Development of a Screening Measure to Identify Breast Appearance Dissatisfaction in Women

Body image dissatisfaction, particularly related to breast appearance, plays an important role in cosmetic breast surgery (CBS) decisions and psychological wellbeing. However, existing measures are often lengthy, overlook healthy women considering CBS, and fail to adequately address the nipple–areola complex (NAC), a critical component of breast satisfaction. This study introduces the 12-item Breast Appearance Concerns Scale (BACS), a brief screening tool developed to address existing gaps and to document breast-specific body image concerns among women considering CBS. Data were collected from a diverse sample of 589 young adult women who completed the BACS along with measures of related constructs such as self-esteem and anxiety. Exploratory and confirmatory factor analyses supported a two-subscale structure: NAC Satisfaction and General Breast Satisfaction. The BACS total score demonstrated strong internal consistency (α = 0.785) and test–retest reliability (r = 0.741). Predictive validity analyses revealed that the General Breast Satisfaction subscale effectively distinguished women who had considered CBS from those who had not (classification accuracy = 72.1%). Receiver Operating Characteristic (ROC) analysis was conducted with the General Breast Satisfaction subscale to establish a preliminary cutoff score. This cutoff provides initial support for use of this subscale as a screening tool to help classify individuals based on their consideration of CBS. Although clinically important, the NAC subscale is still in an early stage of development and requires additional research before cutoff scores can be established to inform surgical decision-making and evaluate patient-reported satisfaction outcomes. Both subscales require further investigation in older populations and clinical settings to support their use as screening tools. These findings position the BACS as a promising screening tool for assessing breast-specific body image concerns, particularly general breast satisfaction, with potential applications in clinical, pre-surgical settings.