Advertisement

Breast Cancer Research and Treatment

, Volume 153, Issue 2, pp 345–351 | Cite as

Long-term objective esthetic outcome after breast-conserving therapy

  • André Hennigs
  • Benjamin Hartmann
  • Geraldine Rauch
  • Michael Golatta
  • Patrik Tabatabai
  • Christoph Domschke
  • Sarah Schott
  • Florian Schütz
  • Christof Sohn
  • Joerg HeilEmail author
Clinical trial

Abstract

The prediction of unfavorable long-term esthetic outcome (AO) is important for patient consultation. We aimed to analyze variables characterizing the improvement and impairment of AO over time after breast-conserving surgery. A subgroup of a prospective, monocenter cohort study was analyzed to evaluate the results of the BCCT.core software (Breast Cancer Conservative Treatment.cosmetic results) which was used to objectively assess the AO before (n = 356), shortly after (n = 294) and in median 3 years after surgery (n = 356). We analyzed potential influencing factors (such as body mass index, (y)pT-stage, weight of resected specimen, etc.) on the AO using logistic regression analyses (n = 256). Finally, we tried to characterize groups of patients with improving or impaired AO over time (n = 294). Predictors for an unfavorable AO were an axillary lymphadenectomy (OR = 4.05), a tumor in the 12 o’clock position (OR = 2.22), a tumor stage larger or equal to (y)pT2 stage (OR = 2.11), and a surgical specimen weight >75 g (OR = 2.71). Patients with lower specimen weight were more likely to improve in the long-term follow-up (p = 0.018), whereas patients with a higher (y)pT-stage tended to become impaired with time. Although overall AO decreased over time, nearly half of the patients with an unfavorable AO shortly after surgery improved in the long-term follow-up. Predictors of unfavorable AO can be used in patient consultation preoperatively to prepare them for the postsurgical period and/or to recommend surgical alternatives (e.g., more complex oncoplastic techniques). Knowledge of improvement and impairment may help patients and physicians in the postsurgical consultation setting.

Keywords

Breast cancer Objective aestethic outcome Breast-conserving therapy Bcct.core 

Notes

Acknowledgments

Prof. Joerg Heil received funding from the German Research Foundation (HE 6824/1-1).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The ethics commission of the University of Heidelberg Medical School approved the study. All patients gave their written consent to participate.

Supplementary material

10549_2015_3540_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 13 kb)

References

  1. 1.
    Mitov FS, Molov VV (2006) Breast-conserving surgery in early-stage breast cancer (indications, local recurrences, survival, cosmetic results). Folia Med (Plovdiv) 48(1):23–30Google Scholar
  2. 2.
    Fowble B et al (1996) The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor-positive early-stage breast cancer. Int J Radiat Oncol Biol Phys 35(4):669–677CrossRefPubMedGoogle Scholar
  3. 3.
    van Dongen JA et al (2000) Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 92(14):1143–1150CrossRefPubMedGoogle Scholar
  4. 4.
    Fisher B et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347(16):1233–1241CrossRefPubMedGoogle Scholar
  5. 5.
    Driul L et al (2013) New surgical trends in breast cancer treatment: conservative interventions and oncoplastic breast surgery. Minerva Ginecol 65(3):289–296PubMedGoogle Scholar
  6. 6.
    Waljee JF et al (2008) Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol 26(20):3331–3337CrossRefPubMedGoogle Scholar
  7. 7.
    Heil J (2010) Change of aesthetic and functional outcome over time and their relationship to quality of life after breast conserving therapy. Eur J Surg Oncol 37:116CrossRefPubMedGoogle Scholar
  8. 8.
    Kim MS et al (2008) Assessment of breast aesthetics. Plast Reconstr Surg 121(4):186e–194eCrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Andrade WN, Semple JL (2006) Patient self-assessment of the cosmetic results of breast reconstruction. Plast Reconstr Surg 117(1):44–47 discussion 48-9CrossRefPubMedGoogle Scholar
  10. 10.
    Al-Ghazal SK, Blamey RW (1999) Cosmetic assessment of breast-conserving surgery for primary breast cancer. Breast 8(4):162–168CrossRefPubMedGoogle Scholar
  11. 11.
    Heil J et al (2012) Objective assessment of aesthetic outcome after breast conserving therapy: subjective third party panel rating and objective BCCT.core software evaluation. Breast 21(1):61–65CrossRefPubMedGoogle Scholar
  12. 12.
    Cardoso MJ (2007) Turning subjective into objective: The BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast 16:456CrossRefPubMedGoogle Scholar
  13. 13.
    Cardoso MJ et al (2009) Comparing two objective methods for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat 116(1):149–152CrossRefPubMedGoogle Scholar
  14. 14.
    Heil J (2010) Aesthetics in breast conserving therapy: do objectively measured results Match patients’ evaluations. Ann Surg Oncol 18:134CrossRefPubMedGoogle Scholar
  15. 15.
    Cardoso MJ et al (2012) Recommendations for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat 135(3):629–637CrossRefPubMedGoogle Scholar
  16. 16.
    Heil J et al (2010) Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS). Breast 19(6):470–474CrossRefPubMedGoogle Scholar
  17. 17.
    Hoffmann J, Wallwiener D (2009) Classifying breast cancer surgery: a novel, complexity-based system for oncological, oncoplastic and reconstructive procedures, and proof of principle by analysis of 1225 operations in 1166 patients. BMC Cancer 9:108CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Wockel A, Kreienberg R (2008) First Revision of the German S3 Guideline ‘Diagnosis, Therapy, and Follow-Up of Breast Cancer’. Breast Care (Basel) 3(2):82–86CrossRefGoogle Scholar
  19. 19.
    Preuss J, Lester L, Saunders C (2012) BCCT.core—can a computer program be used for the assessment of aesthetic outcome after breast reconstructive surgery? Breast 21(4):597–600CrossRefPubMedGoogle Scholar
  20. 20.
    Cardoso MJ et al (2008) Is face-only photographic view enough for the aesthetic evaluation of breast cancer conservative treatment? Breast Cancer Res Treat 112(3):565–568CrossRefPubMedGoogle Scholar
  21. 21.
    Eder M (2011) Objective breast symmetry evaluation using 3-D surface imaging. Breast 21:152CrossRefPubMedGoogle Scholar
  22. 22.
    Cardoso MJ et al (2007) Factors determining esthetic outcome after breast cancer conservative treatment. Breast J 13(2):140–146CrossRefPubMedGoogle Scholar
  23. 23.
    Foersterling E et al (2014) Predictors of early poor aesthetic outcome after breast-conserving surgery in patients with breast cancer: initial results of a prospective cohort study at a single institution. J Surg Oncol 110(7):801–806CrossRefPubMedGoogle Scholar
  24. 24.
    Kelly DA et al (2012) Outcome analysis of 541 women undergoing breast conservation therapy. Ann Plast Surg 68(5):435–437CrossRefPubMedGoogle Scholar
  25. 25.
    Wang HT et al (2008) Aesthetic outcomes in breast conservation therapy. Aesthet Surg J 28(2):165–170CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • André Hennigs
    • 1
  • Benjamin Hartmann
    • 1
  • Geraldine Rauch
    • 1
  • Michael Golatta
    • 1
  • Patrik Tabatabai
    • 1
  • Christoph Domschke
    • 1
  • Sarah Schott
    • 1
  • Florian Schütz
    • 1
  • Christof Sohn
    • 1
  • Joerg Heil
    • 1
    Email author return OK on get
  1. 1.University Breast UnitUniversity Hospital of HeidelbergHeidelbergGermany

Personalised recommendations