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Randomized Controlled Trial
. 2022 Oct:65:104-109.
doi: 10.1016/j.breast.2022.07.001. Epub 2022 Jul 18.

Simple oncoplastic breast defect closure improves long-term cosmetic outcome of breast conserving surgery for breast cancer: A randomised controlled trial

Christopher Hadjittofi  1 , Hend Almalki  1 , Bahar Mirshekar-Syahkal  1 , Simon Pain  1 , Katalin Zechmeister  1 , Maged Hussien  2
Affiliations
Randomized Controlled Trial

Simple oncoplastic breast defect closure improves long-term cosmetic outcome of breast conserving surgery for breast cancer: A randomised controlled trial

Christopher Hadjittofi et al. Breast. 2022 Oct.

Abstract

Introduction: Breast conserving surgery (BCS) is associated with unsatisfactory cosmetic outcomes in up to 30% of patients, carrying psychological and quality-of-life implications. This study compares long-term cosmetic outcomes after BCS for breast cancer with v without simple oncoplastic defect closure.

Methods: A randomised controlled trial was performed, recruiting patients who underwent BCS over four years and randomising to the "reshaping" group (closure of excision defect with mobilised breast tissue; n = 124) and to the "control" group (no attempt at defect closure; n = 109). The estimated excision volume (EEV) was <20% of breast volume (BV) in both groups. Photography and breast retraction assessment (BRA) were recorded preoperatively. Cosmetic outcomes were blindly assessed annually for five years by BRA, panel assessment of patients, and body image questionnaire (BIQ).

Results: There were no significant differences between the reshaping and control groups in mean age (52.4 v 53.0; p = 0.63), body mass index (27.8 v 27.7; p = 0.80), margin re-excision (9 v 9; p = 0.78), mean BV (562.5 v 590.3 cc; p = 0.56), mean EEV (54.6 v 60.1 cc; p = 0.14), mean EEV/BV ratio (11.2 v 11.0; p = 0.84), or mean specimen weight (52.1 v 57.7 g; p = 0.24). Reshaping group patients had significantly better outcomes compared to control group patients in terms of mean BRA (0.9 v 2.8; p < 0.0001), achieving a score of "good" or "excellent" by panel assessment at 5 years (75.8% v 48%, p < 0.0001), body image questionnaire top score at 5 years (66.9% v 35.8%; p = 0.0001).

Conclusions: Simple oncoplastic closure of defects after breast-conserving surgery improves long-term objective and subjective cosmetic outcomes.

Keywords: Breast; Cancer; Cosmesis; Oncoplastic; Satisfaction.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Surgical technique.
Fig. 2
Fig. 2
Mean breast retraction assessment values.
Fig. 3
Fig. 3
Preoperative (3a) and five-year postoperative (3b) photographs of control-group patient with tumour in the superior aspect of the right breast.
Fig. 4
Fig. 4
Preoperative (4a) and five-year postoperative (4b) photographs of reshaping-group patient with tumour inferior to the areola.
See this image and copyright information in PMC

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