Current Concepts and Emerging Technologies in Aesthetic Outcome Assessment of Breast Reconstruction

BACKGROUND: Aesthetic outcomes are a crucial determinant of the overall success of breast reconstruction. Recently, aesthetic assessment has evolved from relying mainly on subjective impressions to incorporating more quantitative methods. OBJECTIVES: This systematic review summarizes current concepts and emerging technologies in aesthetic outcome assessment after breast reconstruction. METHODS: A comprehensive search of studies evaluating aesthetic outcomes following implant-based, autologous or hybrid breast reconstruction was performed between 2000 and 2025. Assessments were classified as subjective or objective. Extracted variables included assessment characteristics, aesthetic outcome domains and patient-centered outcomes. Risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Levels of evidence were classified according to the Oxford Centre for Evidence-Based Medicine (OCEBM). RESULTS: A total of 51 studies involving 7,711 participants from 16 countries were included. Subjective tools were most frequently employed, led by the BREAST-Q (35/51, 69%), followed by expert or panel-based evaluations (17/51, 33%) and the visual analogue scale (2/51, 4%). Objective methods were applied in 19 studies and included three-dimensional surface imaging (3D-SI) (8/51, 16%), BCCT.core (7/51, 14%), eye-tracking (3/51, 6%), and AI-based analyses (3/51, 6%). While subjective tools captured satisfaction with breast appearance, objective tools quantified morphological parameters and positional landmarks. CONCLUSIONS: BREAST-Q remains the cornerstone of outcome evaluation after breast reconstruction, providing patient-centered perspectives, including, but not limited to aesthetic perception. A progressive shift toward multimodal evaluation was noticed, as no single modality comprehensively addressed all aesthetic domains. Future research should focus on integrating subjective and objective assessment methods within a unified framework.