Systematization of Oncoplastic Surgery: Selection of Surgical Techniques and Patient-Reported Outcome in a Cohort of 1,035 Patients

Abstract

Introduction: Functional and aesthetic outcome after breast-conserving surgery are vital endpoints for patients with primary breast cancer. A large variety of oncoplastic techniques exist; however, it remains unclear which techniques yield the highest rates of local control at first surgery, omission of reexcision or subsequent mastectomy, and merits the highest degree of patient satisfaction.

Methods: In this retrospective case cohort trial with a customized investigational questionnaire for assessment of patient satisfaction with the surgical result, we analyzed 1,035 patients with primary, unilateral breast cancer and oncoplastic surgery from 2004 to 2009.

Results: Analysis of patient reported outcome (PRO) revealed that 88 % of the cohort was satisfied with their aesthetic result using oncoplastic techniques following the concept presented. These results also were achieved in difficult tumor localizations, such as upper inner and lower inner quadrant. Conversion rate from breast-conserving therapy to secondary mastectomy was low at 7.2 % (n = 68/944 patients). The systematization of oncoplastic techniques presented-embedded in a multimodal concept of breast cancer therapy-facilitates tumor control with a few number of uncomplicated techniques adapted to tumor site and size with a median resection of 32 (range 11-793) g. Five-year recurrence rate in our cohort was 4.0 %.

Conclusions: Patient's satisfaction was independent from age, body mass index, resection volume, tumor localization, and type of oncoplastic surgery (p > 0.05). We identified postoperative pain as an important negative impact factor on patient's satisfaction with the aesthetic result (p = 0.0001).

Fig. 1

Surgical techniques

Fig. 2

Selection of oncoplastic techniques

Fig. 3

a Aesthetic outcome (1 = very good; 2 = good; 3 = satisfactory; 4 = fair; 5 = insufficient; 6 = unsatisfactory) and the influence of resection volume (g). b Aesthetic outcome (1 = very good; 2 = good; 3 = satisfactory; 4 = fair; 5 = insufficient; 6 = unsatisfactory) and the influence of the choice of the primary surgical technique (1 = glandular rotation mammoplasty; 2 = dermoglandular rotation mammoplasty; 3 = tumor-adapted mastopexies; 4 = lateral thoracic advancement flap; 5 = latissimus-dorsi-flap; 6 = others). c Aesthetic outcome (1 = very good; 2 = good; 3 = satisfactory; 4 = fair; 5 = insufficient; 6 = unsatisfactory) and the influence of the tumor localization (1 = upper outer; 2 = upper inner; 3 = lower outer; 4 = lower inner; 5 = transition; 6 = multicentric and multifocal)