Skip to main content

Advertisement

Log in

Aesthetic, Quality-of-Life, and Clinical Outcomes after Inferior Pedicle Oncoplastic Reduction Mammoplasty

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

Abstract

Background

Oncoplastic breast surgery is more likely to achieve superior aesthetic outcomes compared to lumpectomy alone. Oncoplastic reduction mammoplasty (ORM) is a volume displacement oncoplastic technique that combines lumpectomy and reduction mammoplasty. Data on aesthetic and quality-of-life (QoL) outcomes after ORM are scarce in the literature. Based on a literature review, this present study reports outcomes on the largest group of ORM patients to date.

Methods

A retrospective review was conducted of all patients who underwent ORM between 2011 and 2018 at a tertiary care centre. Patients were excluded if no pedicle information was available or did not undergo post-operative radiotherapy. All patients with available post-operative photographs were aesthetically evaluated by four blinded, independent investigators blinded based on breast symmetry, nipple symmetry, and overall appearance. The BREAST-Q (breast conserving module) was used to assess QoL outcomes.

Results

Two-hundred-and-sixteen consecutive patients (223 breasts) were included. Macromastia (cup size D or higher) was present in 173 patients (80.1%). Inferior pedicle ORM was utilized in 179 (80.3%) breasts. Eighty-eight patients (40.7%) were aesthetically evaluated, of whom 69 patients (78.4%) had “good”, “very good”, or “excellent” grades in all aesthetic categories. Seventy-five patients (85.2%) had “good” or better grades in overall appearance. Preoperative ptosis grade, cup size, presence of post-operative complications, and breast specimen weight had no significant correlations with aesthetic grades. Inferior pedicle ORM was associated with a higher “satisfaction with breast” Q-score (p=0.017) compared to other pedicle approaches.

Conclusion

Inferior pedicle ORM achieves objectively excellent aesthetic outcomes and high patient satisfaction with the reconstruction.

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

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Jonczyk MM, Jean J, Graham R et al (2019) Surgical trends in breast cancer: a rise in novel operative treatment options over a 12 year analysis. Breast Cancer Res Tr 173:267–274

    Article  Google Scholar 

  2. Mansell J, Weiler-Mithoff E, Stallard S et al (2017) Oncoplastic breast conservation surgery is oncologically safe when compared to wide local excision and mastectomy. Breast 32:179–185

    Article  CAS  PubMed  Google Scholar 

  3. Barnea Y, Inbal A, Barsuk D et al (2014) Oncoplastic reduction using the vertical scar superior-medial pedicle pattern technique for immediate partial breast reconstruction. Can J Surg 57:E134–E140

    Article  PubMed  PubMed Central  Google Scholar 

  4. Chan SWW, Chueng PSY, Lam SH (2010) Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg 34:1447–1452

    Article  PubMed  Google Scholar 

  5. Losken A, Dugal CS, Styblo TM et al (2014) A meta-analysis comparing breast conservation therapy alone to the oncoplastic technique. Ann Plas Surg 72:145–149

    Article  CAS  Google Scholar 

  6. D’Aniello C, Grimaldi L, Barbato A et al (1999) Cosmetic results in 242 patients treated by conservative surgery for breast cancer. Scand J Plast Reconstr Surg Hand Surg 34:419–422

    Google Scholar 

  7. Clough KB, Cuminet J, Fitoussi A et al (1998) Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg 41:471–481

    Article  CAS  PubMed  Google Scholar 

  8. Munhoz AM, Montag E, Arruda E et al (2008) Assessment of immediate conservative breast surgery reconstruction: a classification system of defects revisited and an algorithm for selecting the appropriate technique. Plast Reconstr Surg 121:716–727

    Article  CAS  PubMed  Google Scholar 

  9. Santos G, Urban C, Edelweiss MI et al (2015) Long-term comparison of aesthetical outcomes after oncoplastic surgery and lumpectomy in breast cancer patients. Ann Surg Oncol 22:2500–2508

    Article  PubMed  Google Scholar 

  10. Chang EI, Peled AW, Foster RD et al (2012) Evaluating the feasibility of extended partial mastectomy and immediate reduction mammoplasty reconstruction as an alternative to mastectomy. Ann Surg 255:1151–1157

    Article  PubMed  Google Scholar 

  11. Clough KB, Lewis JS, Couturaud B et al (2003) Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg 237:26–34

    Article  PubMed  PubMed Central  Google Scholar 

  12. Peled AW, Sbitany H, Foster RD et al (2014) Oncoplastic mammoplasty as a strategy for reducing reconstructive complications associated with postmastectomy radiation therapy. Breast J 20:302–307

    Article  PubMed  Google Scholar 

  13. Clough KB, Kaufman GJ, Nos C et al (2010) Improving breast cancer surgery: a classification and quadrant per quadrant atlas for oncoplastic surgery. Ann Surg Oncol 17:1375–1391

    Article  PubMed  Google Scholar 

  14. Scomacao I, Al-Hilli Z, Schwarz G (2020) The role of oncoplastic surgery for breast cancer. Curr Treat Options Oncol 21:1–11

    Article  Google Scholar 

  15. Audretsch W, Rezai M, Kolotas C et al (1998) Tumor-specific immediate reconstruction in breast cancer patients. Semin Plast Surg 11:71–100

    Article  Google Scholar 

  16. Kronowitz SJ, Kuerer HM, Buchholz TA et al (2008) A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg 122:1631–1647

    Article  CAS  PubMed  Google Scholar 

  17. Duraes EFR, Durand P, Morisada M et al (2022) A novel validated breast aesthetic scale – VBRAS. Plast Reconstr Surg 149:1297–1308

    Article  CAS  PubMed  Google Scholar 

  18. Klassen AF, Dominici L, Fuzesi S et al (2020) Development and validation of the BREAST-Q breast conserving therapy module. Ann Surg Onc 27:2238–2247

    Article  Google Scholar 

  19. Kronowitz SJ, Hunt KK, Kuerer HM et al (2007) Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg 120:1755–1768

    Article  CAS  PubMed  Google Scholar 

  20. Matory WE Jr, Wertheimer M, Fitzgerald TJ et al (1990) Aesthetic results following partial mastectomy and radiation therapy. Plast Reconstr Surg 85:739–746

    Article  PubMed  Google Scholar 

  21. Piper ML, Esserman LJ, Sbitany H et al (2016) Outcomes following oncoplastic reduction mammoplasty: a systematic review. Ann Plast Surg 76:S222–S226

    Article  CAS  PubMed  Google Scholar 

  22. Emiroglu M, Sert I, Karaali C et al (2016) The effectiveness of simultaneous oncoplastic breast surgery in patients with locally advanced breast cancer. Breast Cancer 23:463–470

    Article  PubMed  Google Scholar 

  23. Munhoz AM, Montag E, Arruda EG et al (2006) Critical analysis of reduction mammaplasty techniques in combination with conservative breast surgery for early breast cancer treatment. Plast Reconstr Surg 117:1091–1103

    Article  CAS  PubMed  Google Scholar 

  24. Gray JR, McCormick B, Cox L et al (1991) Primary breast irradiation in large-breasted or heavy women: analysis of cosmetic outcome. Int J Radiat Oncol Biol Phys 21:347–354

    Article  CAS  PubMed  Google Scholar 

  25. Atisha DM, Alderman AK, Kuhn LE et al (2008) The impact of obesity on patient satisfaction with breast reconstruction. Plast Reconstr Surg 121:1893–1899

    Article  CAS  PubMed  Google Scholar 

  26. Emiroglu M, Sert I, Inal A (2015) The role of oncoplastic breast surgery in breast cancer treatment. J Breast Health 11:1–9

    Article  PubMed  PubMed Central  Google Scholar 

  27. Davison SP, Mesbahi AN, Ducic I et al (2007) The versatility of the superomedial pedicle with various skin reduction patterns. Plast Reconstr Surg 120:1466–1476

    Article  CAS  PubMed  Google Scholar 

  28. Habibi M, Broderick KP, Sebai ME et al (2018) Oncoplastic breast reconstruction: should all patients be considered. Surg Oncol Clin N Am 27:167–180

    Article  PubMed  Google Scholar 

  29. Hall-Findlay EJ, Shestak KC (2015) Breast reduction. Plast Reconstr Surg 136:531e–544e

    Article  CAS  PubMed  Google Scholar 

  30. Weber WP, Haug M, Kurzeder C et al (2018) Oncoplastic breast consortium consensus conference on nipple-sparing mastectomy. Breast Cancer Res Treat 172:523–537

    Article  PubMed  PubMed Central  Google Scholar 

  31. Mundy LR, Homa K, Klassen AF et al (2017) Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg 139:1046e–1055e

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Howes BH, Watson DI, Xu C et al (2016) Quality of life following total mastectomy with and without reconstruction versus breast-conserving surgery for breast cancer: a case-controlled cohort study. J Plast Reconstr Aesthet Surg 69:1184–1191

    Article  PubMed  Google Scholar 

  33. Di Micco R, O’Connell RL, Barry PA et al (2017) Standard wide local excision or bilateral reduction mammoplasty in large-breasted women with small tumours: surgical and patient-reported outcomes. Eur J Surg Oncol 43:636–641

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  35. Agrawal A (2019) Oncoplastic breast surgery and radiotherapy-Adverse aesthetic outcomes, proposed classification of aesthetic components, and causality attribution. Breast J 25:207–218

    Article  PubMed  Google Scholar 

  36. Yi A, Kim HH, Shin HJ et al (2009) Radiation-induced complications after breast cancer radiation therapy: a pictorial review of multimodality imaging findings. Korean J Radiol 10:496–507

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kronowitz SJ, Feledy JA, Hunt KK et al (2006) Determining the optimal approach to breast reconstruction after partial mastectomy. Plast Reconstr Surg 117:1–11

    Article  CAS  PubMed  Google Scholar 

  38. Mattingly AE, Ma Z, Smith PD et al (2017) Early postoperative complications after oncoplastic reduction. South Med J 110:660–666

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

No funding was received for this stud.y

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Graham Schwarz.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose pertaining to this study.

Ethical approval

Ethical approval of the review methodology was granted by the Institutional Review Board (IRB). This study was conducted in accordance with the Helsinki Declaration.

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

Xia, T.Y., Scomacao, I., Duraes, E. et al. Aesthetic, Quality-of-Life, and Clinical Outcomes after Inferior Pedicle Oncoplastic Reduction Mammoplasty. Aesth Plast Surg 47, 905–911 (2023). https://doi.org/10.1007/s00266-023-03257-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-023-03257-7

Keywords

Navigation