Breast-conserving therapy for breast cancer: Cosmetic results and options for delayed reconstruction

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2017-10, Vol.70 (10), p.1336-1344
• Main Authors: Negenborn, Vera L., MD, Volders, José H., MD, Krekel, Nicole M.A., MD PhD, Haloua, Max H., MD PhD, Bouman, Mark-Bram, MD PhD, Buncamper, Marlon E., MD PhD, Niessen, Frank B., MD PhD, Winters, Hay A.H., MD PhD, Terwee, Caroline B., PhD, Meijer, Sybren, MD PhD, van den Tol, M.Petrousjka, MD PhD
• Format: Article
• Language: English
• Subjects: Adult; Axilla; Breast neoplasms; Breast Neoplasms - pathology; Breast Neoplasms - surgery; Cosmetic techniques; Esthetics; Female; Humans; Lymph Node Excision - methods; Lymph Nodes - pathology; Lymph Nodes - surgery; Mammaplasty - methods; Mammaplasty - psychology; Mastectomy; Mastectomy, Segmental - adverse effects; Mastectomy, Segmental - methods; Middle Aged; Netherlands; Observer variation; Patient Outcome Assessment; Patient Preference - psychology; Patient Selection; Plastic Surgery; Postoperative Complications - prevention & control; Professional Practice - standards; Quality Improvement; Reconstructive surgical procedures; Segmental; Time-to-Treatment; Tumor Burden
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2017.05.005

Summary Objectives Optimizing of the cosmetic outcome after breast conservative therapy (BCT) is important. We aim to determine the cosmetic outcome following BCT, factors influencing this cosmesis, and identify the most favourable options for delayed breast reconstruction. Materials and Methods Four reconstructive surgeons evaluated the cosmetic outcome of 109 patients after BCT. Additionally, the surgeons indicated which patients were amenable for delayed reconstruction, and the preferred type of reconstruction. The inter- and intraobserver agreement of the surgeons were rated. Results The mean overall cosmetic outcome was rated as fair (2.7/4.0, SD 0.9, 1.0 - 4.0). Risk factors for a poor cosmesis were larger breast size (OR 3.81, p = 0.040), larger tumour (OR 1.63, p = 0.028) and axillary lymph node dissection (ALND) (OR 3.09, p = 0.013). Reconstruction of the ipsilateral side was recommended in 55.6% and 94.5% of patients with good and poor cosmesis; contralateral reconstruction in 16.7% and 73.3%, respectively. Flap reconstruction and lipofilling were most commonly reported for the ipsilateral, and breast reduction for the contralateral breast, with reasonable improvement expected (2.2/4.0, SD 0.5, 1.08-3.3). The inter- (0.5 - 0.7) and intraobserver (0.63 - 0.79) agreement of the cosmesis was moderate to good, but poor regarding the recommended reconstruction techniques (mainly < 0.50). Conclusion Cosmetic outcome after BCT is influenced by breast and tumour size, and ALND. Although several reconstructive options are available, the optimal method for revision surgery has not yet been determined. Future studies are necessary to obtain evidence-based guidelines for reconstructive surgery after BCT.