TITLE:
Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes—A Preferred Approach to Outcomes Assessment
AUTHORS:
Michael Sugrue, Alison Johnston, Amy Degnim, Isabel T. Rubio, M. Petrouska Van den Tol, Risal Djohan, Mark Valentine, Geraldine Mac Gregor
KEYWORDS:
Breast Cancer, Breast Conserving Surgery, Cosmetic Outcome, Cosmetic Assessment
JOURNAL NAME:
Advances in Breast Cancer Research,
Vol.8 No.1,
December
25,
2018
ABSTRACT: Introduction: Reducing positive margins and need for re-excision
yet maintaining cosmesis is key in breast cancer surgery. This study describes
the evaluation of early outcomes of a combined cosmetic assessment programme
following breast conservation surgery (BCS). Methods: An ethically
approved prospective study was conducted at Letterkenny University Hospital and
a 15-month timeframe was chosen. All consecutive patients
undergoing conservative breast surgery with complete local excision, from July
2015 to October 2016, were entered into the study. Patients undergoing
mastectomy and reconstruction with either implant or autologous tissue were not
included. 41 patients undergoing BCS were analysed. Objective
and subjective cosmetic evaluations were carried out. Assessments used were the
Breast Cancer Conservative Treatment—cosmetic results [BCCT.core 2.0] Software, a panel
of 4 experts in breast surgery and the Breast Cancer Treatment Outcome Scale
(BCTOS). Demographic and pathological data, breast excision weight, % breast
volume excised (BVE), margin positivity, complications and re-excision were
documented. Data was expressed as mean and standard deviation for normally
distributed data and medians and inter quartile range for non-normal data.
Scores were also dichotomised to excellent/good and fair/poor and results were analysed. Results: 41 patients’ mean age is 55 ± 13 years. Mean breast
volume was 768.3 cm3 ± 440; BVE weighed 78.6g ± 42.6 (18.9 - 214.4) and %BVE
11.3% ± 5.2% (5.1 - 23.3). Re-excision rate was 2/41 (4.9%) all for positive
margins. 0/41 infections or haematomas occurred. Cosmetic status of 10 - 14 days post surgery was excellent or good by
BCCT.core Software 78%, Expert panel 82.9%, BCTOS scale (92.7%), and fair or
poor in 22%, 17.1% and 7.3% respectively. Conclusion: This study successfully
evaluated objective and subjective cosmetic related outcomes following breast
conserving surgery, incorporating both patient and surgeon in these
assessments. The encouraging results show that despite low re-excision rates, acceptable cosmetic outcomes were achieved.