographic measurements of colour using a hypothesis test for equivalence, the intraclass correlation coefficient and the Bland-Altman method.

Results: Overall, good agreement was obtained for three parameters (L*a*b*) measured by colorimetry and photography from the results of three statistical analyses.

Conclusion: Colour measurements obtained by digital photography were equivalent to those obtained using colorimetry. Thus, digital photography is a reliable, cost-effective measurement method of skin colour and should be further investigated for quantitative analysis of surgical outcomes.

Figure 1

2D image of Scar A1 on Model A. The scars created for Model A resemble normal scars that are typically seen 3 to 6 months after breast reconstruction surgery with either LD or TRAM flap. No donor site scar was created in this study. Scar A1 was created on left breast around the nipple-areola complex (NAC) with incision running into the low superior lateral area. Scars were created by adding base color and top color makeup on the base of either latex or rigid collodion or combination of these.

Figure 2

2D image of scar A2 on Model A. The scars created for Model A resemble normal scars that are typically seen 3 to 6 months after breast reconstruction surgery with either LD or TRAM flap. No donor site scar was created in this study. The scar was expanded around the nipple area into the medial region of the breast. Scars were created by adding base color and top color makeup on the base of either latex or rigid collodion or combination of these.

Figure 3

2D image of scar A3 on Model A. The scars created for Model A resemble hypertrophic scars that are typically seen 3 to 6 months after breast reconstruction surgery with either LD or TRAM flap. No donor site scar was created in this study. Scars were created by adding base color and top color makeup on the base of either latex or rigid collodion or combination of these. Liquid latex was added to make nipple more asymmetric on Scar A3.

Figure 4

2D image of scar B1 on Model B. The scars created for Model B resemble normal scars that are typically seen 6 months to 1 year after breast reconstruction surgery with either LD or TRAM flap. No donor site scar was created in this study. Scar B1 was created on left breast around the nipple-areola complex (NAC) with incision running into the low superior lateral area. Scars were created by adding base color and top color makeup on the base of either latex or rigid collodion or combination of these.

Figure 5

2D image of scar B2 on Model B. The scars created for Model B resemble hypertrophic scars that are typically seen 6 months to 1 year after breast reconstruction surgery with either LD or TRAM flap. No donor site scar was created in this study. Scars were created by adding base color and top color makeup on the base of either latex or rigid collodion or combination of these. Scar B2 was started from Scar B1 and crescent shaped region to lateral side of areola was added.

Figure 6

2D image of scar B3 on Model B. The scars created for Model B resemble keloid scars that are typically seen 6 months to 1 year after breast reconstruction surgery with either LD or TRAM flap. No donor site scar was created in this study. Scars were created by adding base color and top color makeup on the base of either latex or rigid collodion or combination of these. Scar B3 was built off from Scar B2 and added rigid collodion to create a keloid appearance

Figure 7

Bland-Altman analysis for the agreement of scar groups A (a, b, c) and B (d, e, f) between the measurements of three artificial scars (N = 3) for each of the three parameters that were measured by colorimeter and digital camera. The parameters measured were: (a) L value, (b) a* value, and (c) b* value. The results show that good agreement was obtained for all three parameters measured as indicated by the fact that 95% of the differences were within the limit of agreement defined by Bland-Altman.