Therapeutic mammaplasty--a systematic review of the evidence

Therapeutic mammaplasty (TM) is suggested to have a number of advantages by comparison to conventional breast conserving surgery (BCS), but there is a paucity of published data on TM which evaluates oncologic and aesthetic end-points, and outcomes remain uncertain.

Online databases were searched to identify studies regarding TM. Identified studies were scrutinised and key data relating to oncologic and aesthetic outcome, patient reported outcome measures (PROMs) and study design were recorded.

Most identified studies were retrospective, and no randomised controlled trials were found. Mean tumour size was reported in nine of 20 studies, with only four of 20 reporting on mean surgical margins obtained at TM. Management of a positive surgical margin following TM varied considerably between studies. With a median follow-up of between 13 and 68 months, rates of local recurrence, metastasis and death were comparable to BCS. Aesthetic assessment was complete in only three of 15 studies. PROMs and aesthetic outcomes were evaluated using non-validated tools. All studies evaluating aesthetic outcome contained evaluation by clinicians, but included patient views in only 10/15 studies. Complication rates ranged between 10% (6/63) and 91% (28/31), but delayed adjuvant treatment in only 6% of cases.

Identified studies fail to clarify indications or confirm the suggested improved outcomes from TM over BCS, although oncological outcomes appear comparable. High complication rates impact little on delivery of adjuvant therapies. Prospective data registration is required to define indications and quality assurances, and support development of specific assessment tools for this technique in the future.