Mastectomy is a variable associated with increased incidence of upper-body morbidity after breast cancer. Scar severity may contribute to this risk however there is no recognized mastectomy scar assessment. The Observer Scale (OS) from Patient and Observer Scar Assessment Scale (POSAS) has been evaluated in breast linear scar research but not for mastectomy scar tissue. This study investigates the suitability of OS to rate scar severity of two common scar types after mastectomy.
Therapists indicating interest in mastectomy scar from Linkedin connections and Google searched websites (English) were invited to participate in an online survey. Each OS feature was surveyed for two scenarios: mastectomy linear scar (LS) and mastectomy chest wall adhesion (CWA) assessment. Therapists rated the level of importance of five additional instructions or skill requirements for each scar feature, with the aim of achieving a more reliable assessment of scar severity. Data from therapists reporting 2+ years of experience was evaluated.
28 responders met the experience criteria. Each therapist evaluated 4/9 scar types after mastectomy and many evaluated 9/9. CWA and LS assessment rated as strongly important in their practice (71%, 57%). Responders had high agreement (>90%) with the level of importance (5/6+6/6) for: clothing removal instruction for six OS scar features (LS, CWA) and scar palpation skills for the pliability feature (CWA). Sound agreement (80-90%) occurred for: scar palpation skills for vascularity (CWA), thickness and pliability features (LS) and knowledge of mastectomy scar types for thickness feature (LS, CWA). Reasonable agreement (70-80%) occurred for: scar stretch instruction for vascularity feature (LS) and pliability feature (CWA) and knowledge of scar types for most scar features. Mixed opinion (<55%) occurred for importance of photographic examples.
Modifications to OS instructions and observer training should be developed for mastectomy LS assessment. CWA assessment was more important for therapists, supporting the need for additional measurement tools for clinicians. Clarification of scar types evaluated in LS and CWA assessment is required as nine scar types are potentially within this zone.