Therapeutic mammaplasty for breast cancer: oncological and aesthetic outcomes

Therapeutic mammaplasty (TM) for breast cancer is a widely practiced oncoplastic technique. Patient selection criteria and method of margin assessment are not clearly established. The aim of our review was to analyse oncological and aesthetic outcomes over a 7 year period.

We conducted a retrospective review of 251 breast cancer patients who underwent TM from 2002 to 2009 at the Netcare Breast Care Centre, Johannesburg. Primary chemotherapy was used to downsize large tumours. Intraoperative margin assessment was performed. Statistical analysis was performed using Kaplan-Meier estimates. Cosmetic outcomes were assessed by an independent review panel using photographic material.

Mean tumour size was 15.4 mm. Mean resection weight was 237 g. Sixty-four (25.5 %) patients received primary chemotherapy. Mean margin taken was 15 mm. The back-to-theatre rate was 2 % (5 cases). A total of 222 patients underwent bilateral procedures. Contralateral occult disease was identified in six cases (2.4 %). The early (<2 months) complication rate was 3.2 %. Late complications were related to adjuvant radiotherapy (20.7 %). Mean follow-up was 50 months. The recurrence rate was 4 %. Five of six patients with locoregional recurrence had DCIS at initial surgery. The mortality rate was 3.2 %. The overall survival rate was 96.4 % and the metastasis-free survival rate was 94.6 %. Acceptable aesthetic results were achieved in 96 % of the patients.

Primary chemotherapy allowed for TM in patients with large tumours. Intraoperative margin assessment decreased reoperation rate. Contralateral matching procedures resulted in histological detection of occult disease. TM is an oncologically appropriate and cosmetically favourable technique.