Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery

Abstract

BackgroundWith the development of new surgical techniques in breast cancer, such as oncoplastic breast surgery, increased knowledge of risk factors for poor satisfaction with conventional breast-conserving surgery (BCS) is needed in order to determine which patients to offer these techniques to. The aim of this study was to investigate patient satisfaction regarding aesthetic result and skin sensitivity in relation to patient, tumour, and treatment factors, in a consecutive sample of patients undergoing conventional BCS.MethodsWomen eligible for BCS were recruited between February 1, 2008 and January 31, 2012 in a prospective setup. In all, 297 women completed a study-specific questionnaire 1 year after conventional BCS and radiotherapy. Potential risk factors for poor satisfaction were investigated using logistic regression analysis.ResultsThe great majority of the women, 84%, were satisfied or very satisfied with the overall aesthetic result. The rate of satisfaction regarding symmetry between the breasts was 68% and for skin sensitivity in the operated breast it was 67%. Excision of more than 20% of the preoperative breast volume was associated with poor satisfaction regarding overall aesthetic outcome, as was axillary clearance. A high BMI (≥30 kg/m2) seemed to affect satisfaction with symmetry negatively. Factors associated with less satisfied patients regarding skin sensitivity in the operated breast were an excision of ≥20% of preoperative breast volume, a BMI of 25–30 kg/m2, axillary clearance, and radiotherapy. Re-excision and postoperative infection were associated with lower rates of satisfaction regarding both overall aesthetic outcome and symmetry, as well as with skin sensitivity.ConclusionsSeveral factors affect patient satisfaction after BCS. A major determinant of poor satisfaction in this study was a large excision of breast volume. If the percentage of breast volume excised is estimated to exceed 20%, other techniques, such as oncoplastic breast surgery, with or without contralateral surgery, or mastectomy with reconstruction, may be considered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-1053-8) contains supplementary material, which is available to authorized users.

Breast‐specific factors determine cosmetic outcome and patient satisfaction after breast‐conserving therapy: Results from the randomized COBALT study

“…The importance of a woman's perception of the appearance of her breast after BCT is reflected in the numerous questionnaires that have been developed and the growing number of studies incorporating patient self‐evaluation . These questionnaires are designed to identify failures of BCT and to identify the breast‐specific factors, patient, and tumor‐related items that are responsible for unacceptable outcomes.…”

“…Over the past ten years, several authors have included breast‐specific factors in questionnaires that recorded overall good/excellent cosmetic outcome or satisfaction at rates of 76‐84% . In 2014, Parvez et al stated that one third of patients reported a large to moderate difference in breast size and shape three years after surgery.…”

“…Nowadays, studies of patient opinion on cosmetic results are generally based on institutional questionnaires that focus on breast‐specific factors, although the number and type of questions may vary . Historically, many authors have used a 4‐point Likert scale (excellent/good/fair/poor) to rate breast‐specific factors.…”

“…Historically, many authors have used a 4‐point Likert scale (excellent/good/fair/poor) to rate breast‐specific factors. Patient‐reported cosmetic outcomes have been based on only one question comparing the treated breast with the contralateral breast or on (more reliable) questionnaires with up to nine questions on breast‐specific factors . An example of the latter is a study by Waljee et al in which the authors extracted all eight questions from the BCTOS questionnaire, including six questions on breast‐specific factors, with data averaged to generate an overall asymmetry score.…”

“…An example of the latter is a study by Waljee et al in which the authors extracted all eight questions from the BCTOS questionnaire, including six questions on breast‐specific factors, with data averaged to generate an overall asymmetry score. In a recent (2016) study from Dahlback et al patients were asked to rate their satisfaction with aesthetic outcome, symmetry between the breasts, shape, and size of the operated breast, as well as appearance of the scar …”