Purpose: Although various strategies have been reported, thereare no defined criteria for cosmetic evaluation methods afterbreast-conserving surgery (BCS). Since Asians tend to havesmaller breasts, indistinct inframammary folds, and conspicuousscars, differences in the cosmetic results are expected. So weexamined two subjective methods and one objective method todetermine the differences, and elements necessary for a cosmeticevaluation after BCS. Methods: Frontal photographs of 190Japanese were evaluated using the Harris scale (Harris) and theevaluation method proposed by the Japanese Breast Cancer SocietySawai group (Sawai group) as the subjective methods, andthe Breast Cancer Conservation Treatment cosmetic results(BCCT.core) as the objective method, respectively. In order to examinethe necessary elements for developing a new ideal method,100 out of 190 were selected and assessed separately by sixraters using both the Harris and modified Sawai group methodsin the observer assessment. The correlation between the twomethods was examined using the Spearman rank-correlation coefficient. Results: The results of the BCCT.core and the other twomethods were clearly different. In the observer assessment, theconsensuses of the six raters were evaluated as follows: 27, 27,26, and 20 cases were evaluated as “excellent,” “good,” “fair,”and “poor,” respectively. For the Spearman rank-correlation coefficient,values higher than 0.7 indicated a strong correlation, asseen by the values of 0.909 for the breast shape and 0.345 forthe scar. The breast shape accounted for the most significantpart of the evaluation, and the scar had very little correlation. Conclusion:In this study, we recognized a clear difference betweenthe subjective and objective evaluation methods, and identifiedthe necessary elements for cosmetic evaluation. We would like tocontinue developing an ideal cosmetic evaluation that is similar tosubjective one and is independent from raters.