Advertisement

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

Abstract

Background

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

Methods

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.

Results

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.

Conclusions

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.

Keywords

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.

Notes

Acknowledgment

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

Disclosure

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.

References

  1. 1.
    Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087–106.CrossRefPubMedGoogle Scholar
  2. 2.
    Fisher B, Anderson S, Bryant J, 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;347:1233–41.CrossRefPubMedGoogle Scholar
  3. 3.
    van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst. 2000;92:1143–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Kuroi K, Shimozuma K, Ohsumi S, Imai H, Ono M. Current status of health outcome assessment of medical treatment in breast cancer. Breast Cancer. 2007;14:74–80.CrossRefPubMedGoogle Scholar
  5. 5.
    Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347:1227–32.CrossRefPubMedGoogle Scholar
  6. 6.
    Heil J, Holl S, Golatta M, et al. Aesthetic and functional results after breast conserving surgery as correlates of quality of life measured by a German version of the Breast Cancer Treatment Outcome Scale (BCTOS). Breast. 2010;19:470–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Waljee JF, Hu ES, Ubel PA, Smith DM, Newman LA, Alderman AK. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26:3331–7.CrossRefPubMedGoogle Scholar
  8. 8.
    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.CrossRefPubMedGoogle Scholar
  9. 9.
    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.CrossRefPubMedGoogle Scholar
  10. 10.
    Taylor ME, Perez CA, Halverson KJ, et al. Factors influencing cosmetic results after conservation therapy for breast cancer. Int J Radiat Oncol Biol Phys. 1995;31:753–64.CrossRefPubMedGoogle Scholar
  11. 11.
    Wang HT, Barone CM, Steigelman MB, et al. Aesthetic outcomes in breast conservation therapy. Aesthet Surg J. 2008;28:165–70.CrossRefPubMedGoogle Scholar
  12. 12.
    Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol. 1992;10:356–63.PubMedGoogle Scholar
  13. 13.
    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.CrossRefPubMedGoogle Scholar
  14. 14.
    Stanton AL, Krishnan L, Collins CA. Form or function? Part 1. Subjective cosmetic and functional correlates of quality of life in women treated with breast-conserving surgical procedures and radiotherapy. Cancer. 2001;91:2273–81.CrossRefPubMedGoogle Scholar
  15. 15.
    Kreienberg R, Albert AS, Follmann M, et al. German S3 guideline: diagnosis, therapy, and follow-up of breast cancer. 2012.Google Scholar
  16. 16.
    Foersterling E, Golatta M, Hennigs A, et al. Predictors of early poor aesthetic outcome after breast-conserving surgery in patients with breast cancer: initial results of a prospective cohort study at a single institution. J Surg Oncol. 2014;110:801–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Cardoso MJ, Cardoso JS, Vrieling C, et al. Recommendations for the aesthetic evaluation of breast cancer conservative treatment. Breast Cancer Res Treat. 2012;135(3):629–37.CrossRefPubMedGoogle Scholar
  18. 18.
    Heil J, Dahlkamp J, Golatta M, et al. Aesthetics in breast conserving therapy: do objectively measured results match patients’ evaluations? Ann Surg Oncol. 2011;18(1):134–8.CrossRefPubMedGoogle Scholar
  19. 19.
    Amichetti M, Busana L, Caffo O. Long-term cosmetic outcome and toxicity in patients treated with quadrantectomy and radiation therapy for early-stage breast cancer. Oncology. 1995;52:177–81.CrossRefPubMedGoogle Scholar
  20. 20.
    Heil J, Czink E, Golatta M, et al. Change of aesthetic and functional outcome over time and their relationship to quality of life after breast conserving therapy. Eur J Surg Oncol. 2011;37(2):116–21.CrossRefPubMedGoogle Scholar
  21. 21.
    Van Limbergen E, Rijnders A, van der Schueren E, Lerut T, Christiaens R. Cosmetic evaluation of breast conserving treatment for mammary cancer. 2. A quantitative analysis of the influence of radiation dose, fractionation schedules and surgical treatment techniques on cosmetic results. Radiother Oncol. 1989;16:253–67.CrossRefPubMedGoogle Scholar
  22. 22.
    Christiaens MR, Cataliotti L, Fentiman I, et al. Comparison of the surgical procedures for breast conserving treatment of early breast cancer in seven EORTC centres. Eur J Cancer. 1996;32A:1866–75.CrossRefPubMedGoogle Scholar
  23. 23.
    Association of Breast Surgery at B. Surgical guidelines for the management of breast cancer. Eur J Surg Oncol. 2009;35(suppl 1):1–22.CrossRefGoogle Scholar
  24. 24.
    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.CrossRefPubMedGoogle Scholar

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

Personalised recommendations