Aesthetic and functional outcome after breast conserving surgery – Comparison between conventional and oncoplastic resection
Introduction
A good aesthetic outcome after breast conserving therapy (BCT) in breast cancer is important. Previous studies have demonstrated correlations between aesthetic outcome and quality of life (QoL).1, 2, 3 Several factors associated with poor aesthetic outcome have been identified: central, medial or inferior tumour locations,4, 5 larger tumour size,4 larger specimen volume,5 re-operation due to positive margins,6 radiation therapy and radiation boost.7, 8
Various oncoplastic techniques have been developed to improve aesthetic outcome after BCT. Increasing number of studies confirm oncologic safety of oncoplastic breast conserving surgery.9, 10, 11, 12 With oncoplastic techniques, patients with larger or multifocal tumours may become eligible for BCT rather than mastectomy, without compromising aesthetic outcome.
A recent meta-analysis10, 13 implicates that oncoplastic breast surgery provides a better aesthetic outcome. However, also contradictory results have been reported.14 Moreover, evaluation of patient-reported aesthetic outcome is lacking a gold standard and current methods vary widely.13, 15 Study instruments to evaluate aesthetic and functional outcome vary from a single question assessing to validated multi-item questionnaires. Previous studies also show that patient-reported aesthetic outcome questionnaires provide more favourable aesthetic outcomes than objective aesthetic outcome measurements.1, 3
For these reasons, this study aims to compare patient-reported aesthetic and functional outcome after conventional resection and oncoplastic resection and to evaluate possible prognostic factors for poor aesthetic outcome in a population-based setting.
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Patients and methods
All patients having breast conserving surgery (BCS) due to primary breast cancer at the Helsinki and Uusimaa Hospital District during 2010 were included in this study; 664 patients were retrospectively identified from a database. 27 patients were excluded due to bi-lateral disease or earlier breast cancer. Remaining 637 patients constitute the study population. The data was completed with information from electronic patient records on tumour characteristics, complications and oncoplastic
Patient and tumour characteristics
Questionnaire was returned by 379 (59%) patients; 293 (77%) of these patients had conventional and 86 (23%) oncoplastic resection. The proportion of conventional and oncoplastic procedures in the whole study population was similar, 79% and 21%, respectively. Patient and tumour characteristics are displayed in Table 1. Patients in the oncoplastic resection group had significantly larger tumour diameter (p < 0.001), larger resection specimens (p < 0.001), and more often multifocal tumours
Discussion
Our study results indicate that conventional resection provides good aesthetic outcome in appropriately selected patients. Patient-evaluated aesthetic outcome was good or excellent in the majority of patients.
Interestingly, on the BCTOS aesthetic subscale nearly all individual items were worse after oncoplastic resection. However, this finding is most likely due to selection bias. Oncoplastic resection allows the excision of larger or multifocal tumours to obtain best possible aesthetic
Conclusions
Overall patient satisfaction with aesthetic outcome after BCT is high. Conventional resection provides good aesthetic outcome in appropriately selected patients. Oncoplastic resection enables BCT in patients with larger and multifocal tumours with a favourable aesthetic outcome.
Conflict of interest
None.
Acknowledgements
KO was supported by Kurt and Doris Palander Foundation grant.
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