Oncologic and Aesthetic Results Following Breast-Conserving Therapy with 0.5 cm Margins in 100 Consecutive Patients

Abstract

The purpose of this study was to evaluate the oncologic and aesthetic results of patients undergoing breast-conserving therapy with 0.5 cm surgical margins and determine the factors that influence the need for reconstruction. One hundred consecutive patients who underwent breast-conserving surgery with 0.5 cm surgical margins followed by radiotherapy for invasive cancer and ductal carcinoma in situ (DCIS) were followed prospectively and evaluated for recurrence and aesthetic result. Thirteen patients underwent reexcision to achieve a 0.5 cm margin. Factors including breast size, location of the tumor, specimen size and volume, tumor size and volume, and TNM stage, if axillary dissection or reexcision were required, were included in the analysis. Aesthetic evaluation consisted of both patient rating and an independent observer rating on a 10-point scale that assessed volume, shape, symmetry, areola/nipple, and scar. Of the 100 patients that underwent breast-conserving therapy, the overall aesthetic results revealed that 8% of the patients scored themselves seven or less, another 8% were scored seven or less by the independent observer, and another 7% were scored seven or less by both the patient and the observer. Of these patients, only one proceeded to have a reconstructive procedure. Analysis of variance revealed a significant correlation between tumor size (cm(2)) and an aesthetic score of seven or less (p = 0.023), and specimen volume (cm(3)) and an aesthetic score of seven or less (p = 0.039). Chi-squared analysis revealed a significant difference (chi(2) = 4.39, p < 0.5) in the aesthetic result in patients with stage IIA disease. Other independent factors such as age, breast size, location of the tumor, axillary dissection, and reexcision did not influence the overall aesthetic result. A Pearson correlation of patient and independent observer ratings showed a positive correlation (r = 0.4; 95% confidence interval [CI] 0.19-0.57) between the two groups. There were zero local recurrences of breast cancer during the study period. Our results demonstrate that following breast-conserving therapy with a minimum of 0.5 cm resection margins, it is possible to achieve excellent oncologic and aesthetic results. Patients with large tumors that require a large volume of resection or with stage IIA disease should be considered for reconstructive evaluation.

The Feasibility of Irreversible Electroporation for the Treatment of Breast Cancer and Other Heterogeneous Systems

“…26,41,44 Although great strides have been made in breast conserving therapy, the invasive nature of surgical resection oftentimes results in significant scarring and disfigurement, with approximately 20% of patients undergoing breast-conserving therapy unsatisfied with their final breast cosmetic outcome. 13,16 Such cases may undergo additional reconstructive procedures to improve aesthetic outcome. 13,16,20 The improvement of oncoplastic techniques may help to curb this high percentage.…”

Significance of resection margin as a risk factor for local control of early stage breast cancer

“…In a previous study that aimed to determine what percentage of the cavity reresection specimen contain tumor cells in the case reresection is performed until clear resection margin of at least 5 mm is obtained, we reported that around 30% of specimen re-resected to achieve 5mm free resection margin will contain tumor tissue 16 . From these data, it is clear that resection margin less than 5 mm is definitely not sufficient to achieve tumor negative breast after surgical procedure [17][18] . The other important question is, however, whether obtaining free resection margin will have an impact on local recurrence rate and subsequently on overall survival of breast cancer patients [19][20][21][22][23][24][25][26][27] .…”

“…As mentioned above, after supportive data from a previous study we decided to evaluate the local relapse free survival in this group of patients in the case the clear resection margin 5 mm is achieved. We always have to keep in mind the importance of cosmetic outcome of breast surgery 18 . We also have to consider the fact that the isolated local relapse does not have to impact the overall survival since the local relapse may be successfully treated by local surgery or radiotherapy.…”

Recent developments in breast-conserving surgery for breast cancer patients

“…In patients with an expected volume reduction of more than 10%, surgeons should think about the use of oncoplastic surgery [162][163][164] as cosmetic outcome may significantly be impaired. The breast volume reduction of more than 10% reduced the cosmetic result by 50% [163].…”