Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery

Since breast-conserving surgery demonstrated identical long term survival on seven randomized trials, it has become the preferred treatment option over mastectomy. Oncoplastic surgery applying simple reshaping and displacement techniques allows inclusion of patients with large tumors in the group selected for breast-conserving surgery. However, the cosmetic outcome and the degree of patient satisfaction, especially in relation to the original breast volume and the percentage of breast tissue excised is not well documented.

The present study was designed to assess patient satisfaction with cosmetic outcome after oncoplastic breast-conserving surgery, and to establish the correlation between patient satisfaction and percentage of breast volume excision (PBVE).

A total of 169 Asian patients underwent breast-conserving surgery for primary breast cancer at either United Christian Hospital (UCH) or Hong Kong Sanatorium and Hospital (HKSH) from Nov 2007 to Jan 2008 by two breast surgeons. Among this group, 162 patients with breast-conserving surgery incorporating oncoplastic techniques were prospectively recruited for study. Tumor characteristics, patient satisfaction, cosmetic outcome and surgeons' score were prospectively documented. Breast volume (BV) calculation was based on preoperative mammography (BV = 1/3pir(1)r(2)h), which was validated by our previous study to correlate strongly with actual BV (r = 0.98). PBVE was calculated by dividing the fresh specimen weight by the calculated BV. A standardized questionnaire was used to assess patient satisfaction and surgeons' score on cosmetic outcome during the first 1-3 postoperative months. The correlation between PBVE and patient satisfaction was studied.

The median age of the group of patients studied was 52 years (range: 20-96 years). The median tumor size was 2.5 cm (range: 0.6-5 cm). The median breast volume was 493 cm(3) (range: 210-1,588 cm(3)). The median PBVE was 7.4% (range: 1-42%), and 94% of patients were very satisfied or satisfied with the cosmetic outcome. In addition, 85% of patients felt that the treated breast was nearly identical with or only slightly different from the untreated breast. In scoring breast shape, surgeons indicated that 89% of the treated breasts were identical to or only minimally different from the untreated breast. Patient satisfaction decreased significantly when the PBVE exceeded 20%. Neither tumor location nor distance of the tumor from the nipple had any effect on patient satisfaction.

This study showed high patient satisfaction and good cosmetic outcome after oncoplastic breast-conserving surgery, even in small breast sized Asian women. The application of oncoplastic technique allows large volume excision, and satisfaction remains high with breast volume excision less than 20% regardless of tumor location or distance of the tumor from the nipple. More complicated oncoplastic techniques, e.g., breast replacement, might be required if breast volume excision exceeds 20%.