Factors associated with breast symmetry after breast conserving surgery for cancer

Breast-conserving surgery (BCS) is the standard of care for treatment of early breast cancer. Factors associated with poor cosmetic results are not well described. The aim of the present study was to evaluate factors associated with breast asymmetry after BCS for invasive breast cancer.

Patients who underwent unilateral BCS for invasive breast cancer and completed at least six months after radiation therapy were included. After informed consent, patients answered a validated questionnaire for breast symmetry. Demographic, clinical-pathological and surgical variables were recorded. Bilateral breast volume was measured in office and volume difference > 20% was considered objective asymmetry. Variables were analyzed with χ(2) test and significance was considered at p < 0.05.

One-hundred and thirtythree patients were included. Mean patient age was 56 ± 9 years. Most patients were married (78%) with educational level of high school or greater (50.8%). Mean body mass index (BMI) was 25 ± 8. Twelve percent of patients underwent ≥ 2 surgical procedures. Eighty-one percent of patients had tumors > 1 cm. Twenty-two percent of patients had objective breast asymmetry and 27% perceived themselves with asymmetry. There were no significant relationship between objective and subjective asymmetry. The only variable significantly associated with perception of breast asymmetry was educational level ≥ high school.

There was no relationship between subjective and objective breast asymmetry after BCS, suggesting that cosmetic results are mainly related to patient subjective perception. The only variable associated with subjective breast asymmetry was high educational level, possibly because higher cosmetic expectations in this group of patients.