Early Breast Cancer: Cosmetic and Functional Results After Treatment by Conservative Techniques

Abstract

patients with early breast cancer were referred to the Department of Radiation Oncology at Westmead Hospital for radiation therapy following initial tumour excision. After a median follow-up of 26 months, five patients developed a loco-regional recurrence (4%) and nine developed metastatic disease but with local control.There were 105 eligible patients who were sent a letter/questionnaire which included: a request to attend a clinic, to allow an objective assessment of the cosmetic result of the treated breast by two clinicians, questions regarding breast function as it affected quality of life, and a request that they undertake a self-assessment of the treated breast from a cosmetic point of view.Seventy-six patients attended for assessment of the following factors: whether surgery was optimal as determined by predefined criteria, measurement of breast oedema, arm oedema, breast retraction and telangiectasia, and an overall cosmetic assessment performed independently by both a radiation oncologist and surgeon. A physician not involved in management undertook a cosmetic assessment using standard photographs.Approximately 20% of patients replied that their choice of clothing had been affected by treatment, 10% were embarrassed and 70% experienced some continuing tenderness or discomfort in their treated breast.The extent of surgery was judged to be suboptimal in 22% but that proportion increased to 34% of cases referred from external clinics. The overall incidence of moderate or severe breast oedema was 9%, breast retraction So%, telangiectasia 16% and arm oedema 21%. Those patients with longer follow-up (i.e., > 36 months) had a higher incidence of breast retraction (67%). telangiectasia (30%) and arm oedema (33%) but less breast oedema (7%).As expected, the patients rated the appearance of their breast more favourably than did clinicians. Overall, the result was rated as good or excellent by 75% of patients compared with 55% when the assessment was made by a surgeon or radiation oncologist.The main factor identified as contributing to a poor cosmetic result was the area of the iridium implant. The area of implant was larger when suboptimal surgery had been carried out, the main component of which was excessive length of scar. LARSOND., WEINSTEIN M., GOLDLIERC I., etal. (1986) Edema of the arm as a function of the extent of axillary surgery in patients with stage 1-11 carcinoma of the breast treated with primary radiotherapy. Inr. Radiar. Oncol. Biol. Phys. 12, 1575-82. 31. J . 119-28.

Lymphedema and breast cancer: a review of the literature

“…It may present as heaviness or aching of the arm, swelling of fingers, or sometimes as difficulty putting on long sleeves. The risk of severe lymphedema is approximately 6% after single treatment, but goes up to 30% after the combination of surgery (axillary clearance) and radiotherapy treatment [80]. Lymphedema may occur at any time after treatment (even 20-30 years after axillary treatment).…”

Assessment of Breast Aesthetics

“…20 It is also noteworthy that there is a lack of concordance between different observer groups. [22][23][24] Sneeuw et al reported that patients demonstrated significantly greater variation ( Ͻ 0.10) in aesthetic scoring compared with professionals ( ϭ 0.64) using four-point subscales. 20 In contrast, a study by Cohen et al, which used a global fivepoint scale, reported greater internal consistency among patients (Cronbach ␣ ϭ 0.92) compared with medical professionals (Cronbach ␣ ϭ 0.74 to 0.89).…”

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“…This procedure involves removal of excess breast tissue to reshape and lift the breasts. Benefits of the surgery include increased comfort in your upper back, neck and shoulders; less shoulder pressure from bra straps; increased ability to exercise and participate in physical activities; and a more positive self-image 20 . The surgery may also help you breathe and sleep easier.…”

“…Follicular micro or mini grafts are used to provide the desired density of hair. Since the new transplanted hair is from one's own body, it will grow naturally with time & one can shampoo, trim or even shave it 5 .…”

“…The skin is gently separated from the underlying muscles of the face and any excess fat is removed. The skin is then lifted up and pulled back, with the excess trimmed off 5,12 . The cut is then stitched closed.…”