Outcome reporting in therapeutic mammaplasty: a systematic review

Abstract

Background Therapeutic mammaplasty (TM) is an oncological procedure which combines tumour resection with breast reduction and mastopexy techniques. Previous systematic reviews have demonstrated the oncological safety of TM but reporting of critically important outcomes, such as quality of life, aesthetic and functional outcomes, are limited, piecemeal or inconsistent. This systematic review aimed to identify all outcomes reported in clinical studies of TM to facilitate development of a core outcome set. Methods Medline, EMBASE, CINAHL and Web of Science were searched from inception to 5 August 2020. Included studies reported clinical outcomes following TM for adult women. Two authors screened articles independently for eligibility. Data were extracted regarding the outcome definition and classification type (for example, oncological, quality of life, etc.), time of outcome reporting and measurement tools. Results Of 5709 de-duplicated records, 148 were included in the narrative synthesis. The majority of studies (n = 102, 68.9 per cent) reported measures of survival and/or recurrence; approximately three-quarters (n = 75, 73.5 per cent) had less than 5 years follow-up. Aesthetic outcome was reported in half of studies (n = 75, 50.7 per cent) using mainly subjective, non-validated measurement tools. The time point at which aesthetic assessment was conducted was highly variable, and only defined in 48 (64.0 per cent) studies and none included a preoperative baseline for comparison. Few studies reported quality of life (n = 30, 20.3 per cent), functional outcomes (n = 5, 3.4 per cent) or resource use (n = 28, 18.9 per cent). Conclusion Given the oncological equivalence of TM and mastectomy, treatment decisions are often driven by aesthetic and functional outcomes, which are infrequently and inconsistently reported with non-validated measurement tools.

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“…Se sabe que el estrés psicosocial es un factor predisponente y de riesgo potencial para presentar y exacerbar los síntomas de la DP por somatización del evento desencadenante (1,40,52,53), por lo que no es una coincidencia que la mayor parte de las estudiantes en este estudio pertenezca a la facultad de medicina, cuyo estilo de vida es particularmente estresante, más que otras carreras, como ha sido reportado por varios autores (47,54). Esto se ha visto reforzado sobre todo en estos últimos años, considerando las grandes demandas académicas que atraviesan en su día a día, laborales y emocionales durante las pasantías, la paralización frecuente de las clases presenciales, las tomas de decisiones constantes frente al sufrimiento de los pacientes asignados, insatisfacción con la elección universitaria y profesional, así como las condiciones de los puestos de trabajo a nivel hospitalario y en las aulas de clases, carentes de recursos básicos, en su gran mayoría, y ahora agregándose la pandemia por la COVID-19, lo que hace que la población de los profesionales de la salud, incluyendo a los estudiantes, sea caracterizada como vulnerable al momento de somatizar y exacerbar signos y síntomas presentes (54)(55)(56)(57)(58)(59).…”

“…El riesgo de infecciones también fue significativamente mayor (56). Otras complicaciones asociadas fueron alteraciones estéticas de la cicatriz luego de la mastectomía y peores condiciones para realizar los procedimientos reconstructivos (57).…”

Association of travel time, patient characteristics, and hospital quality with patient mobility for breast cancer surgery: A national population‐based study

“…Although not standardized, there is evidence that oncoplastic techniques, such as therapeutic mammoplasty and autologous reconstructions, are associated with better patient outcomes. Therefore, it is likely that this knowledge is being informally disseminated through primary care networks and patient groups, and the availability of these oncoplastic techniques in hospitals could confer a competitive advantage increasing market share 10,35,39,40 . Patients undergoing BCS were not more likely to receive care at multidisciplinary cancer centers, where they would be able to have all their care (surgery and radiotherapy) at one location.…”

Conservative Treatment of Breast Cancer and Oncoplasty at the Teaching Hospital Mother and Child of Jeanne Ebori Foundation in Libreville (Gabon)

“…Oncoplastic breast surgery is a new trend in conventional breast conserving surgery that merges the concepts of oncology and plastic surgery to achieve satisfactory results both oncologically and aesthetically [10]. It allows the removal of significantly larger tumours because it has become an alternative to mastectomy for tumours larger than 4 cm and for locoregional tumours [5] [9] [10] [15] [16] [17]. In addition, it provides quality of life scores comparable to conventional breast-conserving surgery, while safely allowing resection of larger tumours [19].…”