Validation of the BCCT.core Software for Objective Aesthetic Evaluation Following Bilateral Nipple-sparing Mastectomy and Implant-based Reconstruction.

Background: BCCT.core software has been validated for breast-conserving therapy. This study examined the use of the BCCT.core software as an objective tool to evaluate aesthetic outcomes following bilateral nipple-sparing mastectomy and implant-based breast reconstruction. Methods: A retrospective review of standardized anterior photographs from 123 patients who underwent bilateral nipple-sparing, implant-based breast reconstruction was performed. The BCCT.core software assigned an outcome class (excellent = 1, good = 2, fair = 3, and poor = 4). Seven symmetry and contour parameters were extracted: 4 linear measures (breast retraction assessment, lower breast contour, upward nipple retraction, and breast compliance evaluation), and 3 area-based measures (breast contour difference, breast area difference, and breast overlap difference). Results: All 7 objective parameters demonstrated statistically significant differences across the 4 BCCT.core classes (analysis of variance, P < 0.001 for each). Linear parameters showed narrower confidence intervals and a lower coefficient of variation, suggesting superior discriminatory power and reproducibility. Conclusions: The linear parameters (breast retraction assessment, lower breast contour, upward nipple retraction, and breast compliance evaluation) demonstrated consistent correlations with the BCCT.core aesthetic outcome classes and superior reproducibility compared with area-based indices. These findings validate the BCCT.core software for reconstruction and support its clinical use in standardizing the benchmarking of reconstructive results.