World Journal of Surgery

, Volume 34, Issue 7, pp 1447–1452 | Cite as

Cosmetic Outcome and Percentage of Breast Volume Excision in Oncoplastic Breast Conserving Surgery

  • Sharon W. W. Chan
  • Polly S. Y. Chueng
  • S. H. Lam
Article

Abstract

Background

Since breast-conserving surgery demonstrated identical long term survival on seven randomized trials, it has become the preferred treatment option over mastectomy. Oncoplastic surgery applying simple reshaping and displacement techniques allows inclusion of patients with large tumors in the group selected for breast-conserving surgery. However, the cosmetic outcome and the degree of patient satisfaction, especially in relation to the original breast volume and the percentage of breast tissue excised is not well documented.

Objective

The present study was designed to assess patient satisfaction with cosmetic outcome after oncoplastic breast-conserving surgery, and to establish the correlation between patient satisfaction and percentage of breast volume excision (PBVE).

Materials and methods

A total of 169 Asian patients underwent breast-conserving surgery for primary breast cancer at either United Christian Hospital (UCH) or Hong Kong Sanatorium and Hospital (HKSH) from Nov 2007 to Jan 2008 by two breast surgeons. Among this group, 162 patients with breast-conserving surgery incorporating oncoplastic techniques were prospectively recruited for study. Tumor characteristics, patient satisfaction, cosmetic outcome and surgeons’ score were prospectively documented. Breast volume (BV) calculation was based on preoperative mammography (BV = 1/3πr1r2h), which was validated by our previous study to correlate strongly with actual BV (r = 0.98). PBVE was calculated by dividing the fresh specimen weight by the calculated BV. A standardized questionnaire was used to assess patient satisfaction and surgeons’ score on cosmetic outcome during the first 1–3 postoperative months. The correlation between PBVE and patient satisfaction was studied.

Results

The median age of the group of patients studied was 52 years (range: 20–96 years). The median tumor size was 2.5 cm (range: 0.6–5 cm). The median breast volume was 493 cm3 (range: 210–1,588 cm3). The median PBVE was 7.4% (range: 1–42%), and 94% of patients were very satisfied or satisfied with the cosmetic outcome. In addition, 85% of patients felt that the treated breast was nearly identical with or only slightly different from the untreated breast. In scoring breast shape, surgeons indicated that 89% of the treated breasts were identical to or only minimally different from the untreated breast. Patient satisfaction decreased significantly when the PBVE exceeded 20%. Neither tumor location nor distance of the tumor from the nipple had any effect on patient satisfaction.

Conclusions

This study showed high patient satisfaction and good cosmetic outcome after oncoplastic breast-conserving surgery, even in small breast sized Asian women. The application of oncoplastic technique allows large volume excision, and satisfaction remains high with breast volume excision less than 20% regardless of tumor location or distance of the tumor from the nipple. More complicated oncoplastic techniques, e.g., breast replacement, might be required if breast volume excision exceeds 20%.

References

  1. 1.
    EBCTCG (1995) Effects of radiotherapy and surgery in early breast cancer—an overview of the randomized trials. N Engl J Med 333:1444–1455CrossRefGoogle Scholar
  2. 2.
    Audretsch W, Rezai M, Colotas C et al (1998) Tumor specific immediate reconstruction in breast cancer patients. Perspect Plast Surg 11:71–100Google Scholar
  3. 3.
    Al-Ghazal SK, Fallowfield L (1999) Patient evaluation of cosmetic outcome after conserving surgery for treatment of primary breast cancer. Eur J Surg Oncol 25:344–346CrossRefPubMedGoogle Scholar
  4. 4.
    Fung JTK, Chan SWW, Chiu ANK et al. (2009) Mammographic determination of breast volume by elliptical cone estimation. World J Surg. doi: 10.1007/s00268-009-0283-0
  5. 5.
    National Institutes of Health Consensus Conference (1991) Treatment of early stage breast cancer. JAMA 265:391–395CrossRefGoogle Scholar
  6. 6.
    Clough KB, Cuminet J, Fitoussi A et al (1998) Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 41:471–481CrossRefPubMedGoogle Scholar
  7. 7.
    Fagundes MA, Fagundes HM, Brito CS et al (1993) Breast-conserving surgery and definitive radiation: a comparison between quadrantectomy and local excision with special focus on local–regional control and cosmesis. Int J Radiat Oncol Biol Phys 27:533–560Google Scholar
  8. 8.
    Wang HT, Barcoone CM, Steigelman MB et al (2008) Aesthetic outcomes in breast conservation therapy. Aesthetic Surg J 28:165–170CrossRefGoogle Scholar
  9. 9.
    Schultze J, Lossl K, Kimmig B et al (2008) Cosmetic results after breast conserving carcinoma treatment in patients with intramammarian seromas. Rontgenpraxis 56:169–180CrossRefPubMedGoogle Scholar
  10. 10.
    Bartelink H, Van Dam F (1985) Psychological effects of breast conserving therapy in comparison with radial mastectomy. Int J Radiat Oncol Biol Phys 11:381–385PubMedGoogle Scholar
  11. 11.
    Sneeuw KCA, Aaronson NK, Yarnold M et al (1992) Cosmetic and functional outcomes of breast conserving treatment for early breast cancer. 2. Relationship with psychosocial functioning. Radiother Oncol 25:160–166CrossRefPubMedGoogle Scholar
  12. 12.
    Yau TK, Soong IS, Choi CW et al (2009) Trends and patterns of breast conservation treatment in Hong Kong: 1994–2007. Int J Radiat Oncol Biol Phys 74:98–103PubMedGoogle Scholar
  13. 13.
    Fisher B, Anderson S, Redmond CK et al (1995) Reanaylsis and results after 12 years of follow-up in a randomised clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 333:1456–1461CrossRefPubMedGoogle Scholar
  14. 14.
    Van Dongen JA, Voogd AC, Fentiman IS et al (2000) Long-term results of a randomised trial comparing breast-conserving therapy with mastectomy: European organization for research and treatment of cancer 10801 trial. J Natl Cancer Inst 92:1143–1150CrossRefPubMedGoogle Scholar
  15. 15.
    Jacobson JA, Danforth DN, Cowan KH et al (1995) Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 332:907–911CrossRefPubMedGoogle Scholar
  16. 16.
    Cochrane RA, Valasiadou P, Wilson ARM et al (2003) Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg 90:1505–1509CrossRefPubMedGoogle Scholar
  17. 17.
    Clough KN, Nos C, Salmon RJ et al (1994) Conservative treatment of breast cancers by mammoplasty and irradiation: a new approach to lower quadrant tumors. Plast Reconstr Surg 96:363–370Google Scholar
  18. 18.
    Association of Breast Surgery at BASO, BAPRAS, the training interface group in breast surgery (2007) Oncoplastic breast surgery—a guide to good practice. Eur J Surg Oncol 33:S1–S23Google Scholar
  19. 19.
    Fujishiro S, Mitsumori M, Kokubo M et al (1996) Cosmetic results and complications after breast conserving therapy for early breast cancer. J Gynecol Obstet Reprod (Paris) 25:238–241Google Scholar
  20. 20.
    Johansen J, Overgaard J, Rose C et al (2002) Cosmetic outcome and breast morbidity in breast-conserving treatment. Acta Oncol 41:369–380CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Sharon W. W. Chan
    • 1
  • Polly S. Y. Chueng
    • 2
  • S. H. Lam
    • 1
  1. 1.Kowloon East Cluster Breast Centre, Department of SurgeryUnited Christian HospitalKwun TongPeople’s Republic of China
  2. 2.Hong Kong Sanatorium and HospitalHappy ValleyPeople’s Republic of China

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