The Rainbow Scale for Assessing Breast Ptosis: Validation of Three Different Views

Eyck, B. M., van Dongen, J. A., Athanassopoulos, T., Martins, J. B. & Stevens, H. P., Oct-2016, In : Aesthetic Surgery Journal. 36, 9, p. 1010-1016 7 p.

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Background: Photographic scales have become an increasingly used tool in objectively assessing outcomes in aesthetic surgery. However, no online photographic scale for assessing breast ptosis has been developed yet that is readily available.

Objectives: This study was designed to validate the online Rainbow Scale for the assessment of breast ptosis for the anterior-posterior (AP), lateral, and oblique views.

Methods: For the five grades of the Rainbow Scale format, standardized reference photographs were selected. Six plastic surgeons rated 15 photographs for each view three times. Intra-and inter-observer agreements were calculated by using the weighted kappa coefficient and differences in intra-and inter-observer agreements between the three views were assessed for statistical significance using the Kruskal-Wallis test.

Results: The mean intra-observer agreements were 0.91 (range, 0.82-0.98) for the AP view, 0.88 (range, 0.77-1.00) for the oblique view, and 0.86 (range, 0.74-0.97) for the lateral view and did not vary significantly between all three views. The mean inter-observer agreements were 0.88 (range, 0.77-0.95) for the AP view, 0.84 (range, 0.72-0.94) for the oblique view, and 0.82 (range, 0.58-0.95) for the lateral view. The mean inter-observer agreements of the AP view varied significantly from the oblique view (P =.012) and the lateral view (P =.001).

Conclusions: The Rainbow Scale for breast ptosis has been validated for the AP view, the lateral view, and the oblique view and is reproducible and reliable for the assessment of breast ptosis in three different views in an online setup.

Original languageEnglish
Pages (from-to)1010-1016
Number of pages7
JournalAesthetic Surgery Journal
Issue number9
Publication statusPublished - Oct-2016


  • ptosis, oblique views, breast

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