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The Impact of Breast-Conserving Surgery Re-excision on Patient-Reported Outcomes Using the BREAST-Q

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Approximately 14% of women undergoing breast-conserving surgery (BCS) require re-excision to achieve negative margins following the Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) margin guidelines, which may influence patient-reported outcomes (PROs). Few studies have assessed the impact of re-excision on PROs following BCS.

Patients and Methods

Women with stage 0–III breast cancer undergoing BCS who completed a BREAST-Q PRO measure from 2010 to 2016 were identified from a prospective database. Baseline characteristics were compared between women who underwent one BCS and those who underwent ≥ 1 re-excision surgery for positive margins (R-BCS). Linear mixed models were used to analyze associations between number of excisions and BREAST-Q scores over time.

Results

Of 2543 eligible women, 1979 (78%) had one BCS and 564 (22%) had R-BCS. Younger age, lower BMI, surgery pre-SSO Invasive Guidelines issuance, ductal carcinoma in situ (DCIS), multifocal disease, radiation therapy receipt, and endocrine therapy omission were more common in the R-BCS group. Breast satisfaction and sexual well-being were lower in the R-BCS group 2 years postoperatively. There were no differences in psychosocial well-being between groups over 5 years. On multivariable analysis, re-excision was associated with lower breast satisfaction and sexual well-being (p= 0.007 and p= 0.049, respectively), but there was no difference in psychosocial well-being (p= 0.250).

Conclusions

Women with R-BCS had lower breast satisfaction and sexual well-being 2 years postoperatively, but this difference did not remain long term. Psychosocial well-being in women who underwent one BCS were largely comparable over time to the R-BCS group. These findings may help in counseling women who are concerned about satisfaction and quality-of-life outcomes with BCS if re-excision is necessary.

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Acknowledgment

The preparation of this study was supported in part by NIH/NCI Cancer Center Support Grant P30CA008748 to Memorial Sloan Kettering Cancer Center.

Funding

NIH/NCI Cancer Center Support Grant, P30CA008748.

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Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Regina Matar-Ujvary MD & Mary L. Gemignani MD, MPH

  2. Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Kathryn Haglich BS, MS & Jonas A. Nelson MD, MPH

  3. Department of Surgery, University of Washington, Seattle, WA, USA

    Meghan R. Flanagan MD, MPH

  4. Breast Surgery, New York-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA

    Sarah Fuzesi MD

  5. Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Varadan Sevilimedu MBBS, DrPH

Authors
  1. Regina Matar-Ujvary MD
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  2. Kathryn Haglich BS, MS
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  3. Meghan R. Flanagan MD, MPH
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  4. Sarah Fuzesi MD
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  5. Varadan Sevilimedu MBBS, DrPH
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  6. Jonas A. Nelson MD, MPH
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  7. Mary L. Gemignani MD, MPH
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Corresponding author

Correspondence to Mary L. Gemignani MD, MPH.

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Disclosure

This study was presented in poster format at the 44th Annual San Antonio Breast Cancer Symposium, December 7-10, 2021, San Antonio, TX. All authors have no conflicts of interest or commercial interests to disclose.

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Matar-Ujvary, R., Haglich, K., Flanagan, M.R. et al. The Impact of Breast-Conserving Surgery Re-excision on Patient-Reported Outcomes Using the BREAST-Q. Ann Surg Oncol 30, 5341–5349 (2023). https://doi.org/10.1245/s10434-023-13592-3

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  • DOI: https://doi.org/10.1245/s10434-023-13592-3

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