Aesthetic Outcomes in Patients Undergoing Breast Conservation Therapy for the Treatment of Localized Breast Cancer

Abstract

Localized breast cancer can be treated with lumpectomy and postoperative radiation therapy, also called breast conservation therapy, with an efficacy equivalent to that of mastectomy. Reports evaluating the effects of radiotherapy suggested that breast conservation therapy had "acceptable" cosmetic outcomes; thus, posttreatment evaluation for aesthetic impact has not been instituted as a standard of care. More recent reports have suggested that the effect of breast conservation therapy on aesthetic outcome is not minimal and that patients may benefit from reconstructive consultation. The purpose of this study was to measure objectively the aesthetic change in women who undergo breast conservation therapy and whether the extent of change is significant enough (objectively and subjectively) to warrant plastic surgery consultation. The authors evaluated 21 patients who had undergone breast conservation therapy. Eleven non-breast cancer patients seeking plastic surgery consultation were used as controls. Standardized five-view photographs (frontal, left and right lateral, and left and right lateral oblique views) were obtained. Patient photograph sets were compiled and evaluated independently by eight reviewers (four surgeons, two nurses, and two medical students). Reviewers evaluated the photographs using the breast asymmetry score (score range, 0 to 9) assessing breast size, ptosis, nipple-areola position, shape, scar appearance, contour deformity, and skin changes. The authors considered 2 SD above the control mean as significant. Breast conservation therapy patients also completed a 15-item questionnaire targeting objective and subjective data about treatment-related breast change. Breast conservation therapy patients had an average treatment-related asymmetry score of 1.93, with 35 percent demonstrating significant change as compared with controls. Although most patients (86 percent) were satisfied with the cancer treatment outcome, all patients noted asymmetry. The authors' data indicate that breast conservation therapy can cause significant asymmetry; thus, an option for plastic surgery consultation as part of the treatment protocol is warranted.

Bilateral reduction mammoplasty following breast cancer: A case-control study

“…These patients have usually undergone lumpectomies followed by postoperative radiation therapy and chemotherapy. Although there can be changes in the shape and size of the treated breast as a result of lumpectomy and radiation, it is usually minimal in nature, resulting in, at most, asymmetry (1,2). In the macromastic patient, symptoms of interscapular back pain, prominent shoulder grooving, and intertrigo along the inframammary folds or between the breasts remain despite the described changes to the cancer-afflicted breast.…”

“…Numerous publications regarding breast reconstruction following irradiation report that the radiated breast site is more prone to complications than the nonradiated breast (2)(3)(4)(5). Currently, little information has been published regarding reduction mammoplasties performed on women previously treated for breast cancer.…”

Oncoplastic approach in the conservative treatment of breast cancer: analysis of costs

“…Although breast-conserving treatment is considered to be the least disfiguring surgical option for breast cancer patients, the majority of women report breast asymmetry after this kind of treatment 3,4 . Breast asymmetry may be a constant reminder to these patients of their disease and treatment process, impairing their psychological adjustment after treatment 4 .…”

“…Patients who undergo breast-conserving therapy frequently develop breast asymmetry from either the surgical removal of tissue or radiationrelated fibrosis, or both 3,4 .…”

Bilateral Autologous Breast Reconstruction in a Patient with Unilateral Breast Cancer: A Case Report

“…Even for young women with breast cancer, BCS followed by whole breast radiation therapy (WBRT) is generally considered the first option whenever suitable [4]. However, BCS followed by WBRT can sometimes result in deformities of the breasts, which develop either at the time of surgery or over time [5,6]. A large lumpectomy in a relatively small breast is expected to lead to a soft tissue defect that could be managed through various oncoplastic techniques [7,8].…”