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. 2023 Sep;30(9):5341-5349.
doi: 10.1245/s10434-023-13592-3. Epub 2023 Jun 12.

The Impact of Breast-Conserving Surgery Re-excision on Patient-Reported Outcomes Using the BREAST-Q

Regina Matar-Ujvary  1 , Kathryn Haglich  2 , Meghan R Flanagan  3 , Sarah Fuzesi  4 , Varadan Sevilimedu  5 , Jonas A Nelson  2 , Mary L Gemignani  6
Affiliations

The Impact of Breast-Conserving Surgery Re-excision on Patient-Reported Outcomes Using the BREAST-Q

Regina Matar-Ujvary et al. Ann Surg Oncol. 2023 Sep.

Abstract

Background: Approximately 14% of women undergoing breast-conserving surgery (BCS) require re-excision to achieve negative margins following the Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) margin guidelines, which may influence patient-reported outcomes (PROs). Few studies have assessed the impact of re-excision on PROs following BCS.

Patients and methods: Women with stage 0-III breast cancer undergoing BCS who completed a BREAST-Q PRO measure from 2010 to 2016 were identified from a prospective database. Baseline characteristics were compared between women who underwent one BCS and those who underwent ≥ 1 re-excision surgery for positive margins (R-BCS). Linear mixed models were used to analyze associations between number of excisions and BREAST-Q scores over time.

Results: Of 2543 eligible women, 1979 (78%) had one BCS and 564 (22%) had R-BCS. Younger age, lower BMI, surgery pre-SSO Invasive Guidelines issuance, ductal carcinoma in situ (DCIS), multifocal disease, radiation therapy receipt, and endocrine therapy omission were more common in the R-BCS group. Breast satisfaction and sexual well-being were lower in the R-BCS group 2 years postoperatively. There were no differences in psychosocial well-being between groups over 5 years. On multivariable analysis, re-excision was associated with lower breast satisfaction and sexual well-being (p= 0.007 and p= 0.049, respectively), but there was no difference in psychosocial well-being (p= 0.250).

Conclusions: Women with R-BCS had lower breast satisfaction and sexual well-being 2 years postoperatively, but this difference did not remain long term. Psychosocial well-being in women who underwent one BCS were largely comparable over time to the R-BCS group. These findings may help in counseling women who are concerned about satisfaction and quality-of-life outcomes with BCS if re-excision is necessary.

Keywords: Breast cancer; Breast-conserving surgery; Patient-reported outcomes; Re-excision; Satisfaction.

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Figures

Fig. 1:
Fig. 1:
(a) Cross-sectional Analysis of Average BREAST-Q Satisfaction With Breasts Scores Between 1 BCS and R-BCS Throughout Interval of Observation; (b) Cross-sectional Analysis of Average BREAST-Q Sexual Well-Being Scores Between 1 BCS and R-BCS Throughout Interval of Observation; (c) Cross-sectional Analysis of Average BREAST-Q Psychosocial Well-Being Scores Between 1 BCS and R-BCS Throughout Interval of Observation BCS breast-conserving surgery, R-BCS re-excision surgery for positive margins
See this image and copyright information in PMC

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