Factors affecting cosmetic outcome in breast-conserving cancer treatment — objective quantitative assessment

Abstract

A battery of objective measurements of cosmetic outcome was performed on 114 patients who had been treated by breast-preservation techniques for breast cancer. Cosmetic breast retraction, as determined by Breast Retraction Assessment (BRA) measurements, was significantly greater in patients who underwent extensive primary tumor resection, were more than 60 years old, weighed more than 150 lbs, or had a primary tumor in an upper breast quadrant. While use of a local RT boost, per se, was not a significant factor, those patients with high dose and/or large volume local boosts more frequently had marked retraction. Breast telangiectasia and depigmentation (T/D) was related to use of a local RT boost, patient age greater than 60 years, and use of separate nodal RT fields. Breast T/D was significantly more frequent with use of electron beam local RT boost which delivered a boost skin dose exceeding 1600 cGy. Objective quantitative assessments, such as BRA and T/D area measurements, provide data to determine factors related to each type of cosmetic change and thus provide guidelines for optimizing cosmetic outcome. Limiting the extent of primary tumor resection may minimize the amount of breast retraction. Omitting the local RT boost, particularly large volume, high dose boosts, may reduce the frequency of marked cosmetic retraction and skin T/D.

Immediate breast reconstruction using autologous free dermal fat grafts provides better cosmetic results for patients with upper inner cancerous lesions

“…Assessment of the cosmetic results using the ABNSW system a large excisional volume (extent of surgery), re-excision, the number of procedures, surgical techniques, postoperative complications, tumor size, location of the tumor, radiation dose, inhomogeneity, radiotherapy techniques (fraction schedules, number of radiotherapy fi elds), age, race (white patients had better cosmetic results than black patients), tamoxifen, and patient sensitivity. [25][26][27][28][29][30][31][32][33][34] Above all, the factors besides the surgical procedure, such as tumor location, tumor size, and breast size, are interesting because we have been considering how to establish new methods that are useful for every breast cancer lesion. Several authors have reported an association between a large breast size and poor cosmetic outcome after breast-conserving surgery and radiotherapy, and this effect can be explained by the greater dose inhomogeneity that arises as a result of greater tangent separation.…”

A Comparison of Ink-Directed and Traditional Whole-Cavity Re-Excision for Breast Lumpectomy Specimens With Positive Margins

“…13,21 When patients present with nonpalpable, mammographically detectable lesions and undergo diagnostic needle localized lumpectomies, positive margins are found in 55% to 89% of the specimens. 12,20,[22][23][24][25] If a diagnosis of malignancy is made by core biopsy, followed by a needle localized therapeutic lumpectomy, several studies have shown that the incidence of positive margins can be decreased. For example, 0 of 7 patients, 22 2 of 19 patients (11%), 25 and 16 of 56 patients (29%) 23 had positive margins when a therapeutic needle localized lumpectomy was performed.…”

Late Toxicity of Radiotherapy: A Problem or a Challenge for the Radiation Oncologist?

“…The rate of poor or fair cosmetic outcome in most series is 15-20% or less [7]. Surgical factors as the extent of breast tissue removed and scar orientation impact mostly on breast appearance and cosmetic outcome [8][9][10].…”