Background
Method
Study aim
Participant recruitment
Data collection
Surgery and systemic treatment
Questionnaires
Statistical methods and data analysis
Results
Demographics of responding patients
Total cohort (n = 144) | Responders (n = 120) | Non-responders (n = 24) | |
---|---|---|---|
Age (years) | 60 (32–80) | 61 (33–80) | 52 (32–79) |
BMI (kg/m2) | 25.1 (16.0–42.0)d | 25.2 (16.0–42.0) | 24.2 (19.7–34.6) |
Smoker | 14.0% (n = 20) | 11.8% (n = 14) | 25.0% (n = 6) |
Radiological tumor extent (mm) | 20 (5–60) | 20 (5–60) | 25 (6–60) |
Histological tumor extent (mm) | 23 (6–90) | 22 (6–90) | 25 (10–51) |
Specimen weight (g) | 86 (14–345)e | 92 (14–345) | 62 (33–161) |
Breast volume (cm3)a | 644 (110–2033)f | 644 (110–2033) | 637 (200–1395) |
EPBVE (%)b | 14 (3–35)g | 15 (3–35) | 13 (7–28) |
Oncoplastic method | |||
Raquet | 49.3% (n = 71) | 54.2% (n = 65) | 25.0% (n = 6) |
Round block | 21.5% (n = 31) | 20.0% (n = 24) | 29.2% (n = 7) |
V-mammoplasty | 13.2% (n = 19) | 10.8% (n = 13) | 25.0% (n = 6) |
Inverted-T | 7.6% (n = 11) | 7.5% (n = 9) | 8.3% (n = 2) |
J-mammoplasty | 6.9% (n = 10) | 6.7% (n = 8) | 8.3% (n = 2) |
Other | 1.4% (n = 2) | 0.8% (n = 1) | 4.2% (n = 1) |
Axillary clearance | 27.8% (n = 40) | 30.0% (n = 36) | 16.7% (n = 4) |
Re-excision | 4.9% (n = 7) | 4.2% (n = 5) | 8.3% (n = 2) |
Postoperative complications of the breastc | |||
Grade 1 | 2.1% (n = 3) | 2.5% (n = 3) | 0 |
Grade 2 | 2.1% (n = 3) | 0.8% (n = 1) | 8.3% (n = 2) |
Grade 3 | 1.4% (n = 2) | 1.7% (n = 2) | 0 |
Neoadjuvant chemotherapy | 17.4% (n = 25) | 17.5% (n = 21) | 16.7% (n = 4) |
Adjuvant chemotherapy | 25.0% (n = 36) | 26.7% (n = 32) | 16.7% (n = 4) |
Adjuvant endocrine therapy | 72.2% (n = 104) | 74.2% (n = 89) | 62.5% (n = 15) |
Postoperative radiotherapy | 100% (n = 144) | 100% (n = 120) | 100% (n = 24) |
Breast density | |||
High (BI-RADS® C–D) | 30.6% (n = 55) | 54.2% (n = 13) | 35.0% (n = 42) |
Low (BI-RADS® A–B) | 62.5% (n = 89) | 45.8% (n = 11) | 65.0% (n = 78) |
Follow-up time (months) | 27 (15–54) | 28 (15–54) | 24 (15–54) |
Surgical and treatment specifications of responding patients
Complications of responding patients
Patient satisfaction
Domain |
n
| Median | IQR | Range | Mean (SD) |
---|---|---|---|---|---|
1. Satisfaction with breasts | 119 | 74 | 59–85 | 12–100 | 72 (20) |
2. Adverse effects of radiation | 118 | 100 | 89–100 | 49–100 | 94 (11) |
3. Psychosocial well-being | 119 | 87 | 57–100 | 14–100 | 78 (23) |
4. Sexual well-being | 77 | 60 | 40–69 | 0–100 | 55 (21) |
5. Physical well-being | 119 | 78 | 69–92 | 21–100 | 78 (18) |
6. Satisfaction with information from breast surgeon | 119 | 75 | 58–100 | 37–100 | 76 (19) |
7. Satisfaction with breast surgeon | 118 | 100 | 92–100 | 23–100 | 92 (14) |
8. Satisfaction with medical team | 118 | 100 | 100–100 | 31–100 | 96 (12) |
9. Satisfaction with office staff | 116 | 100 | 100–100 | 44–100 | 97 (9) |
Expectations, information, participation in decision-making | |||||
Not at all | Partly | Almost entirely | Entirely | Missing | |
Has the operation met your expectations regarding the cosmetic outcome? | 1 (0.8%) | 8 (6.7%) | 30 (25.0%) | 79 (65.8%) | 2 (1.7%) |
Did you receive enough information about the expected cosmetic outcome? | 6 (5.0%) | 14 (11.7%) | 24 (20.0%) | 74 (61.7%) | 2 (1.7%) |
Did you perceive an opportunity to participate in the decision making process? | 20 (16.7%) | 16 (13.3%) | 20 (16.7%) | 62 (51.7%) | 2 (1.7%) |
Satisfaction with different aspects of the operated breast | |||||
Dissatisfied | Not entirely satisfied | Satisfied | Very satisfied | Missing | |
Appearance of the operated breast | 4 (3.3%) | 10 (8.3%) | 42 (35.0%) | 64 (53.3%) | 0 |
Size of the operated breast | 4 (3.3%) | 11 (9.2%) | 46 (38.3%) | 58 (48.3%) | 1 (0.8%) |
Shape of the operated breast | 3 (2.5%) | 10 (8.3%) | 47 (39.2%) | 59 (49.2%) | 1 (0.8%) |
NAC positioning | 2 (1.7%) | 8 (6.7%) | 44 (36.7%) | 65 (54.2%) | 1 (0.8%) |
NAC appearance | 2 (1.7%) | 12 (10.0%) | 46 (38.3%) | 57 (47.5%) | 3 (2.5%) |
Symmetry | 6 (5.0%) | 19 (15.8%) | 50 (41.7%) | 44 (36.7%) | 1 (0.8%) |
Appearance of scar | 4 (3.3%) | 13 (10.8%) | 47 (39.2%) | 53 (44.2%) | 3 (2.5%) |
Skin sensitivity | 5 (4.2%) | 18 (15.0%) | 56 (46.7%) | 39 (32.5%) | 2 (1.7%) |
Wish regarding additional/corrective/other surgery | |||||
No | Yes | Missing | |||
Would you rather have removed the entire breast? | 114 (95.0%) | 3 (2.5%) | 3 (2.5%) | ||
Would you like to have corrective surgery of the operated breast? | 109 (90.8%) | 8 (6.7%) | 3 (2.5%) | ||
Would you like to have a procedure of the contralateral breast for symmetry? | 101 (84.2%) | 13 (10.8%) | 6 (5.0%) |
Factor | Q-score ≥ 74 | Q-score < 74 | OR (95% CI)a | OR (95% CI)b |
---|---|---|---|---|
BMI (kg/m2) | ||||
< 25 | 31 (54.4%) | 26 (45.6%) | 1 | 1 |
≥ 25 to < 30 | 21 (47.7%) | 23 (52.3%) | 1.31 (0.59–2.87) | 1.28 (0.58–2.84) |
≥ 30 | 9 (50.0%) | 9 (50.0%) | 1.19 (0.41–3.44) | 1.18 (0.40–3.46) |
Age (years) | ||||
< 50 | 18 (56.3%) | 14 (43.8%) | 1 | 1 |
50–65 | 21 (46.7.7%) | 24 (53.3%) | 1.47 (0.59–3.66) | 1.44 (0.58–3.60) |
> 65 | 22 (52.4%) | 20 (47.6%) | 1.17 (0.46–2.95) | 1.14 (0.45–2.91) |
BI-RADS® classification of breast density | ||||
High density(C–D) | 27 (64.3%) | 15 (35.7%) | 1 | 1 |
Low density (A–B) | 34 (44.2%) | 43 (55.8%) |
2.28 (1.05–4.94)
|
2.32 (1.02–5.29)
|
Smoker | ||||
No | 53 (52.5%) | 48 (47.5%) | 1 | 1 |
Yes | 4 (28.6%) | 10 (71.4%) | 2.76 (0.81–9.38) | 2.59 (0.74–9.12) |
EPBVE (%)c | ||||
< 15 | 31 (50.8%) | 30 (49.2%) | 1 | 1 |
≥ 15 | 25 (51.0%) | 24 (49.0%) | 0.99 (0.47–2.11) | 1.00 (0.45–2.21) |
Specimen weight (grams) | ||||
< 100 | 40 (58.8%) | 28 (41.2%) | 1 | 1 |
≥ 100 | 17 (38.6%) | 27 (61.4%) |
2.27 (1.05–4.93)
| 2.23 (0.99–5.06) |
Axillary clearance | ||||
No | 48 (57.8%) | 35 (42.2%) | 1 | 1 |
Yes | 13 (36.1%) | 23 (63.9%) |
2.43 (1.08–5.44)
|
2.46 (1.09–5.56)
|
Neoadjuvant chemotherapy | ||||
No | 55 (56.1%) | 43 (43.9%) | 1 | 1 |
Yes | 6 (28.6%) | 15 (71.4%) |
3.20 (1.15–8.93)
|
3.26 (1.15–9.24)
|
Adjuvant chemotherapy | ||||
No | 47 (54.0%) | 40 (46.0%) | 1 | 1 |
Yes | 14 (43.8%) | 18 (56.3%) | 1.51 (0.67–3.42) | 1.54 (0.67–3.52) |
Adjuvant endocrine therapy | ||||
No | 15 (48.4%) | 16 (51.6%) | 1 | 1 |
Yes | 46 (52.3%) | 42 (47.7%) | 0.86 (0.38–1.94) | 0.82 (0.35–1.89) |
Factor | Q-score ≥ 74 | Q-score < 74 | OR (95% CI)a | OR (95% CI)b |
---|---|---|---|---|
BMI (kg/m2) | ||||
< 25 | 31 (54.4%) | 26 (45.6%) | 1 | 1 |
≥ 25 to < 30 | 21 (47.7%) | 23 (52.3%) | 1.28 (0.58–2.84) | 1.21 (0.50–2.90) |
≥ 30 | 9 (50.0%) | 9 (50.0%) | 1.18 (0.40–3.46) | 1.08 (0.32–3.68) |
Age (years) | ||||
< 50 | 18 (56.3%) | 14 (43.8%) | 1 | 1 |
50–65 | 21 (46.7.7%) | 24 (53.3%) | 1.44 (0.58–3.60) | 1.06 (0.39–2.93) |
> 65 | 22 (52.4%) | 20 (47.6%) | 1.14 (0.45–2.91) | 0.81 (0.28–2.33) |
BI-RADS® classification of breast density | ||||
High density (C–D) | 27 (64.3%) | 15 (35.7%) | 1 | 1 |
Low density (A–B) | 34 (44.2%) | 43 (55.8%) |
2.32 (1.02–5.29)
| 2.00 (0.79–5.06) |
Axillary clearance | ||||
No | 48 (57.8%) | 35 (42.2%) | 1 | 1 |
Yes | 13 (36.1%) | 23 (63.9%) |
2.46 (1.09–5.56)
| 1.57 (0.52–4.72) |
Neoadjuvant chemotherapy | ||||
No | 55 (56.1%) | 43 (43.9%) | 1 | 1 |
Yes | 6 (28.6%) | 15 (71.4%) |
3.26 (1.15–9.24)
| 3.02 (0.70–13.12) |
Specimen weight (grams) | ||||
≤ 100 | 40 (58.8%) | 28 (41.2%) | 1 | 1 |
> 100 | 17 (38.6%) | 27 (61.4%) | 2.23 (0.99–5.06) | 1.45 (0.59–3.54) |
Wish for contralateral surgery
Would you like to have a procedure of the contralateral breast for symmetry?a | |||||
---|---|---|---|---|---|
Satisfaction with aspect of the operated breasta | Yes (n = 13) | No (n = 101) | p value | ||
Satisfiedb | Dissatisfied | Satisfied | Dissatisfied | ||
Appearance of the operated breast | 10 (76.9%) | 3 (23.1%) | 92 (91.1%) | 9 (8.9%) | 0.139 |
Size of the operated breast | 8 (66.7%) | 4 (33.3%) | 92 (91.1%) | 9 (8.9%) | 0.032* |
Shape of the operated breast | 8 (66.7%) | 4 (33.3%) | 94 (93.1%) | 7 (6.9%) | 0.017* |
NAC positioning | 10 (83.3%) | 2 (16.7%) | 94 (93.1%) | 7 (6.9%) | 0.224 |
NAC appearance | 8 (72.7%) | 3 (27.3%) | 90 (89.1%) | 11 (10.9%) | 0.140 |
Symmetry | 4 (33.3%) | 8 (66.7%) | 86 (85.1%) | 15 (14.9%) | < 0.001* |
Appearance of scar | 9 (69.2%) | 4 (30.8%) | 86 (86.9%) | 13 (13.1%) | 0.109 |
Skin sensitivity | 7 (58.3%) | 5 (41.7%) | 82 (82.0%) | 18 (18.0%) | 0.068 |
Correlation between “Satisfaction with breasts” and other BREAST-Q™ BCT domains
Other BREAST-Q™ BCT domains | |||
---|---|---|---|
Correlation | Interpretationa | p value | |
1. Adverse effects of radiation | 0.186 | Very weak | 0.043* |
2. Psychosocial well-being | 0.562 | Moderate | < 0.001* |
3. Sexual well-being | 0.584 | Moderate | < 0.001* |
4. Physical well-being | 0.389 | Weak | < 0.001* |
5. Satisfaction with information from breast surgeon | 0.441 | Moderate | < 0.001* |
6. Satisfaction with breast surgeon | 0.214 | Weak | 0.020* |
7. Satisfaction with medical team | 0.228 | Weak | 0.013* |
8. Satisfaction with office staff | 0.182 | Very weak | 0.051 |
Discussion
First author of study | |||
---|---|---|---|
Dahlbäck* | O’Connell** | Current study | |
Year published | 2017 | 2016 | |
Evaluated surgical method(s) | BCT/WLE | BCT/WLE | OPS |
Time period when operations were performed | 2008–2012 | 2009–2015 | 2013–2016 |
Response rate | 71% | 58% | 83% |
Number of responding participants | 348 | 200 | 120 |
Radiological tumor extent (mm) | 15 (median value) | 16 (mean value) | 20 (median value) |
Weight of specimen excised (grams) | – | 32.5 (mean value) | 86 (median value) |
Breast Q™ BCT domains | |||
“Satisfaction with breasts” | 66 (57–80)a | 68 (55–80) | 74 (59–85) |
“Effects of radiotherapy” | 100 (89–100) | 89 (78.25–100) | 100 (89–100) |
“Psychosocial well-being” | 82 (61–100) | 82 (63–100) | 87 (57–100) |
“Sexual well-being” | 60 (48–79) | 57 (45–66) | 60 (49–69) |
“Physical well-being” | 81 (69–92) | 75 (64–86) | 78 (69–92) |
“Satisfaction with information from breast surgeon” | 62 (53–84) | 77 (64–100) | 75 (58–100) |
“Satisfaction with breast surgeon” | 100 (81–100) | 100 (100–100) | 100 (92–100) |
“Satisfaction with medical team” | 100 (92–100) | 100 (100–100) | 100 (100–100) |
“Satisfaction with office staff” | 100 (93–100) | 100 (100–100) | 100 (100–100) |