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.