Background Breast‐conserving treatment (BCT) for breast cancer can lead to deformation of the treated breast, resulting in patient dissatisfaction with the final cosmetic outcome. Currently, literature on the specific information needs of patients concerning the cosmetic effects of BCT is lacking. The aim of the present study was to investigate the information needs of breast cancer patients regarding the long‐term cosmetic outcome after BCT. Subjects, Materials, and Methods The data from 115 women who had undergone BCT in a general teaching hospital breast cancer unit in The Netherlands were studied. Structured questionnaires and semi‐structured interviews were conducted between October 2012 and April 2013. A mixed model of quantitative and qualitative research was used to explore patient‐reported information needs. A phenomenological approach was used to analyze the qualitative data. Results This study shows that women undergoing BCT want to discuss long‐term cosmetic effects. Most patients appreciate such information immediately after the diagnosis. Patients indicated that it is also important to pay attention to the cosmetic effects during the follow‐up visits, because deformation of the breast can also occur at a later stage. Furthermore, half the patients indicated that they would not likely raise the subject of cosmetic effects of the treatment themselves. Conclusion Breast cancer patients have a need for long‐term attention for cosmetic outcome of BCT, which should be tailored during the treatment and follow‐up process. Implications for Practice Currently, no literature exists concerning patients' needs for information regarding the cosmetic effects of breast‐conserving therapy (BCT). Bringing up the cosmetic effects of BCT by health care professionals does not appear to be a standard part of treatment and follow‐up. It is expected that the quality of care and life will be improved by providing information and guidance regarding the cosmetic outcome of BCT within the existing structure of the breast cancer pathway. Discussion and visualization of the cosmetic effects prior to treatment will lead to more realistic expectations, and as a result, secondary interventions, such as partial prostheses and plastic surgery, may be easier to discuss and accept.

Background In the present study, we set out to compare patient reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome.Methods Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years’ follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair–poor Harvard score was estimated using logistic regression analysis.Results The study included 108 female patients (age: 40–91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38–0.50). The items “size” and “shape” were identified as the strongest determinants of cosmetic outcome.Conclusions Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.

Background The aim of this study was to investigate which factors patients considered to be important for determining the degree of cosmetic satisfaction with regards to perceived body image after previous breast-conserving therapy (BCT). Methods Outcomes considered relevant by the patients were first identified using interviews. A questionnaire based on this group input was then devised and added to the physician-based Sneeuw questionnaire. Next, a quantitative study using this questionnaire was conducted in Dutch patients treated at least 6 months earlier for (non-) invasive breast cancer by BCT. Exclusion criteria were: previous mastectomy or BCT of the contralateral breast, BCT with nipple resection, metastatic disease, local recurrence or (previous) plastic breast surgery. Descriptive statistics were used throughout. Results A total of 149 patients (aged 36–87 years) completed the questionnaire. From this focus group input, the top three factors in overall importance (important or very important) for satisfaction were: ‘wearability of bra’ (67%), ‘breast sensitivity’ (59%) and ‘asymmetry’ (51%). Younger patients (< 55 years) considered ‘breast size’ to be most important, whereas ‘wearability of bra’ was most frequently reported by older patients (> 55 years). Time since BCT did not significantly influence the rating of relevant factors. Conclusion Patients consider ‘wearability of bra’, ‘breast sensitivity’ and ‘asymmetry’ as the most important factors when assessing their satisfaction with regards to cosmetic outcome and body image. These factors should be addressed in routine clinical practice during (pre) counseling.

Background: A deformed breast following Breast-Conserving Treatment (BCT) is influenced by an array of factors encompassing final cosmesis. This overview examines the factors that may influence cosmetic outcome for BCT patients. Methods: Literature search was performed using PubMed and EMBASE databases. Research articles published in English (1990English ( -2018 pertaining to patients that had previously undergone unilateral BCT for breast cancer were included. Results: 42 articles were used for our final analysis that utilized subjective and objective tools to assess cosmetic outcome. Factors can be allocated as patient, tumor, surgery, radiotherapy or systemic therapy associated. Based on significance in both univariable as well as multivariable analysis and frequency of reporting, extensiveness of primary tumor resection, tumor size, tumor location, adjuvant radiotherapy and adjuvant chemotherapy, were the factors affecting cosmetic outcome the most. Conclusions: In this study, we reviewed and discussed several patient-, tumor-and treatment related factors affecting cosmetic outcome. Many different tools, either subjective or objective, are observed worldwide.

No abstract