Measuring appearance of implant-based breast reconstruction after mastectomy for breast cancer - an online approach to research. Using 3-dimensional surface images we intend to create a tool to measure appearance after surgery in order to improve standards of care for women. We want to minimise the number of visits and amount of time involved in research participation so this pilot study will develop new online tools for information giving and gathering, and for consent so that only one visit to hospital will be required for photographs. This will also extend the availability of expensive 3D technology to more women.

Aim To test the feasibility of a number of novel initiatives prior to their use in a multi-centre study. The future study will develop a way to measure cosmetic outcome for implant-based breast reconstruction using 3-dimensional Surface Imaging (3D-SI).

Methods At The Royal Marsden Hospital in Sutton 125 implant-based reconstructions are performed per year (data from 2014). The study team would like to invite women who have had their treatment within the previous 1-5 years to participate in the pilot. The women can be identified through operation records. The study team will aim to include 50.

A letter of invitation will be sent by post. This will include a participant information leaflet, a link to the website, and a unique study ID for each participant. In recent studies, more than 8 out of ten women who were asked to participate agreed.

The website will have the following features:

• Patient study information including links to other relevant information sources (e.g. ABS, Breast Cancer Care, RMH, ICR, BRC), patient testimonials, and biographies from the study team.
• An online consent process for the study.
• A questionnaire for patient demographics (height, weight etc)and treatment information (i.e. type of operation and other treatments like radiotherapy).
• An online version of the BREAST-Q reconstruction module and radiotherapy module from the breast conserving surgery BREAST-Q (a questionnaire designed to assess quality of life and satisfaction with care for patients having breast surgery).
• An online calendar to book a 3D-SI appointment at the hospital.
• A user survey to gain patient feedback on the website and the concept of online consent.
• A 'contact us' section in case further information is required.

At each stage the participant will enter their unique study ID so all of the information collected will remain anonymous. We will hold the code for study IDs securely. There is no patient identifiable data collected on the website. The participant will be guided through the different aspects of the online recruitment processes outlined above. When they have read the patient information, they can click on the link to consent to the study at which point a check screen will ask:

1. I have had enough information and wish to consent to the study - link to the consent form
2. I would like further information which is not available on the website - link to contact us section

Only then will they be able to access the data collection stages of the website and book a photography slot, thereby we can be sure that no patient starts to enter information or attends for a photograph without valid consent.

Following this the participant will be required to attend the hospital only once for an appointment (booked online) for a 3D photograph and height and weight measurement. This will take less than 20 minutes. This will be the end of the patient involvement in the study.

Success in this pilot will provide:

• A bespoke website to facilitate online patient education, consent, and data collection to streamline research processes.
• Information on uptake rate and specific evaluation of the acceptability of the web system and accuracy of patient entered data.
• Data on the accuracy of the VECTRA software to measure implant base reconstruction.
• A secure online 3D-SI storage facility to enable access from multiple hospitals to enable wider involvement in large scale research.
• A library of 3D-surface images on which to base a panel assessment score for implant-based reconstruction by way of a consensus meeting at the outset of the future multi-centre study.

Inclusion Criteria:

• Female patients
• Over 18 years
• Have undergone implant-based reconstruction 1-5 years before study entry (can be unilateral or bilateral, immediate or delayed, nipple-sparing or nipple-sacrificing, risk reducing or therapeutic)

Exclusion Criteria:

• <1 year or over 5 years from surgery
• Explantation
• Local or distant recurrence
• Lacks capacity

This is an observational study of female participants who have undergone mastectomy and implant-based reconstruction within the last 1-5 years. The research will be carried out at the Royal Marsden NHS Foundation Trust Sutton.