Evaluating outcomes after correction of the breast conservation therapy deformity

In an effort to preserve the native breast shape, most women with breast cancer are treated with breast conservation therapy (BCT). However, a breast deformity can develop after BCT and can be challenging to repair. The goal of this review was to evaluate outcomes based on the extent of the deformity and reconstructive technique.

Sixty-three patients treated for a BCT deformity between 2003 and 2012 were included. Data queried included demographics, extent of the deformity, type of reconstruction, and outcomes. A panel judged aesthetic outcomes, and patient satisfaction was determined using the validated Breast Q reconstruction questionnaire. Comparisons were made across reconstructive techniques.

There were 22 grade I/II deformities, and 29 grade III/IV deformities. Local scar revision procedures and fat grafting were more common for grade I, and myocutaneous flaps were more common for grade IV. Bilateral reduction techniques (n = 20) and contralateral reduction only (n = 6) were most common for grade II/III defects. Augmentation was used in 9 grade III patients. Combined reconstructive techniques were required in 23% of the patients. Eighty-nine percent had a contralateral symmetry procedure. Complications occurred in 34.9%, with no significant variation across the different modes of reconstruction. There was a trend toward higher complication rates with increasing defect severity (0% for grade 1, 32% for grade 2, 39% for grade 3, and 50% for grade 4). Patients required an average of 1.3 procedures (range, 1-3), at an average follow-up of 2.5 years. Eighty percent of patients had only 1 reconstructive operation, 14% required a second operation, and 6% a third. Patient satisfaction was generally high and the mean aesthetic rating was 5 out of 7, and trended down with the extent of the deformity. Patients who underwent contralateral reduction only had the highest aesthetic scores (5.8/7).

Reconstructive options for the correction of BCT deformities are numerous and need to be appropriately tailored for each patient in part based on the extent of the deformity. Although revisions are not uncommon, good patient satisfaction and esthetic outcomes can be achieved.