Cosmesis and satisfaction after breast conserving surgery (BCS) correlates with the percentage of breast volume lost

Cochrane, R.; Valasiadou, P.; Wilson, Ajay; Al-Ghazal, Sharif; Macmillan, R.D.

doi:10.1016/s0959-8049(01)80124-6

Cited by 12 publications

(19 citation statements)

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“…With regard to the absolute resection volumes, it is striking that in over a third of our patients, more than 85 cm 3 was excised. In these patients, the cosmetic outcome will definitely be impaired as shown in earlier studies (11,13,15,17). In almost all these patients, excess tissue was excised; over half of these patients presented a tumor size of <2 cm, and a 33.51 cm 3 volume resection would have been sufficient.…”

Section: Discussionmentioning

confidence: 93%

“…Cosmetic failures are defined as pronounced breast asymmetry and skin alterations such as retraction of the scar. Factors determining these cosmetic outcomes include the site of the tumor in the breast, the volume of the resected breast tissue, postoperative wound complications and the amount of radiotherapy, including the radiotherapy boost (10)(11)(12)(13)(14)(15)(16)(17). Overall, the key determinant of cosmetic outcome is the total volume of breast tissue resection.…”

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confidence: 99%

“…Overall, the key determinant of cosmetic outcome is the total volume of breast tissue resection. A number of studies found that if the size of the lump exceeds 50-85 cm 3 , the rate of cosmetic failure is significantly higher, regardless of the size of the breast (11,13,15,17).…”

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confidence: 99%

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Excessive Resections in Breast-Conserving Surgery: A Retrospective Multicentre Study

et al. 2011

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The main determinant of cosmetic outcomes following breast-conserving surgery (BCS) for breast cancer is the volume of resection. The importance of achieving optimal oncological control may lead to an unnecessarily large resection of breast tissue. The aim of this study is to evaluate excess resection volume in BCS for cancer by determining a calculated resection ratio (CRR). This retrospective study was conducted in four affiliated institutions and involved 726 consecutive patients with T1-T2 invasive breast cancer treated by BCS between January 2006 and 2009. The pathology reports were reviewed for tumor palpability, tumor size, surgical specimen size, and oncological margin status. The optimal resection volume (ORV) was defined as the spherical tumor volume with an added 1.0 cm margin of healthy breast tissue. The total resection volume (TRV) was defined as the ellipsoid volume of the surgical specimen. CRR was determined by dividing the TRV by the ORV. Of all tumors, 72% (525/726) were palpable, and 28% (201/726) were nonpalpable. The tumor stage was T1 in 492 patients (67.8%) and T2 in 234 patients (32.2%). The median CRR was 2.5 (0.01-42.93). Margin status was positive or focally positive in 153 patients (21.1%). Lower tumor stage was associated with a higher CRR (factor 0.61 [p < 0.0001] and a lower positive margin rate [p = 0.064]). Accordingly, the median CRR of the nonpalpable lesions was higher than that of the palpable lesions (3.1 and 2.2, respectively; p < 0.01), and the involved margin rate was lower (17.4% and 22.5%, respectively; p = 0.13). Of patients with a CRR >4.0, 10.7% still had tumor involved margins. This study clearly shows that BCS is associated with excessive resection of healthy breast tissue while clear margins are not assured. Surgical factors should be modified to improve surgical accuracy.

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Section: Discussionmentioning

confidence: 93%

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confidence: 99%

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Excessive Resections in Breast-Conserving Surgery: A Retrospective Multicentre Study

et al. 2011

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“…When applied in such cases, cosmetic outcomes are poor with postoperative deformity or asymmetry of bilateral breasts, dimpling of the skin and displacement of the NAC. [13][14][15] Although reduction mammoplasty can be an appropriate surgical approach, additional reduction surgery of the contralateral breast becomes mandatory in such cases to secure bilateral symmetry. However, many patients are reluctant to undergo additional surgery involving the contralateral healthy breast and, sometimes, patients who have small breasts and mild or no ptosis tend to refuse further surgery of opposite breast.…”

Section: Discussionmentioning

confidence: 99%

Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer

2020

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We propose a novel oncoplastic surgical technique, dermoglandular rotation flap with subaxillary advancement flap, as a feasible one‐stage operation. Breast conserving surgery, incorporating the dermoglandular rotation flap with subaxillary advancement flap, was performed in 49 female patients with breast cancer, between January and December 2015. After a full‐thickness fibroglandular resection including the tumor, an inferior‐ or a superior‐based rotation flap was performed according to the location of the defect. The subaxillary flap consisted of skin, dermis, and subcutaneous fat tissue and was mobilized from the chest wall musculature. Since subaxillary skin has greater redundancy, it can be easily moved to reach the lateral aspect of the breast. Approximation of the subaxillary flap to the lateral side of rotated dermoglandular flap served to relieve skin tension and avoid displacement of the nipple‐areola complex (NAC). Consequently, there was wider dermoglandular tissue rotation and efficient filling of defect without any significant postoperative deformity. The mean follow‐up period was 46.5 ± 3.1 months (range, 42.4‐52.1 months). Mean tumor size, on pathology, was 2.1 cm (range, 0.4‐6.0). Mean excised breast tissue weight was 78.4 g (range, 28.6‐195.0). More than half of the patients (51%) studied had excised breast tissue weighing more than 80 g. None of the included patients had positive surgical margins in final pathologic reports. Most patients answered excellent or good for self‐estimated cosmetic outcomes including symmetry of the breast and NAC, breast shape, scarring, and overall satisfaction. A modified dermoglandular rotation flap technique along with subaxillary advancement flap is a feasible and effective oncoplastic technique for breast cancers.

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“…Most frequently reported patient-related factors influencing final cosmetic result are age, weight, body mass index, breast size, and menopausal status. Tumor size, surgical specimen weight, scar visibility, use of chemotherapy, and radiation dose have been reported as tumor-or therapy-related factors [4][5][6][7][8]. Data of the last 3 decades show that some 70%-93% of the patients during a follow-up period of about 3-4 years found the cosmetic result of BCT including irradiation acceptable Correspondence [4,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Cosmetic Consequences of Breast-Conserving Treatment for Breast Cancer: Something Worth Talking About

et al. 2018

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Background Breast‐conserving treatment (BCT) for breast cancer can lead to deformation of the treated breast, resulting in patient dissatisfaction with the final cosmetic outcome. Currently, literature on the specific information needs of patients concerning the cosmetic effects of BCT is lacking. The aim of the present study was to investigate the information needs of breast cancer patients regarding the long‐term cosmetic outcome after BCT. Subjects, Materials, and Methods The data from 115 women who had undergone BCT in a general teaching hospital breast cancer unit in The Netherlands were studied. Structured questionnaires and semi‐structured interviews were conducted between October 2012 and April 2013. A mixed model of quantitative and qualitative research was used to explore patient‐reported information needs. A phenomenological approach was used to analyze the qualitative data. Results This study shows that women undergoing BCT want to discuss long‐term cosmetic effects. Most patients appreciate such information immediately after the diagnosis. Patients indicated that it is also important to pay attention to the cosmetic effects during the follow‐up visits, because deformation of the breast can also occur at a later stage. Furthermore, half the patients indicated that they would not likely raise the subject of cosmetic effects of the treatment themselves. Conclusion Breast cancer patients have a need for long‐term attention for cosmetic outcome of BCT, which should be tailored during the treatment and follow‐up process. Implications for Practice Currently, no literature exists concerning patients' needs for information regarding the cosmetic effects of breast‐conserving therapy (BCT). Bringing up the cosmetic effects of BCT by health care professionals does not appear to be a standard part of treatment and follow‐up. It is expected that the quality of care and life will be improved by providing information and guidance regarding the cosmetic outcome of BCT within the existing structure of the breast cancer pathway. Discussion and visualization of the cosmetic effects prior to treatment will lead to more realistic expectations, and as a result, secondary interventions, such as partial prostheses and plastic surgery, may be easier to discuss and accept.

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Cosmesis and satisfaction after breast conserving surgery (BCS) correlates with the percentage of breast volume lost

Cited by 12 publications

References 0 publications

Excessive Resections in Breast-Conserving Surgery: A Retrospective Multicentre Study

Excessive Resections in Breast-Conserving Surgery: A Retrospective Multicentre Study

Dermoglandular rotation flap with subaxillary advancement flap as an oncoplastic technique for breast cancer

Cosmetic Consequences of Breast-Conserving Treatment for Breast Cancer: Something Worth Talking About

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