How does oncoplastic surgery compare with standard partial mastectomy? A systematic review of patient reported outcomes.

Abstract

Background: Many breast-conserving surgical options exist for patients with breast cancer. Surgical choices can have lasting effects on a patient’s life, so patient satisfaction is important to assess. Patient-reported outcome measures provide important tools when evaluating surgical modalities. This systematic review aimed to evaluate how patients describe breast-conserving surgical choices in standard partial mastectomy and oncoplastic surgery options. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses search was performed in PubMed for studies discussing standard partial mastectomy or oncoplastic surgery and measurement of preoperative and postoperative patient-reported outcomes using the BREAST-Q or other validated patient-reported outcome measures. Oncoplastic surgery was categorized as volume displacement or volume replacement. Articles in languages other than English, not involving partial mastectomy or oncoplastic surgery, or not measuring patient-reported outcomes were excluded. Weighted proportions were generated and analyzed with a Welch t test. Results: Of 390 articles, 43 met inclusion criteria, and 8784 patients were included in a pooled database. Although standard partial mastectomy scored well, oncoplastic surgery performed significantly better than partial mastectomy in all postoperative BREAST-Q categories: satisfaction with breasts (74.3 versus 65.7), psychosocial well-being (81.3 versus 78.0), sexual well-being (61.6 versus 54.9), and satisfaction with outcome (85.4 versus 62.2). Level 2 volume displacement surgery had the most favorable scores. Conclusions: Breast-conserving surgical choices that include a variety of oncoplastic surgery and partial mastectomy methods all score well in patient-reported outcome measures, with oncoplastic surgery significantly preferred over partial mastectomy. Oncoplastic surgery should be considered in all cases, and the appropriate breast-conserving surgical choice should depend on the patient’s tumor presentation and anatomy.

Narrative review of patient-reported outcomes of breast reconstruction

“…Rose et al stated patients undergoing oncoplastic breast reconstruction had better health related quality of life outcomes in terms of psychosocial well-being compared to breast conservation surgery alone ( 49 ). A recent meta-analysis of 43 articles including 8,784 patients stated patients undergoing oncoplastic reconstruction had significantly higher scores on all patient-reported outcomes measures compared to standard partial mastectomy ( 50 ). Unfortunately, many patients do not know about the opportunity for reconstruction after a lumpectomy which identifies an area where the breast cancer treatment team has the ability to improve upon patient satisfaction ( 51 ).…”

Evolution of breast conserving surgery—current implementation of oncoplastic techniques in breast conserving surgery: a literature review

“…A systematic review found that women who underwent O-BCS had better sexual well-being and residual skin sensitivity compared to those who underwent mastectomy, despite the type of reconstruction ( 74 ). These findings suggest that preserving the breast tissue and improving breast appearance through oncoplastic techniques can have a positive impact on sexual well-being for breast cancer survivors ( 75 ).…”

Practical oncoplastic surgery techniques needed for practice

“…OPS also improves patient quality of life measured by patient-reported outcome measures (PROMs), such through a BREAST-Q survey ( 4 - 6 ). Measures such as psychosocial well-being have been shown to be higher in patients treated with OPS as compared to BCS.…”