Breast Appearance and Function After Breast Conserving Surgery and Radiotherapy

Abstract

Between 1978 and 1985, 247 breast cancer patients were treated with breast conserving surgery and radiotherapy. One hundred and twenty of these patients form the basis of this report, having replied to an 1 1-point structured questionnaire evaluating breast appearance and breast, shoulder and arm function. Good to perfect cosmetic, functional and overall scores are shown to be in the range 6149%. The extent of primary surgery and axillary irradiation are the major factors affecting the cosmetic appearance. Other problems with cosmetic and functional assessment from subjective and objective view points are also discussed.Key words: Breast cancer, breast conservation, cosmetic results, patient self-evaluation.The equivalence of breast conserving surgery and radiotherapy with mastectomy, in terms of traditional endpoints such as survival, local recurrence and distant recurrence, is now well established ( 1 4 ) . Several studies (5-7) have indicated that mastectomy patients suffer high levels of anxiety andor depression following and presumably largely related to their diagnosis and surgery. The psychological effects of breast conserving surgery and radiotherapy are less well understood. For many years clinicians have intuitively assumed that the obvious cosmetic advantage of breast conservation over mastectomy must be accompanied by a corresponding psychological advantage. Only recently, however, have some of these assumptions been borne out, with evidence for improved self-image, better adaptation to surgery, better psychosexual functioning and lessened fear of recurrence in patients treated with breast conservation (8-1 l).Several observer-based scales have been devised to assess cosmesis in the treated breast and these generally reveal good to excellent cosmesis in 6 6 4 2 % of patients (12-17). Less emphasis exists in the literature regarding the subjective assessment of cosmesis and even less again concerning the functional aspects of the treated breast, ipsilateral arm and shoulder. When two treatment approaches produce comparable results in terms of definitive end-points, such as disease-free, or overall survival, then patient-based assessments of breast form and function assume much greater importance. Increasingly, the treatment of early breast cancer is being regarded by many Australian women as a consumer commodity. Informed patient participation in the decision making process and the seeking of second opinions are becoming increasingly common issues which the doctor primarily treating breast cancer must realistically face. Thus, a consumer-based analysis of the cosmetic and functional results of a breast conservation protocol is not inappropriate. This paper concerns the results of a patient-based questionnaire regarding breast appearance and breast, shoulder and arm function following breast conservation treatment at the Institute of Oncology and Radiotherapy, Prince of Wales Hospital, from 1978 to 1985. Material and MethodsFrom 1978 to 1985,247 patients with 249 primary breast malignancies wer...

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