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Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study

  • Reconstructive Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We analyzed the change of aesthetic outcome (AO) over time and explored factors characterizing poor AO after breast-conserving surgery (BCS).

Methods

This prospective single-center cohort study included 849 patients preoperatively planned for BCS between September 2007 and December 2011. Long-term follow-up was made once in 2013. AO was measured by the Aesthetic Status (AS) of the Breast Cancer Treatment Outcome Scale questionnaire. Clinical, surgical, and pathologic variables were evaluated to identify predictors of poor AO. We applied single factor variance analyses and univariable logistic regression analyses for outcome analysis.

Results

The long-term follow-up rate in 2013 was 73 % (621 nonrecurrent with final BCS). A poor or fair AO was reported in 30 (4.8 %) and 98 (15.8 %) of these 621 patients, respectively. Single factor variance analysis showed a negative impact of higher specimen weight on AO (p < 0.001). Univariable logistic regression analysis revealed the following risk factors for poor AO: radial breast incision [odds ratio (OR) 1.97], periareolar incision (OR 1.85), fishmouth-shaped incision with resection of the nipple–areola complex (OR 8.12), impaired wound healing (OR 3.14), and seroma (OR 2.16). No patient rating her AO as fair or poor shortly after BCS improved in the long-term follow-up.

Conclusions

The incidence of poor AO is relatively rare but increases in the long-term follow-up. Patients experiencing poor AO after BCS are likely to remain unsatisfied with the outcome over time. Factors predicting unfavorable AO can assist preoperative planning with regards to the choice between simple breast conserving techniques or more complex oncoplastic procedures.

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Acknowledgment

J.H. received funding from the German Research Foundation (HE 6824/1-1).

Disclosure

There are no conflicts of interests (e.g. employment, consultancies, stock ownership, honoraria, patent applications/registrations and grants or other funding) by any of the authors.

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Authors and Affiliations

  1. Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany

    André Hennigs MD, Hannah Biehl, Michael Golatta MD, Patrik Tabatabai MD, Christoph Domschke MD, Sarah Schott MD, Markus Wallwiener MD, Florian Schütz MD, Christof Sohn MD & Jörg Heil MD

  2. Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany

    Geraldine Rauch PhD

Authors
  1. André Hennigs MD
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  2. Hannah Biehl
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  3. Geraldine Rauch PhD
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  4. Michael Golatta MD
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  5. Patrik Tabatabai MD
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  6. Christoph Domschke MD
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  7. Sarah Schott MD
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  8. Markus Wallwiener MD
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  9. Florian Schütz MD
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  10. Christof Sohn MD
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  11. Jörg Heil MD
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Correspondence to André Hennigs MD.

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Hennigs, A., Biehl, H., Rauch, G. et al. Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study. Ann Surg Oncol 23, 1744–1751 (2016). https://doi.org/10.1245/s10434-015-4943-z

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  • DOI: https://doi.org/10.1245/s10434-015-4943-z

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