[Esthetic results of the conservative treatment in breast carcinoma]

To assess the factors affecting cosmetic results after conservative breast cancer treatment, the findings of 164 patients submitted to conservative surgery plus radiotherapy 1988 to 1992, were reviewed. Surgery, except for one wider excision, consisted in quadrantectomy; the whole breast was given 50 Gy with telecobalt therapy and the 10-Gy boost on the surgical bed was administered with a Roentgen therapy unit. In 119 patients hormone therapy and/or chemotherapy were combined. The middle and median follow-up rates were 43.2 and 38 months, respectively. Outcomes were graded as excellent, satisfactory and poor (on the basis of asymmetry, volume loss and nipple retraction) and correlated with the Stepwise Logistic Regression method with patients' age, tumor size and site, combined chemotherapy and/or hormone therapy, surgical technique (axillary "en bloc" dissection) and surgery department. Lower external quadrant site, surgery department and some combined treatments (CMF and anthracycline plus Tamoxifen) bore a major influence on prognosis. Lower external quadrant site as a factor influencing treatment outcome is not reported in similar literature studies. Different treatment results in different surgery departments are certainly not related to different surgical techniques. The influence of combined adjuvant treatments on cosmetic results, related to the interaction with radiation damage repair, may worsen the cosmetic result, which is one of the main goals of conservative treatment. We hope that the whole treatment course (surgery, irradiation, medical treatment) can be customized to lesion characteristics and to patient's needs.