Cosmetic outcomes following breast conservation therapy: in search of a reliable scale

Fortin, Amanda J; Cheang, Mary; Latosinsky, Steven

doi:10.1007/s10549-006-9223-y

Cited by 17 publications

(15 citation statements)

References 33 publications

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“…3) Compare overall aesthetic outcomes using five standardized photographs graded by three independent blinded observers using the three-point, five-item, Lowery breast aesthetic score at 1-year [29,30]. …”

Section: Introductionmentioning

confidence: 99%

The Multi Centre Canadian Acellular Dermal Matrix Trial (MCCAT): study protocol for a randomized controlled trial in implant-based breast reconstruction

Zhong

Temple‐Oberle

Höfer

et al. 2013

Trials

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BackgroundThe two-stage tissue expander/implant (TE/I) reconstruction is currently the gold standard method of implant-based immediate breast reconstruction in North America. Recently, however, there have been numerous case series describing the use of one-stage direct to implant reconstruction with the aid of acellular dermal matrix (ADM). In order to rigorously investigate the novel application of ADM in one-stage implant reconstruction, we are currently conducting a multicentre randomized controlled trial (RCT) designed to evaluate the impact on patient satisfaction and quality of life (QOL) compared to the two-stage TE/I technique.Methods/designsThe MCCAT study is a multicenter Canadian ADM trial designed as a two-arm parallel superiority trial that will compare ADM-facilitated one-stage implant reconstruction compared to two-stage TE/I reconstruction following skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM) at 2 weeks, 6 months, and 12 months. The source population will be members of the mastectomy cohort with stage T0 to TII disease, proficient in English, over the age of 18 years, and planning to undergo SSM or NSM with immediate implant breast reconstruction. Stratified randomization will maintain a balanced distribution of important prognostic factors (study site and unilateral versus bilateral procedures). The primary outcome is patient satisfaction and QOL as measured by the validated and procedure-specific BREAST-Q. Secondary outcomes include short- and long-term complications, long-term aesthetic outcomes using five standardized photographs graded by three independent blinded observers, and a cost effectiveness analysis.DiscussionThere is tremendous interest in using ADM in implant breast reconstruction, particularly in the setting of one-stage direct to implant reconstruction where it was previously not possible without the intermediary use of a temporary tissue expander (TE). This unique advantage has led many patients and surgeons alike to believe that one-stage ADM-assisted implant reconstruction should be the procedure of choice and should be offered to patients as the first-line treatment. We argue that it is crucial that this technique be scientifically evaluated in terms of patient selection, surgical technique, complications, aesthetic outcomes, cost-effectiveness, and most importantly patient-reported outcomes before it is promoted as the new gold standard in implant-based breast reconstruction.Trial registrationClinicalTrials.gov: NCT00956384

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Section: Introductionmentioning

confidence: 99%

The Multi Centre Canadian Acellular Dermal Matrix Trial (MCCAT): study protocol for a randomized controlled trial in implant-based breast reconstruction

Zhong

Temple‐Oberle

Höfer

et al. 2013

Trials

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“…This contradiction may not necessarily be based on objective criteria but due to the fact that breast cancer patients have an initial fear of losing their breast. However, we felt, as other authors also concluded [40,41], that the 4-points score provided sufficient reliability to be used routinely.…”

Section: Discussionmentioning

confidence: 81%

Pedicled dermoglandular flap reconstruction following breast conserving surgery

Khafagy

Fakhr

Hamed

et al. 2012

Journal of the Egyptian National Cancer Institute

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“…This is in large part due to the fact that currently there is no consensus regarding optimal methods of measurement of cosmetic outcome following BCT. 4,5 Numerous researchers from different disciplines, including plastic surgery, 8,9 surgical oncology, 10 radiation oncology, 1,3,11–15 and even multidisciplinary teams, 16–20 have assessed cosmetic outcomes, using a variety of techniques. The vast majority of studies have evaluated results using some variation of a 4-point rating scale, frequently in conjunction with a questionnaire that evaluates a global form of cosmesis.…”

Section: Discussionmentioning

confidence: 99%

“…Although investigators have used validated instruments to evaluate BCT outcomes, 19 these measures only provided a general measure of patient satisfaction with their results and did not allow for specific identifiers in cosmesis, which could reveal dissatisfaction with the surgical scar, breast symmetry, or other variables. It remains that there is no consensus regarding optimal methods of measurement of cosmetic outcome, 4,5 and the question of ethnic differences in cosmetic outcome remains unanswered.…”

Section: Discussionmentioning

confidence: 99%

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A Pilot Assessment of Ethnic Differences in Cosmetic Outcomes following Breast Conservation Therapy

Hirsch

Chukwu

Butt³

et al. 2014

Plastic and Reconstructive Surgery Global Open

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Background:One of the primary benefits of breast conserving therapy (BCT) is the potential ability to preserve the aesthetic appearance of the breast. However, current literature and clinical experience suggest that the aesthetic benefits of BCT may not be equally shared among ethnic groups. This is a pilot study that uses novel techniques to evaluate the cosmetic outcomes of African American and white women following BCT.Methods:A total of 21 participants (10 African American and 11 white) completed the study. Cosmetic outcomes following BCT were evaluated by a multidisciplinary team using both quantitative and qualitative measures, including 3-dimensional photographic analysis and a pilot questionnaire. Preliminary measures were taken to evaluate the validity of the questionnaire.Results:There were no statistically significant differences in objective measures of breast symmetry between African American patients and white patients (P > 0.05 in all cases). However, all raters reported the African American patients to have worse breast symmetry and appearance when compared with white patients. Interrater reliability was found to be fair with regard to the nipple complex questions [intraclass correlation (ICC), 0.56], good with regard to the breast mound questions (ICC, 0.66), and poor with regard to the scar appearance questions (ICC = 0.32).Conclusions:Although generalizing the results of this study is limited by the small sample size, it seems that there is a difference in the perception of cosmetic outcomes between white and African American patients. The novel techniques of cosmetic evaluation used in this study show promise toward identifying variables that can affect cosmetic outcome following BCT.

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Cosmetic outcomes following breast conservation therapy: in search of a reliable scale

Cited by 17 publications

References 33 publications

The Multi Centre Canadian Acellular Dermal Matrix Trial (MCCAT): study protocol for a randomized controlled trial in implant-based breast reconstruction

The Multi Centre Canadian Acellular Dermal Matrix Trial (MCCAT): study protocol for a randomized controlled trial in implant-based breast reconstruction

Pedicled dermoglandular flap reconstruction following breast conserving surgery

A Pilot Assessment of Ethnic Differences in Cosmetic Outcomes following Breast Conservation Therapy

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