Cosmetic outcomes of rotation flap and suture scaffold for breast-conserving therapy in the lower quadrants

Achieving good cosmetic outcomes after breast-conserving therapy (BCT) is crucial, particularly for tumors in the lower quadrant (BD region). This study evaluated the cosmetic outcomes of two oncoplastic techniques in patients with breast cancer in the BD region: rotation flap (RF) and suture scaffold (SS).

This retrospective cohort study, conducted at a single institution, initially identified 45 consecutive female patients with primary unilateral breast cancer who underwent breast-conserving therapy using the RF (n = 22) or SS (n = 23) methods. After excluding those with tumors located outside the BD region and one patient lost to follow-up from each group, 25 patients (RF, n = 16; SS, n = 9) were included in the analysis. The cosmetic outcome at 6-12 months postoperatively was evaluated by two independent reviewers using the Harvard Breast Cosmesis Scale. Inter-rater agreement was quantified using quadratically weighted Cohen's κ values.

RF (n = 16) resulted in favorable cosmesis (81% excellent/good and 0% poor), while SS (n = 9) showed 56% excellent/good and 22% poor. The weighted kappa (κw) indicated a high inter-rater agreement for both RF (n = 16; κw​ = 0.897, p = 0.000331) and SS (n = 9; κw​ = 0.838, p = 0.0109). A comparison of these kappa coefficients revealed no statistically significant heterogeneity (p = 0.886; 95% CI for difference: -0.750-0.868). Complications were infrequent (RF, 6%; SS, 0%).

In this single-center study, RF generally provided favorable cosmetic outcomes for BCT in the BD region. SS application resulted in more variable cosmetic results. RF may be a promising option for achieving good cosmesis at this anatomical location.