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Aesthetic Outcomes in Women Undergoing Breast-Conserving Therapy Followed by Mastectomy and Reconstruction
Ibrahim Khansa, MD;
Pankaj Tiwari, MD;
James H. Boehmler IV, MD
The Ohio State University Wexner Medical Center
2013-02-28
Presenter: Ibrahim Khansa, MD
Affidavit:
The material presented in this abstract is Dr. Khansa's original work, and has not been previously published in any journal or presented at any meeting.
Director Name: Gregory Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: In women with early-stage breast cancer, breast-conserving therapy (BCT) provides comparable survival to mastectomy. BCT has the advantage of preserving most of the breast, its skin envelope and the nipple-areola complex. However, aesthetic deformity may result from the excision of significant amounts of breast tissue, as well as radiation therapy. Several studies have compared patients who underwent BCT to different patients who underwent mastectomy and reconstruction, and found superior aesthetic outcomes in the latter group. No study has compared aesthetic outcome in the same women who underwent BCT followed by mastectomy and reconstruction due to recurrence.
Methods: Between 2007 and 2012, 42 women with a prior history of BCT developed breast cancer recurrence and underwent mastectomy and microsurgical breast reconstruction at our institution. Photographs before and after mastectomy and reconstruction were rated by a panel of six judges (two independent plastic surgeons, one radiation oncologist, one medical oncologist, two medical students), using a validated scale.
Results: Overall, patients received a significantly higher aesthetic score after mastectomy and reconstruction than after BCT. The greatest areas of aesthetic improvement were breast volume and projection. Patients whose lumpectomy was in the upper outer or upper inner quadrants of the breast, and those undergoing bilateral mastectomy and reconstruction had the greatest aesthetic improvement.
Conclusions: When advising patients with early-stage breast cancer, the superior aesthetic outcome of mastectomy and microsurgical breast reconstruction compared to BCT must be weighed against disadvantages such as loss of sensation and the length of surgery.
