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Scar outcomes are traditionally evaluated at 12 months post-surgery, yet early prediction of long-term scar characteristics may facilitate timely interventions, enhance treatment strategies, shorten clinical trial durations, and improve patient outcomes. This study evaluates whether 3-month scar assessments reliably predict 12-month outcomes using validated scar assessment scales and interrater reliability measures. Two surgeons evaluated a prospective cohort of 40 surgical patients using standardised scar assessment tools. Logistic regression assessed the predictive value of 3-month classifications for 12-month binary outcomes (‘good’ vs. ‘poor’ scar quality), while linear regression evaluated continuous scar scores. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values quantified predictive accuracy. Scars classified as ‘good’ at 3 months were significantly more likely to remain ‘good’ at 12 months (p < 0.001), with strong predictive performance (AUC = 0.763). Linear regression demonstrated significant predictive accuracy for width, height, and overall opinion. However, vascularity predictions were weak, and depth was not significantly associated with long-term outcomes. Interrater reliability was moderate to good across measures, with intraclass correlation coefficients values ranging from 0.215 (depth) to 0.714 (width), and Cohen's Kappa for binary scar classifications of 0.505 (p < 0.001). Early 3-month scar assessments reliably predict 12-month outcomes for width, height, and overall opinion, while vascularity and depth remain less predictable. Scars rated as ‘good’ at 3 months are unlikely to worsen, while ‘poor’ scars rarely improve without intervention. These findings highlight the utility of early scar evaluations in guiding postoperative management and patient counselling.
Scar outcomes are known to vary by skin tone and race, yet few studies have systematically evaluated these differences using validated tools. To evaluate differences in scar maturation across Fitzpatrick skin types and racial groups from 3 to 12 months postoperatively using the modified Patient and Observer Scar Assessment Scale (POSAS) scale. We conducted a prospective observational study of 40 patients undergoing breast surgery at a single academic centre. All scars were assessed at 3 and 12 months postoperatively using the modified POSAS. Fitzpatrick skin types were categorized into I–II, III–IV, and V–VI, and racial groups included Caucasian, Black, and Hispanic patients. Fitzpatrick Types I–II had the greatest vascularity reduction (–2.06 ± 2.10), while Types V–VI showed the least improvement (–0.80 ± 1.61). Pigmentation increased in Types V–VI (+0.35 ± 1.89) and improved in lighter skin tones. Black and Hispanic patients had significantly lower odds of favourable pigmentation outcomes (p < 0.07). Fitzpatrick Types V–VI also had lower odds of improved scar relief (OR = 0.125, p = 0.034). This study highlights differences in scar maturation across skin tone and racial categories using a standardized scale. These trends underscore the importance of tailoring postoperative scar counselling and interventions to individual patients’ skin types and racial backgrounds.
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