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Published in: World Journal of Surgical Oncology 1/2019

Open Access 01-12-2019 | Breast Cancer | Research

Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™

Authors: Anna Gardfjell, Cecilia Dahlbäck, Kristina Åhsberg

Published in: World Journal of Surgical Oncology | Issue 1/2019

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Abstract

Background

Oncoplastic breast-conserving surgery allows larger resections in unfavorable locations, with an improved chance of preserving esthetics. Indications and timing for potential contralateral surgery to obtain symmetry are not clear. The aim of this study was to evaluate patient satisfaction after unilateral oncoplastic volume displacement surgery, to investigate potential risk factors for lower patient satisfaction and to assess patient wish for contralateral surgery.

Method

A cohort of 144 women, consecutively treated for breast cancer with unilateral breast-conserving oncoplastic volume displacement surgery, followed by radiotherapy and with an unoperated contralateral breast, was sent the BREAST-Q™ breast-conserving therapy (BCT) and a study-specific questionnaire. In all, 120 women (83%) responded. For these women, the median value for resected specimen weight was 92 g (range 14–345) and for the estimated percentage of the breast volume excised 15% (range 3–35%).

Results

The median patient-reported score for “Satisfaction with breast” (BREAST-Q™ BCT) was 74/100. Factors associated with a score below median value in a simple logistic regression model adjusted for age and BMI were axillary clearance (OR 2.46, 95% CI 1.09–5.56), neoadjuvant chemotherapy (OR 3.26, 95% CI 1.15–9.24), and low breast density (OR 2.32 95% CI 1.02–5.29). Thirteen women (11%) were interested in contralateral surgery.

Conclusion

Most patients in this study cohort, who had undergone breast-conserving therapy with oncoplastic volume displacement techniques, were satisfied with their breasts without surgery to the contralateral breast. This indicates that contralateral surgery to achieve symmetry only should be performed after individual evaluation and as a delayed procedure.
Literature
2.
go back to reference Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.CrossRef Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med. 2002;347(16):1233–41.CrossRef
3.
go back to reference Litiere S, Werutsky G, Fentiman IS, Rutgers E, Christiaens MR, Van Limbergen E, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13(4):412–9.CrossRef Litiere S, Werutsky G, Fentiman IS, Rutgers E, Christiaens MR, Van Limbergen E, et al. Breast conserving therapy versus mastectomy for stage I-II breast cancer: 20 year follow-up of the EORTC 10801 phase 3 randomised trial. Lancet Oncol. 2012;13(4):412–9.CrossRef
4.
go back to reference Schover LR. The impact of breast cancer on sexuality, body image, and intimate relationships. CA Cancer J Clin. 1991;41(2):112–20.CrossRef Schover LR. The impact of breast cancer on sexuality, body image, and intimate relationships. CA Cancer J Clin. 1991;41(2):112–20.CrossRef
5.
go back to reference Al-Ghazal SK, Fallowfield L, Blamey RW. Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity? Eur J Surg Oncol. 1999;25(6):571–3.CrossRef Al-Ghazal SK, Fallowfield L, Blamey RW. Does cosmetic outcome from treatment of primary breast cancer influence psychosocial morbidity? Eur J Surg Oncol. 1999;25(6):571–3.CrossRef
6.
go back to reference Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 1998;41(5):471–81.CrossRef Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 1998;41(5):471–81.CrossRef
7.
go back to reference Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10(2):124–6.CrossRef Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10(2):124–6.CrossRef
8.
go back to reference Chan SW, Cheung PS, Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg. 2010;34(7):1447–52.CrossRef Chan SW, Cheung PS, Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg. 2010;34(7):1447–52.CrossRef
9.
go back to reference Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90(12):1505–9.CrossRef Cochrane RA, Valasiadou P, Wilson AR, Al-Ghazal SK, Macmillan RD. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90(12):1505–9.CrossRef
10.
go back to reference Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA. The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol. 1999;25(6):566–70.CrossRef Al-Ghazal SK, Blamey RW, Stewart J, Morgan AA. The cosmetic outcome in early breast cancer treated with breast conservation. Eur J Surg Oncol. 1999;25(6):566–70.CrossRef
11.
go back to reference Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JH, Jager JJ, et al. The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ‘boost vs. no boost’ trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol 2000;55(3):219–232.CrossRef Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JH, Jager JJ, et al. The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC ‘boost vs. no boost’ trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol 2000;55(3):219–232.CrossRef
12.
go back to reference Dahlback C, Manjer J, Rehn M, Ringberg A. Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery. World J Surg Oncol. 2016;14(1):303.CrossRef Dahlback C, Manjer J, Rehn M, Ringberg A. Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery. World J Surg Oncol. 2016;14(1):303.CrossRef
13.
go back to reference Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17(5):1375–91.CrossRef Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM. Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol. 2010;17(5):1375–91.CrossRef
14.
go back to reference Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg. 2008;206(2):274–80.CrossRef Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg. 2008;206(2):274–80.CrossRef
15.
go back to reference Ozmen T, Polat AV, Polat AK, Bonaventura M, Johnson R, Soran A. Factors affecting cosmesis after breast conserving surgery without oncoplastic techniques in an experienced comprehensive breast center. Surgeon. 2015;13(3):139–44.CrossRef Ozmen T, Polat AV, Polat AK, Bonaventura M, Johnson R, Soran A. Factors affecting cosmesis after breast conserving surgery without oncoplastic techniques in an experienced comprehensive breast center. Surgeon. 2015;13(3):139–44.CrossRef
16.
go back to reference Yi A, Kim HH, Shin HJ, Huh MO, Ahn SD, Seo BK. Radiation-induced complications after breast cancer radiation therapy: a pictorial review of multimodality imaging findings. Korean J Radiol. 2009;10(5):496–507.CrossRef Yi A, Kim HH, Shin HJ, Huh MO, Ahn SD, Seo BK. Radiation-induced complications after breast cancer radiation therapy: a pictorial review of multimodality imaging findings. Korean J Radiol. 2009;10(5):496–507.CrossRef
17.
go back to reference White J, Achuthan R, Turton P, Lansdown M. Breast conservation surgery: state of the art. Int J Breast Cancer. 2011;2011:107981.CrossRef White J, Achuthan R, Turton P, Lansdown M. Breast conservation surgery: state of the art. Int J Breast Cancer. 2011;2011:107981.CrossRef
18.
go back to reference Agrawal A. Oncoplastic breast surgery and radiotherapy-adverse aesthetic outcomes, proposed classification of aesthetic components, and causality attribution. Breast J. 2019;25(2):207–18.CrossRef Agrawal A. Oncoplastic breast surgery and radiotherapy-adverse aesthetic outcomes, proposed classification of aesthetic components, and causality attribution. Breast J. 2019;25(2):207–18.CrossRef
19.
go back to reference Dahlback C, Manjer J, Rehn M, Ringberg A. Patients undergoing breast-conserving surgery can benefit from the opportunity to participate in choosing their surgical technique. World J Surg. 2017;41(3):734–41.CrossRef Dahlback C, Manjer J, Rehn M, Ringberg A. Patients undergoing breast-conserving surgery can benefit from the opportunity to participate in choosing their surgical technique. World J Surg. 2017;41(3):734–41.CrossRef
20.
go back to reference Franceschini G, Terribile D, Magno S, Fabbri C, Accetta C, Di Leone A, et al. Update on oncoplastic breast surgery. Eur Rev Med Pharmacol Sci. 2012;16(11):1530–40.PubMed Franceschini G, Terribile D, Magno S, Fabbri C, Accetta C, Di Leone A, et al. Update on oncoplastic breast surgery. Eur Rev Med Pharmacol Sci. 2012;16(11):1530–40.PubMed
21.
go back to reference Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, et al. Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2015;22(8):2500–8.CrossRef Santos G, Urban C, Edelweiss MI, Zucca-Matthes G, de Oliveira VM, Arana GH, et al. Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol. 2015;22(8):2500–8.CrossRef
22.
go back to reference Smeele HP, der Does de Willebois EML V, Eltahir Y, De Bock GH, Van Aalst VC, Jansen L. Acceptance of contralateral reduction mammoplasty after oncoplastic breast conserving surgery: a semi-structured qualitative interview study. Breast. 2019;45:97–103.CrossRef Smeele HP, der Does de Willebois EML V, Eltahir Y, De Bock GH, Van Aalst VC, Jansen L. Acceptance of contralateral reduction mammoplasty after oncoplastic breast conserving surgery: a semi-structured qualitative interview study. Breast. 2019;45:97–103.CrossRef
23.
go back to reference Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345–53.CrossRef Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg. 2009;124(2):345–53.CrossRef
24.
go back to reference Liu LQ, Branford OA, Mehigan S. BREAST-Q measurement of the patient perspective in oncoplastic breast surgery: a systematic review. Plast Reconstr Surg Glob Open. 2018;6(8):e1904.CrossRef Liu LQ, Branford OA, Mehigan S. BREAST-Q measurement of the patient perspective in oncoplastic breast surgery: a systematic review. Plast Reconstr Surg Glob Open. 2018;6(8):e1904.CrossRef
25.
go back to reference Chand ND, Browne V, Paramanathan N, Peiris LJ, Laws SA, Rainsbury RM. Patient-reported outcomes are better after oncoplastic breast conservation than after mastectomy and autologous reconstruction. Plast Reconstr Surg Glob Open. 2017;5(7):e1419.CrossRef Chand ND, Browne V, Paramanathan N, Peiris LJ, Laws SA, Rainsbury RM. Patient-reported outcomes are better after oncoplastic breast conservation than after mastectomy and autologous reconstruction. Plast Reconstr Surg Glob Open. 2017;5(7):e1419.CrossRef
26.
go back to reference Dahlback C, Ullmark JH, Rehn M, Ringberg A, Manjer J. Aesthetic result after breast-conserving therapy is associated with quality of life several years after treatment. Swedish women evaluated with BCCT.core and BREAST-Q. Breast Cancer Res Treat. 2017;164(3):679–87.CrossRef Dahlback C, Ullmark JH, Rehn M, Ringberg A, Manjer J. Aesthetic result after breast-conserving therapy is associated with quality of life several years after treatment. Swedish women evaluated with BCCT.core and BREAST-Q. Breast Cancer Res Treat. 2017;164(3):679–87.CrossRef
27.
go back to reference O’Connell RL, DiMicco R, Khabra K, O’Flynn EA, deSouza N, Roche N, et al. Initial experience of the BREAST-Q breast-conserving therapy module. Breast Cancer Res Treat. 2016;160(1):79–89.CrossRef O’Connell RL, DiMicco R, Khabra K, O’Flynn EA, deSouza N, Roche N, et al. Initial experience of the BREAST-Q breast-conserving therapy module. Breast Cancer Res Treat. 2016;160(1):79–89.CrossRef
28.
go back to reference Atisha DM, Rushing CN, Samsa GP, Locklear TD, Cox CE, Shelley Hwang E, et al. A national snapshot of satisfaction with breast cancer procedures. Ann Surg Oncol. 2015;22(2):361–9.CrossRef Atisha DM, Rushing CN, Samsa GP, Locklear TD, Cox CE, Shelley Hwang E, et al. A national snapshot of satisfaction with breast cancer procedures. Ann Surg Oncol. 2015;22(2):361–9.CrossRef
29.
go back to reference van Paridon MW, Kamali P, Paul MA, Wu W, Ibrahim AMS, Kansal KJ, et al. Oncoplastic breast surgery: achieving oncological and aesthetic outcomes. J Surg Oncol. 2017;116(2):195–202.CrossRef van Paridon MW, Kamali P, Paul MA, Wu W, Ibrahim AMS, Kansal KJ, et al. Oncoplastic breast surgery: achieving oncological and aesthetic outcomes. J Surg Oncol. 2017;116(2):195–202.CrossRef
30.
go back to reference Nordic medico-statistical committee (NOMESCO). NOMESCO classification of surgical procedures. Copenhagen: NOMESCO; 2010. Nordic medico-statistical committee (NOMESCO). NOMESCO classification of surgical procedures. Copenhagen: NOMESCO; 2010.
31.
go back to reference Panhofer P, Ferenc V, Schutz M, Gleiss A, Dubsky P, Jakesz R, et al. Standardization of morbidity assessment in breast cancer surgery using the Clavien Dindo classification. Int J Surg. 2014;12(4):334–9.CrossRef Panhofer P, Ferenc V, Schutz M, Gleiss A, Dubsky P, Jakesz R, et al. Standardization of morbidity assessment in breast cancer surgery using the Clavien Dindo classification. Int J Surg. 2014;12(4):334–9.CrossRef
32.
go back to reference Kalbhen CL, McGill JJ, Fendley PM, Corrigan KW, Angelats J. Mammographic determination of breast volume: comparing different methods. AJR Am J Roentgenol. 1999;173(6):1643–9.CrossRef Kalbhen CL, McGill JJ, Fendley PM, Corrigan KW, Angelats J. Mammographic determination of breast volume: comparing different methods. AJR Am J Roentgenol. 1999;173(6):1643–9.CrossRef
33.
go back to reference Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer (Auckl). 2011;5:43–52. Kayar R, Civelek S, Cobanoglu M, Gungor O, Catal H, Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer (Auckl). 2011;5:43–52.
34.
go back to reference American College of Radiology. ACR BI-RADS Atlas. 5th ed. Reston: American College of Radiology; 2013. American College of Radiology. ACR BI-RADS Atlas. 5th ed. Reston: American College of Radiology; 2013.
37.
go back to reference Socialstyrelsen. National guidelines for breast, prostate and colon cancer treatment [Swedish]. Updated version (2015); 2014. p. 24–38. Socialstyrelsen. National guidelines for breast, prostate and colon cancer treatment [Swedish]. Updated version (2015); 2014. p. 24–38.
38.
go back to reference Kim H, Kang BJ, Kim SH, Kim HS, Cha ES. What we should know in mammography after reduction mammoplasty and mastopexy? Breast Cancer. 2015;22(4):391–8.CrossRef Kim H, Kang BJ, Kim SH, Kim HS, Cha ES. What we should know in mammography after reduction mammoplasty and mastopexy? Breast Cancer. 2015;22(4):391–8.CrossRef
39.
go back to reference McCulley SJ, Durani P, Macmillan RD. Therapeutic mammaplasty for centrally located breast tumors. Plast Reconstr Surg. 2006;117(2):366–73.CrossRef McCulley SJ, Durani P, Macmillan RD. Therapeutic mammaplasty for centrally located breast tumors. Plast Reconstr Surg. 2006;117(2):366–73.CrossRef
40.
go back to reference Cardoso MJ, Cardoso J, Amaral N, Azevedo I, Barreau L, Bernardo M, et al. Turning subjective into objective: the BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast. 2007;16(5):456–61.CrossRef Cardoso MJ, Cardoso J, Amaral N, Azevedo I, Barreau L, Bernardo M, et al. Turning subjective into objective: the BCCT.core software for evaluation of cosmetic results in breast cancer conservative treatment. Breast. 2007;16(5):456–61.CrossRef
41.
go back to reference Cardoso MJ, Cardoso JS, Oliveira HP, Gouveia P. The breast cancer conservative treatment. Cosmetic results - BCCT.core - Software for objective assessment of esthetic outcome in breast cancer conservative treatment: a narrative review. Comput Methods Prog Biomed. 2016;126:154–9.CrossRef Cardoso MJ, Cardoso JS, Oliveira HP, Gouveia P. The breast cancer conservative treatment. Cosmetic results - BCCT.core - Software for objective assessment of esthetic outcome in breast cancer conservative treatment: a narrative review. Comput Methods Prog Biomed. 2016;126:154–9.CrossRef
Metadata
Title
Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™
Authors
Anna Gardfjell
Cecilia Dahlbäck
Kristina Åhsberg
Publication date
01-12-2019
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2019
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-019-1640-6

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