by Christopher Hadjittofi, Hend Almalki, Bahar
Mirshekar-Syahkal, Simon Pain, Katalin Zechmeister, Maged Hussien
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.
