Assessment of breast symmetry in breast cancer patients undergoing therapeutic mammaplasty using the Breast Cancer Conservation Therapy cosmetic results software (BCCT.core)

Abstract

Background: Therapeutic mammaplasty (TM) is a standard oncoplastic technique utilising aesthetic breast reduction principles to facilitate tumour resection and breast reshaping. Simultaneous contralateral mammaplasties are often performed to maintain symmetry. BCCT.core software, which principally assesses breast symmetry, has been previously employed for evaluating cosmetic results after standard breast conservation therapy and latterly TMs for upper pole tumours. The purpose of this study was to validate this novel tool for TMs in all breast zones.Methods: Standardised photographs of 20 consecutive patients who underwent TM were evaluated for symmetry using BCCT.core versus a plastic surgical panel completing a visual analogue scale. Results were rated as (excellent/good/fair/poor). Outcomes between the two methods were compared.Results: Twenty patients aged 37 to 63 years with a median 36G bra size had 22 TMs (18 unilateral, 2 bilateral). Indications were invasive breast cancer (87%) and ductal carcinoma in situ (DCIS) (13%). The median (range) tumour size was 22.5 mm (6-90 mm) with a resection weight of 245.8 g (16-1,079 g).Primary nipple pedicles were superomedial (63%), inferior (21%) and superolateral (16%). Five patients required a secondary glandular pedicle for volume redistribution to maintain breast shape. The BCCT.core software vs. panel symmetry assessments were 37% vs. 39% (excellent), 63% vs. 50% (good) and 0% vs. 11% (fair). Wilcoxon matched-pairs sign rank tests and Spearman rank correlations found the pairings to be statistically significant (P<0.05).Conclusions: Despite small patient numbers, BCCT.core gave comparable findings with the panel and is thus useful for objectively assessing cosmesis of TMs in all breast zones.

Cosmetic Outcomes and Symmetry Comparison in Patients Undergoing Bilateral Therapeutic Mammoplasty for Breast Cancer

“…The strength of this study is its large cohort of patients undergoing pure bilateral surgery (n = 146) and the three predefined outcome measures for cosmetic outcome (BCCT.core, and patients and surgeons assessments). Previous studies evaluating patients undergoing bilateral breast cancer surgery [18][19][20][21][22] involved smaller cohort sizes of 20-82 patients, outcome measures were limited to one or two assessment methods, and only two studies used BCCT.core scores as an objective evaluation model for cosmetic outcomes [20,21]. In summary, our results confirmed previous findings of very favorable cosmetic outcomes after therapeutic mammoplasty in patients with primary breast cancer, with low surgical complication rates [18][19][20][21][22][23].…”

“…Previous studies evaluating patients undergoing bilateral breast cancer surgery [18][19][20][21][22] involved smaller cohort sizes of 20-82 patients, outcome measures were limited to one or two assessment methods, and only two studies used BCCT.core scores as an objective evaluation model for cosmetic outcomes [20,21]. In summary, our results confirmed previous findings of very favorable cosmetic outcomes after therapeutic mammoplasty in patients with primary breast cancer, with low surgical complication rates [18][19][20][21][22][23]. Importantly, we also showed that cosmetic outcomes were not influenced by confounding factors such as tumor size or BMI.…”

Breast Asymmetry Evaluation Using Objective Measures after Breast Cancer Surgery

“…Using a method similar to Noguchi [12], Al-Ghazal [14,15] performed an overall assessment by comparing the subjective evaluation of a six member panel and the patients with the objective scores which were based on the measures of breast retraction, nipple deviation as well as subjective factors such as skin atrophy, skin changes and surgical scars. This method was further developed by Krishnan [16] who added four individual ratings-volume difference, breast asymmetry, fibrosis and telangiectasia-to create an overall cosmetic index which later had a pioneering role in the development of two objective scoring systems using frontal 2D images: the Breast Analyzing Tool (BAT) [7,8,17,18] and the Breast Cancer Conservative Treatment Cosmetic Result (BCCT.core) [4,19]. In addition to the main three parametersbreast area, breast circumference and nipple position-which are evaluated in the BAT score, BCCT.core also analyzes the color differences and surgical scars along with asymmetry and has been used following a wide variety of procedures including breast conserving surgery [19] and other therapeutic mammoplasty [20,21].…”

The Impact of Radiation on Nipple Symmetry After Bilateral Nipple-Sparing Mastectomy and Implant-Based Reconstruction

“…It quantifies breast size, symmetry, and shape, facilitating a precise analysis of breast aesthetics postsurgery and postradiation. 1,[5][6][7][8] This integration of technology in outcome assessment could transform the current understanding of radiation's impact on breast reconstruction.…”

“…To mitigate subjectivity, the Breast Cancer Conservative Treatment (BCCT.core) software emerges as a robust, objective tool. It quantifies breast size, symmetry, and shape, facilitating a precise analysis of breast aesthetics postsurgery and postradiation 1,5–8 . This integration of technology in outcome assessment could transform the current understanding of radiation's impact on breast reconstruction.…”