Skip to main content

Advertisement

SpringerLink
Log in

A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study

  • Original Articles
  • Breast Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Purpose

Approximately 25–30% of patients suffer from breast deformity and/or asymmetry after conventional breast-conserving surgery (CBCS). Generally, it is thought that oncoplastic breast-conserving surgery (OBCS) results in an improved cosmetic result; however, studies comparing the prognosis and aesthetic outcomes of CBCS and OBCS in early breast cancer (EBC) are inadequate.

Methods

A total of 143 patients were included in this retrospective cohort study; 53 underwent OBCS and 90 underwent CBCS. The resected weight, complications, esthetic results, patient satisfaction, and recurrence rate were compared between the groups. Patient-reported outcomes (PRO) were assessed by the BREAST-Q questionnaire.

Results

The mean age of the patients in OBCS group was 43.8 years. This was younger than that in CBCS group (49.1 years, p < 0.001). Postoperative complications (11.3% vs. 8.9%, p = 0.64) and re-excision (5.7% vs. 6.7%, p > 0.99) rates were similar. The OBCS group had higher breast satisfaction and psychosocial well-being than the CBCS group (75 vs. 63, p < 0.001 and 84 vs. 77, p = 0.05); however, sexual well-being (56 vs. 66, p = 0.05) and physical well-being (65 vs. 76, p < 0.001) were worse in OBCS. After 42.3 (range: 12.6–69.2)-month median follow-up, no difference in event-free survival (EFS) was demonstrated between the groups (p = 0.13).

Conclusion

Although OBCS has the better aesthetic outcomes and identical oncological safety in comparison with CBCS, the sexual and physical well-being in OBCS are not improved for Asian patients. Hence, choosing an appropriate procedure may be more important for the typically small to moderate-sized breasts characteristic of Asian females unlike Westerners.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

CBCS:

Conventional breast-conserving surgery

OBCS:

Oncoplastic breast-conserving surgery

BCS:

Breast-conserving surgery

PRO:

Patient-reported outcomes

QOL:

Quality of life

EBC:

Early breast cancer

IDC:

Invasive ductal carcinoma

ILC:

Invasive lobular carcinoma

EFS:

Event-free survival

ER:

Estrogen receptor

PR:

Progesterone receptor

HER-2:

Human epidermal growth factor receptor 2

ALN:

Axillary lymph nodes

ALND:

Axillary lymph nodes dissection

ALNR:

Axillary lymph nodes radiotherapy

LDF:

Latissimus dorsi flap

LOS:

Length of stay

References

  1. Wrubel E, Natwick R, Wright GP (2021) Breast-conserving therapy is associated with improved survival compared with mastectomy for early-stage breast cancer: a propensity score matched comparison using the national cancer database. Ann Surg Oncol 28(2):914–919

    Article  PubMed  Google Scholar 

  2. Kim H, Lee SB, Nam SJ et al (2021) Survival of breast-conserving surgery plus radiotherapy versus total mastectomy in early breast cancer. Ann Surg Oncol 28(9):5039–5047

    Article  PubMed  Google Scholar 

  3. de Boniface J, Szulkin R, Johansson ALV (2021) Survival after breast conservation versus mastectomy adjusted for comorbidity and socioeconomic status: a Swedish national 6-year follow-up of 48 986 women. JAMA Surg 156(7):628–637

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang L, He Y, Li J et al (2020) Comparisons of breast conserving therapy versus mastectomy in young and old women with early-stage breast cancer: long-term results using propensity score adjustment method. Breast Cancer Res Treat 183(3):717–728

    Article  PubMed  Google Scholar 

  5. Lazow SP, Riba L, Alapati A, James TA (2019) Comparison of breast-conserving therapy versus mastectomy in women under age 40: national trends and potential survival implications. Breast J 25(4):578–584

    Article  PubMed  Google Scholar 

  6. Corradini S, Reitz D, Pazos M et al (2019) Mastectomy or breast-conserving therapy for early breast cancer in real-life clinical practice: outcome comparison of 7565 cases. Cancers 11(2):160

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. van Bommel A, Spronk P, Mureau M et al (2019) Breast-contour-preserving procedure as a multidisciplinary parameter of esthetic outcome in breast cancer treatment in The Netherlands. Ann Surg Oncol 26(6):1704–1711

    Article  PubMed  PubMed Central  Google Scholar 

  8. Al-Ghazal SK, Blamey RW (1999) Cosmetic assessment of breast-conserving surgery for primary breast cancer. Breast 8(4):162–168

    Article  CAS  PubMed  Google Scholar 

  9. Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V (1998) Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 41(5):471–481

    Article  CAS  PubMed  Google Scholar 

  10. Chatterjee A, Gass J, Patel K et al (2019) A consensus definition and classification system of oncoplastic surgery developed by the American society of breast surgeons. Ann Surg Oncol 26(11):3436–3444

    Article  PubMed  Google Scholar 

  11. Vieira RA, Carrara GF, Scapulatempo Neto C, Morini MA, Brentani MM, Folgueira MA (2016) The role of oncoplastic breast conserving treatment for locally advanced breast tumors: a matching case-control study. Ann Med Surg 10:61–68

    Article  Google Scholar 

  12. van la Parra RFD, Clough KB, Thygesen HH et al (2021) Oncological safety of oncoplastic level II mammoplasties after neoadjuvant chemotherapy for large breast cancers: a matched-cohort analysis. Ann Surg Oncol 28(11):5920–5928

    Article  PubMed  Google Scholar 

  13. Zhygulin A, Fedosov A, Palytsia V et al (2021) Advanced oncoplastic breast conserving surgery: single institution experience with 823 patients. Chirurgia 116(2 Suppl):59–72

    Article  PubMed  Google Scholar 

  14. Weber WP, Morrow M, Boniface J et al (2020) Knowledge gaps in oncoplastic breast surgery. Lancet Oncol 21(8):e375–e385

    Article  PubMed  Google Scholar 

  15. Tevis SE, James TA, Kuerer HM et al (2018) Patient-reported outcomes for breast cancer. Ann Surg Oncol 25(10):2839–2845

    Article  PubMed  Google Scholar 

  16. Chen CM, Cano SJ, Klassen AF et al (2010) Measuring quality of life in oncologic breast surgery: a systematic review of patient-reported outcome measures. Breast J 16(6):587–597

    Article  PubMed  Google Scholar 

  17. Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376

    Article  CAS  PubMed  Google Scholar 

  18. Sprangers MA, Groenvold M, Arraras JI et al (1996) The European organization for research and treatment of cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol 14(10):2756–2768

    Article  CAS  PubMed  Google Scholar 

  19. Sprangers MA, Cull A, Groenvold M, Bjordal K, Blazeby J, Aaronson NK (1998) The European organization for research and treatment of cancer approach to developing questionnaire modules: an update and overview EORTC quality of life study group. Qual Life Res 7(4):291–300

    Article  CAS  PubMed  Google Scholar 

  20. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ (2009) Development of a new patient-reported outcome measure for breast surgery: the BREAST-Q. Plast Reconstr Surg 124(2):345–353

    Article  CAS  PubMed  Google Scholar 

  21. Cohen WA, Mundy LR, Ballard TN et al (2016) The BREAST-Q in surgical research: a review of the literature 2009–2015. J Plast Reconstr Aesthet Surg 69(2):149–162

    Article  PubMed  Google Scholar 

  22. Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL (2017) Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg 139(5):1046e–1055e

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Cantürk NZ, Şimşek T, Özkan GS (2021) Oncoplastic breast-conserving surgery according to tumor location. Eur J Breast Health 17(3):220–233

    Article  PubMed  PubMed Central  Google Scholar 

  24. Clough KB, Kaufman GJ, Nos C, Buccimazza I, Sarfati IM (2010) Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 17(5):1375–1391

    Article  PubMed  Google Scholar 

  25. Moran MS, Schnitt SJ, Giuliano AE et al (2014) Society of surgical oncology-American society for radiation oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol 32(14):1507–1515

    Article  PubMed  Google Scholar 

  26. Memorial Sloan Kettering Cancer Center, The University of British Columbia (2023) BREAST-Q reduction/mastopexy: a user's guide for researchers and clinicians. https://qportfolio.org/wp-content/uploads/2023/01/BREAST-Q-REDUCTION-USERS-GUIDE.pdf

  27. Memorial Sloan Kettering Cancer Center, The University of British Columbia (2023) BREAST-Q BCT translations. https://qportfolio.org/wp-content/uploads/2023/03/BREAST-Q-BREAST-CANCER-TRANSLATIONS.pdf

  28. Memorial Sloan Kettering Cancer Center, The University of British Columbia (2021) BREAST-Q reduction/mastopexy module. https://qportfolio.org/wp-content/uploads/2021/05/BREAST-Q-REDUCTION-TRANSLATIONS.pdf

  29. Wang HT, Barone CM, Steigelman MB et al (2008) Aesthetic outcomes in breast conservation therapy. Aesthet Surg J 28(2):165–170

    Article  PubMed  Google Scholar 

  30. Shaitelman SF, Jeruss JS, Pusic AL (2020) Oncoplastic surgery in the management of breast cancer. J Clin Oncol 38(20):2246–2253

    Article  PubMed  Google Scholar 

  31. Kimball CC, Nichols CI, Vose JG, Peled AW (2018) Trends in lumpectomy and oncoplastic breast-conserving surgery in the US, 2011–2016. Ann Surg Oncol 25(13):3867–3873

    Article  PubMed  Google Scholar 

  32. Romics L, Macaskill EJ, Fernandez T et al (2018) A population-based audit of surgical practice and outcomes of oncoplastic breast conservations in Scotland—an analysis of 589 patients. Eur J Surg Oncol 44(7):939–944

    Article  PubMed  Google Scholar 

  33. Palsdottir EP, Lund SHL, Asgeirsson KSA (2018) Oncoplastic breast-conserving surgery in Iceland: a population-based study. Scand J Surg 107(3):224–229

    Article  CAS  PubMed  Google Scholar 

  34. Rezai M, Knispel S, Kellersmann S, Lax H, Kimmig R, Kern P (2015) Systematization of oncoplastic surgery: selection of surgical techniques and patient-reported outcome in a cohort of 1035 patients. Ann Surg Oncol 22(11):3730–3737

    Article  PubMed  PubMed Central  Google Scholar 

  35. De Lorenzi F, Hubner G, Rotmensz N et al (2016) Oncological results of oncoplastic breast-conserving surgery: long term follow-up of a large series at a single institution: a matched-cohort analysis. Eur J Surg Oncol 42(1):71–77

    Article  PubMed  Google Scholar 

  36. De La Cruz L, Blankenship SA, Chatterjee A et al (2016) Outcomes after oncoplastic breast-conserving surgery in breast cancer patients: a systematic literature review. Ann Surg Oncol 23(10):3247–3258

    Article  PubMed  Google Scholar 

  37. Shin ES, Kim HI, Song SY, Lew DH, Lee DW (2018) Selection of oncoplastic surgical technique in Asian breast cancer patients. Arch Plast Surg 45(1):37–44

    Article  PubMed  Google Scholar 

  38. Rose M, Svensson H, Handler J, Hoyer U, Ringberg A, Manjer J (2020) Patient-reported outcome after oncoplastic breast surgery compared with conventional breast-conserving surgery in breast cancer. Breast Cancer Res Treat 180(1):247–256

    Article  PubMed  PubMed Central  Google Scholar 

  39. Char S, Bloom JA, Erlichman Z, Jonczyk MM, Chatterjee A (2021) A comprehensive literature review of patient-reported outcome measures (PROMs) among common breast reconstruction options: what types of breast reconstruction score well? Breast J 27(4):322–329

    Article  PubMed  Google Scholar 

  40. Chand ND, Browne V, Paramanathan N, Peiris LJ, Laws SA, Rainsbury RM (2017) Patient-reported outcomes are better after oncoplastic breast conservation than after mastectomy and autologous reconstruction. Plast Reconstr Surg Glob Open 5(7):e1419

    Article  PubMed  PubMed Central  Google Scholar 

  41. Gardfjell A, Dahlbäck C, Åhsberg K (2019) Patient satisfaction after unilateral oncoplastic volume displacement surgery for breast cancer, evaluated with the BREAST-Q™. World J Surg Oncol 17(1):96

    Article  PubMed  PubMed Central  Google Scholar 

  42. Shirakabe Y, Suzuki Y, Lam SM (2003) A new paradigm for the aging Asian face. Aesthet Plast Surg 27(5):397–402

    Article  Google Scholar 

  43. McCurdy JA Jr (2007) Considerations in Asian cosmetic surgery. Facial Plast Surg Clin North Am 15(3):387–397

    Article  PubMed  Google Scholar 

  44. Sykes JM (2007) Management of the aging face in the Asian patient. Facial Plast Surg Clin North Am 5(3):353–360

    Article  Google Scholar 

  45. Cimprich B, Ronis DL, Martinez-Ramos G (2002) Age at diagnosis and quality of life in breast cancer survivors. Cancer Pract 10(2):85–93

    Article  PubMed  Google Scholar 

  46. Miaja M, Platas A, Martinez-Cannon BA (2017) Psychological impact of alterations in sexuality, fertility, and body image in young breast cancer patients and their partners. Rev Invest Clin 69(4):204–209

    PubMed  Google Scholar 

  47. Angarita FA, Acuna SA, Cordeiro E, McCready DR, Cil TD (2020) Does oncoplastic surgery increase immediate (30-day) postoperative complications? An analysis of the American college of surgeons national surgical quality improvement program (ACS NSQIP) database. Breast Cancer Res Treat 182(2):429–438

    Article  PubMed  Google Scholar 

  48. Carter SA, Lyons GR, Kuerer HM et al (2016) Operative and oncologic outcomes in 9861 patients with operable breast cancer: single-institution analysis of breast conservation with oncoplastic reconstruction. Ann Surg Oncol 23(10):3190–3198

    Article  PubMed  Google Scholar 

  49. Crown A, Scovel LG, Rocha FG, Scott EJ, Wechter DG, Grumley JW (2019) Oncoplastic breast conserving surgery is associated with a lower rate of surgical site complications compared to standard breast conserving surgery. Am J Surg 217(1):138–141

    Article  PubMed  Google Scholar 

  50. Losken A, Dugal CS, Styblo TM, Carlson GW (2014) A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plast Surg 72(2):145–149

    Article  CAS  PubMed  Google Scholar 

  51. Montgomery DA, Krupa K, Cooke TG (2007) Follow-up in breast cancer: does routine clinical examination improve outcome? A systematic review of the literature. Br J Cancer 97(12):1632–1641

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Kwan ML, Weltzien E, Kushi LH, Castillo A, Slattery ML, Caan BJ (2009) Dietary patterns and breast cancer recurrence and survival among women with early-stage breast cancer. J Clin Oncol 27(6):919–926

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Chongqing Health Center for Women and Children, Chongqing, China

    JH Ren

  2. Women and Children’s Hospital of Chongqing Medical University, Chongqing, China

    JH Ren

  3. Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Yuanyuan Wang, Xiang Zhang, Qiao Cheng, Renxi Tang, Ling Yang, Junge Gong, Jiawei Xu & Hongyuan Li

  4. Department of Oncology-Pathology, Karolinska Institute Stockholm, Stockholm, Sweden

    Kang Wang

  5. The People’s Hospital of Dazu, Chongqing, China

    Qiang Liu

Authors
  1. JH Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yuanyuan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qiao Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qiang Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Renxi Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ling Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Junge Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jiawei Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hongyuan Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hongyuan Li.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 declaration of HELSINKI and its later amendments or comparable ethical standards.

Informed Consent

For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ren, J., Wang, Y., Zhang, X. et al. A Clinical Analysis of Prognosis and Patient-Reported Outcomes of Oncoplastic Breast-Conserving Surgery for Early Breast Cancer: A Retrospective Cohort Study. Aesth Plast Surg (2023). https://doi.org/10.1007/s00266-023-03631-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00266-023-03631-5

Keywords

Search

Navigation