Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™

Abstract

Background Oncoplastic breast-conserving surgery allows larger resections in unfavorable locations, with an improved chance of preserving esthetics. Indications and timing for potential contralateral surgery to obtain symmetry are not clear. The aim of this study was to evaluate patient satisfaction after unilateral oncoplastic volume displacement surgery, to investigate potential risk factors for lower patient satisfaction and to assess patient wish for contralateral surgery. Method A cohort of 144 women, consecutively treated for breast cancer with unilateral breast-conserving oncoplastic volume displacement surgery, followed by radiotherapy and with an unoperated contralateral breast, was sent the BREAST-Q™ breast-conserving therapy (BCT) and a study-specific questionnaire. In all, 120 women (83%) responded. For these women, the median value for resected specimen weight was 92 g (range 14–345) and for the estimated percentage of the breast volume excised 15% (range 3–35%). Results The median patient-reported score for “Satisfaction with breast” (BREAST-Q™ BCT) was 74/100. Factors associated with a score below median value in a simple logistic regression model adjusted for age and BMI were axillary clearance (OR 2.46, 95% CI 1.09–5.56), neoadjuvant chemotherapy (OR 3.26, 95% CI 1.15–9.24), and low breast density (OR 2.32 95% CI 1.02–5.29). Thirteen women (11%) were interested in contralateral surgery. Conclusion Most patients in this study cohort, who had undergone breast-conserving therapy with oncoplastic volume displacement techniques, were satisfied with their breasts without surgery to the contralateral breast. This indicates that contralateral surgery to achieve symmetry only should be performed after individual evaluation and as a delayed procedure.

Long-Term Patient Satisfaction and Quality of Life After Breast-Conserving Therapy: A Prospective Study Using the BREAST-Q

“…All differences were statistically significant, showing that distinct improvement in the physical level occurs during the first year after surgery. These results do not match our expectations, and means of “physical well-being” scores reported by other studies after BCT have been noticeably higher (e.g., 67 during a follow-up period of 12 months, 32 78 during a median follow-up period of 28 months, 47 80 during 5 to 7 years from surgery to survey, 26 and 81 during a median follow-up period of 5.5 years. 28 These studies all had different time frames for the follow-up evaluation, which surely in part explains the variation in the results.…”

Oncoplastic Surgery in the Management of Breast Cancer

“…One study of 120 patients undergoing oncoplastic breast-conserving surgery found a median score of 74 of 100 on the BREAST-Q domain for satisfaction with breasts, with 91% of patients reporting that the operation entirely or almost entirely met their expectations regarding the cosmetic outcome. 28 In a study of 155 women treated with oncoplastic breast conserving surgery, including mammoplasty or LD flap, overall satisfaction with breast surgical outcomes was 82 of 100. 29 It should be noted that of these two techniques, those patients treated with an LD flap reported more back and shoulder symptoms and upper back pain.…”

A single centre experience of local perforator flaps in oncoplastic breast surgery; a cross-sectional study

“…Duration of drain placement varied between 3 and 14 days with removal if the fluid output was less than 25 cc in a day. Duration of surgery from the time of first incision (excluding any axillary surgery) was between 45 and 323 min [median (IQR): 105 [ 25 ]]. 9 patients had their LPF surgery as a daycare procedure and the duration of the entire hospital stay ranged from 5 to 52 h [median (IQR): 24 (41)].…”