Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2016

Open Access 01-12-2016 | Research

Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery

Authors: Cecilia Dahlbäck, Jonas Manjer, Martin Rehn, Anita Ringberg

Published in: World Journal of Surgical Oncology | Issue 1/2016

Login to get access

Abstract

Background

With the development of new surgical techniques in breast cancer, such as oncoplastic breast surgery, increased knowledge of risk factors for poor satisfaction with conventional breast-conserving surgery (BCS) is needed in order to determine which patients to offer these techniques to. The aim of this study was to investigate patient satisfaction regarding aesthetic result and skin sensitivity in relation to patient, tumour, and treatment factors, in a consecutive sample of patients undergoing conventional BCS.

Methods

Women eligible for BCS were recruited between February 1, 2008 and January 31, 2012 in a prospective setup. In all, 297 women completed a study-specific questionnaire 1 year after conventional BCS and radiotherapy. Potential risk factors for poor satisfaction were investigated using logistic regression analysis.

Results

The great majority of the women, 84%, were satisfied or very satisfied with the overall aesthetic result. The rate of satisfaction regarding symmetry between the breasts was 68% and for skin sensitivity in the operated breast it was 67%. Excision of more than 20% of the preoperative breast volume was associated with poor satisfaction regarding overall aesthetic outcome, as was axillary clearance. A high BMI (≥30 kg/m2) seemed to affect satisfaction with symmetry negatively. Factors associated with less satisfied patients regarding skin sensitivity in the operated breast were an excision of ≥20% of preoperative breast volume, a BMI of 25–30 kg/m2, axillary clearance, and radiotherapy. Re-excision and postoperative infection were associated with lower rates of satisfaction regarding both overall aesthetic outcome and symmetry, as well as with skin sensitivity.

Conclusions

Several factors affect patient satisfaction after BCS. A major determinant of poor satisfaction in this study was a large excision of breast volume. If the percentage of breast volume excised is estimated to exceed 20%, other techniques, such as oncoplastic breast surgery, with or without contralateral surgery, or mastectomy with reconstruction, may be considered.
Appendix
Available only for authorised users
Literature
1.
go back to reference McCulley SJ, Macmillan RD. Planning and use of therapeutic mammoplasty—Nottingham approach. Br J Plast Surg. 2005;58:889–901.CrossRefPubMed McCulley SJ, Macmillan RD. Planning and use of therapeutic mammoplasty—Nottingham approach. Br J Plast Surg. 2005;58:889–901.CrossRefPubMed
2.
go back to reference Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg. 2012;99:1389–95.CrossRefPubMed Clough KB, Ihrai T, Oden S, Kaufman G, Massey E, Nos C. Oncoplastic surgery for breast cancer based on tumour location and a quadrant-per-quadrant atlas. Br J Surg. 2012;99:1389–95.CrossRefPubMed
3.
go back to reference Beadle GF, Silver B, Botnick L, Hellman S, Harris JR. Cosmetic results following primary radiation therapy for early breast cancer. Cancer. 1984;54:2911–8.CrossRefPubMed Beadle GF, Silver B, Botnick L, Hellman S, Harris JR. Cosmetic results following primary radiation therapy for early breast cancer. Cancer. 1984;54:2911–8.CrossRefPubMed
4.
go back to reference Budrukkar AN, Sarin R, Shrivastava SK, Deshpande DD, Dinshaw KA. Cosmesis, late sequelae and local control after breast-conserving therapy: influence of type of tumour bed boost and adjuvant chemotherapy. Clin Oncol (R Coll Radiol). 2007;19:596–603.CrossRef Budrukkar AN, Sarin R, Shrivastava SK, Deshpande DD, Dinshaw KA. Cosmesis, late sequelae and local control after breast-conserving therapy: influence of type of tumour bed boost and adjuvant chemotherapy. Clin Oncol (R Coll Radiol). 2007;19:596–603.CrossRef
5.
go back to reference Cetintas SK, Ozkan L, Kurt M, Saran A, Tasdelen I, Tolunay S, Topal U, Engin K. Factors influencing cosmetic results after breast conserving management (Turkish experience). Breast. 2002;11:72–80.CrossRefPubMed Cetintas SK, Ozkan L, Kurt M, Saran A, Tasdelen I, Tolunay S, Topal U, Engin K. Factors influencing cosmetic results after breast conserving management (Turkish experience). Breast. 2002;11:72–80.CrossRefPubMed
6.
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;90:1505–9.CrossRefPubMed 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;90:1505–9.CrossRefPubMed
7.
go back to reference Fedorcik GG, Sachs R, Goldfarb MA. Oncologic and aesthetic results following breast-conserving therapy with 0.5 cm margins in 100 consecutive patients. Breast J. 2006;12:208–11.CrossRefPubMed Fedorcik GG, Sachs R, Goldfarb MA. Oncologic and aesthetic results following breast-conserving therapy with 0.5 cm margins in 100 consecutive patients. Breast J. 2006;12:208–11.CrossRefPubMed
8.
go back to reference Johansen J, Overgaard J, Overgaard M. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation. Acta Oncol. 2007;46:525–33.CrossRefPubMed Johansen J, Overgaard J, Overgaard M. Effect of adjuvant systemic treatment on cosmetic outcome and late normal-tissue reactions after breast conservation. Acta Oncol. 2007;46:525–33.CrossRefPubMed
9.
go back to reference Johansen J, Overgaard J, Rose C, Engelholm SA, Gadeberg CC, Kjaer M, Kamby C, Juul-Christensen J, Blichert-Toft M, Overgaard M. Cosmetic outcome and breast morbidity in breast-conserving treatment—results from the Danish DBCG-82TM national randomized trial in breast cancer. Acta Oncol. 2002;41:369–80.CrossRefPubMed Johansen J, Overgaard J, Rose C, Engelholm SA, Gadeberg CC, Kjaer M, Kamby C, Juul-Christensen J, Blichert-Toft M, Overgaard M. Cosmetic outcome and breast morbidity in breast-conserving treatment—results from the Danish DBCG-82TM national randomized trial in breast cancer. Acta Oncol. 2002;41:369–80.CrossRefPubMed
10.
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;13:139–44.CrossRefPubMed 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;13:139–44.CrossRefPubMed
11.
go back to reference Taylor ME, Perez CA, Halverson KJ, Kuske RR, Philpott GW, Garcia DM, Mortimer JE, Myerson RJ, Radford D, Rush C. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753–64.CrossRefPubMed Taylor ME, Perez CA, Halverson KJ, Kuske RR, Philpott GW, Garcia DM, Mortimer JE, Myerson RJ, Radford D, Rush C. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753–64.CrossRefPubMed
12.
go back to reference Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JH, Jager JJ, Pierart M, Poortmans PM, Struikmans H, Maat B, 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;55:219–32.CrossRefPubMed Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JH, Jager JJ, Pierart M, Poortmans PM, Struikmans H, Maat B, 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;55:219–32.CrossRefPubMed
13.
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;206:274–80.CrossRefPubMed Waljee JF, Hu ES, Newman LA, Alderman AK. Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg. 2008;206:274–80.CrossRefPubMed
14.
go back to reference Wang HT, Barone CM, Steigelman MB, Kahlenberg M, Rousseau D, Berger J, Daum A, Ortegon DP. Aesthetic outcomes in breast conservation therapy. Aesthet Surg J. 2008;28:165–70.CrossRefPubMed Wang HT, Barone CM, Steigelman MB, Kahlenberg M, Rousseau D, Berger J, Daum A, Ortegon DP. Aesthetic outcomes in breast conservation therapy. Aesthet Surg J. 2008;28:165–70.CrossRefPubMed
16.
go back to reference Strombeck JO, Malm M. Priority grouping in a waiting list of patients for reduction mammaplasty. Ann Plast Surg. 1986;17:498–502.CrossRefPubMed Strombeck JO, Malm M. Priority grouping in a waiting list of patients for reduction mammaplasty. Ann Plast Surg. 1986;17:498–502.CrossRefPubMed
17.
go back to reference Hansson E, Manjer J, Ringberg A. Reliability of plastic cups to measure breast volume. J Plast Surg Hand Surg. 2014;48:254–8.CrossRefPubMed Hansson E, Manjer J, Ringberg A. Reliability of plastic cups to measure breast volume. J Plast Surg Hand Surg. 2014;48:254–8.CrossRefPubMed
18.
go back to reference Chan SW, Chueng PS, Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg. 2010;34:1447–52.CrossRefPubMed Chan SW, Chueng PS, Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg. 2010;34:1447–52.CrossRefPubMed
19.
go back to reference Eriksen C, Lindgren EN, Olivecrona H, Frisell J, Stark B. Evaluation of volume and shape of breasts: comparison between traditional and three-dimensional techniques. J Plast Surg Hand Surg. 2011;45:14–22.CrossRefPubMed Eriksen C, Lindgren EN, Olivecrona H, Frisell J, Stark B. Evaluation of volume and shape of breasts: comparison between traditional and three-dimensional techniques. J Plast Surg Hand Surg. 2011;45:14–22.CrossRefPubMed
21.
go back to reference Sneeuw KC, Aaronson NK, Yarnold JR, Broderick M, Regan J, Ross G, Goddard A. Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients’ ratings, observers’ ratings, and objective assessments. Radiother Oncol. 1992;25:153–9.CrossRefPubMed Sneeuw KC, Aaronson NK, Yarnold JR, Broderick M, Regan J, Ross G, Goddard A. Cosmetic and functional outcomes of breast conserving treatment for early stage breast cancer. 1. Comparison of patients’ ratings, observers’ ratings, and objective assessments. Radiother Oncol. 1992;25:153–9.CrossRefPubMed
22.
go back to reference Ringberg A, Bageman E, Rose C, Ingvar C, Jernstrom H. Of cup and bra size: reply to a prospective study of breast size and premenopausal breast cancer incidence. Int J Cancer. 2006;119:2242–3. author reply 2244.CrossRefPubMed Ringberg A, Bageman E, Rose C, Ingvar C, Jernstrom H. Of cup and bra size: reply to a prospective study of breast size and premenopausal breast cancer incidence. Int J Cancer. 2006;119:2242–3. author reply 2244.CrossRefPubMed
23.
go back to reference Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10:124–6.CrossRefPubMed Bulstrode NW, Shrotria S. Prediction of cosmetic outcome following conservative breast surgery using breast volume measurements. Breast. 2001;10:124–6.CrossRefPubMed
24.
go back to reference Markiewicz DA, Schultz DJ, Haas JA, Harris EE, Fox KR, Glick JH, Solin LJ. The effects of sequence and type of chemotherapy and radiation therapy on cosmesis and complications after breast conservation therapy. Int J Radiat Oncol Biol Phys. 1996;35:661–8.CrossRefPubMed Markiewicz DA, Schultz DJ, Haas JA, Harris EE, Fox KR, Glick JH, Solin LJ. The effects of sequence and type of chemotherapy and radiation therapy on cosmesis and complications after breast conservation therapy. Int J Radiat Oncol Biol Phys. 1996;35:661–8.CrossRefPubMed
25.
go back to reference Fowble B, Fein DA, Hanlon AL, Eisenberg BL, Hoffman JP, Sigurdson ER, Daly MB, Goldstein LJ. The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor-positive early-stage breast cancer. Int J Radiat Oncol Biol Phys. 1996;35:669–77.CrossRefPubMed Fowble B, Fein DA, Hanlon AL, Eisenberg BL, Hoffman JP, Sigurdson ER, Daly MB, Goldstein LJ. The impact of tamoxifen on breast recurrence, cosmesis, complications, and survival in estrogen receptor-positive early-stage breast cancer. Int J Radiat Oncol Biol Phys. 1996;35:669–77.CrossRefPubMed
26.
go back to reference Hau E, Browne L, Capp A, Delaney GP, Fox C, Kearsley JH, Millar E, Nasser EH, Papadatos G, Graham PH. The impact of breast cosmetic and functional outcomes on quality of life: long-term results from the St. George and Wollongong randomized breast boost trial. Breast Cancer Res Treat. 2013;139:115–23.CrossRefPubMed Hau E, Browne L, Capp A, Delaney GP, Fox C, Kearsley JH, Millar E, Nasser EH, Papadatos G, Graham PH. The impact of breast cosmetic and functional outcomes on quality of life: long-term results from the St. George and Wollongong randomized breast boost trial. Breast Cancer Res Treat. 2013;139:115–23.CrossRefPubMed
27.
go back to reference Chiari Jr A, Nunes TA, Grotting JC, Cotta FB, Gomes RC. Breast sensitivity before and after the L short-scar mammaplasty. Aesthetic Plast Surg. 2012;36:105–14.CrossRefPubMed Chiari Jr A, Nunes TA, Grotting JC, Cotta FB, Gomes RC. Breast sensitivity before and after the L short-scar mammaplasty. Aesthetic Plast Surg. 2012;36:105–14.CrossRefPubMed
Metadata
Title
Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery
Authors
Cecilia Dahlbäck
Jonas Manjer
Martin Rehn
Anita Ringberg
Publication date
01-12-2016
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2016
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/s12957-016-1053-8

Other articles of this Issue 1/2016

World Journal of Surgical Oncology 1/2016 Go to the issue