Annals of Surgical Oncology

, Volume 23, Issue 5, pp 1744–1751 | Cite as

Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study

  • André Hennigs
  • Hannah Biehl
  • Geraldine Rauch
  • Michael Golatta
  • Patrik Tabatabai
  • Christoph Domschke
  • Sarah Schott
  • Markus Wallwiener
  • Florian Schütz
  • Christof Sohn
  • Jörg Heil
Reconstructive Oncology



We analyzed the change of aesthetic outcome (AO) over time and explored factors characterizing poor AO after breast-conserving surgery (BCS).


This prospective single-center cohort study included 849 patients preoperatively planned for BCS between September 2007 and December 2011. Long-term follow-up was made once in 2013. AO was measured by the Aesthetic Status (AS) of the Breast Cancer Treatment Outcome Scale questionnaire. Clinical, surgical, and pathologic variables were evaluated to identify predictors of poor AO. We applied single factor variance analyses and univariable logistic regression analyses for outcome analysis.


The long-term follow-up rate in 2013 was 73 % (621 nonrecurrent with final BCS). A poor or fair AO was reported in 30 (4.8 %) and 98 (15.8 %) of these 621 patients, respectively. Single factor variance analysis showed a negative impact of higher specimen weight on AO (p < 0.001). Univariable logistic regression analysis revealed the following risk factors for poor AO: radial breast incision [odds ratio (OR) 1.97], periareolar incision (OR 1.85), fishmouth-shaped incision with resection of the nipple–areola complex (OR 8.12), impaired wound healing (OR 3.14), and seroma (OR 2.16). No patient rating her AO as fair or poor shortly after BCS improved in the long-term follow-up.


The incidence of poor AO is relatively rare but increases in the long-term follow-up. Patients experiencing poor AO after BCS are likely to remain unsatisfied with the outcome over time. Factors predicting unfavorable AO can assist preoperative planning with regards to the choice between simple breast conserving techniques or more complex oncoplastic procedures.


Nipple Aesthetic Outcome Impaired Wound Healing Breast Incision Areola Complex 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



J.H. received funding from the German Research Foundation (HE 6824/1-1).


There are no conflicts of interests (e.g. employment, consultancies, stock ownership, honoraria, patent applications/registrations and grants or other funding) by any of the authors.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • André Hennigs
    • 1
  • Hannah Biehl
    • 1
  • Geraldine Rauch
    • 2
  • Michael Golatta
    • 1
  • Patrik Tabatabai
    • 1
  • Christoph Domschke
    • 1
  • Sarah Schott
    • 1
  • Markus Wallwiener
    • 1
  • Florian Schütz
    • 1
  • Christof Sohn
    • 1
  • Jörg Heil
    • 1
  1. 1.Department of GynecologyUniversity Breast UnitHeidelbergGermany
  2. 2.Institute of Medical Biometry and InformaticsUniversity of HeidelbergHeidelbergGermany

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