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The quality of life of breast cancer survivors is ameliorated by minimizing adverse effects on their physical appearance. Breast reconstruction is important for restoring the survivor's appearance. In breast reconstructive surgery, there is a need to develop technologies for quantifying surgical outcomes and understanding women's perceptions of changes in their appearance. Methods for objectively measuring breast anatomy are needed in order to help breast cancer survivors, radiation oncologists and surgeons quantify changes in appearance that occur with different breast reconstructive surgical options.In this study, we present an automated method for computing a variant of the normalized Breast Retraction Assessment, a common measure of symmetry, from routine clinical photographs taken to document breast cancer treatment procedures. The algorithms were designed using a development set of retrospectively collected clinical photographs and evaluated using a separate test set of prospectively collected clinical photographs.We have developed new algorithms for automatically localizing the umbilicus and nipples on standard anterior-posterior clinical photographs, enabling the automatic calculation of measure of breast symmetry.This study demonstrates that under standardized photographic conditions, automatic localization of fiducial points and subsequent computation of measures, such as symmetry, is feasible. The algorithms presented here for quantifying surgical outcomes in breast reconstructive surgery will provide a foundation for future work on assisting a cancer patient and her surgeons in selecting and planning reconstruction procedures that will maximize the woman's psychosocial adjustment to life as a breast cancer survivor.