Bilateral Mammoplasty for Cancer: Surgical, Oncological and Patient-Reported Outcomes

• Published in: European journal of surgical oncology Vol. 43; no. 1; pp. 68 - 75
• Main Authors: Di Micco, Rosa, O’Connell, Rachel L, Barry, Peter A, Roche, Nicola, MacNeill, Fiona A, Rusby, Jennifer E
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.01.2017
• Subjects: Adult; Aged; Aged, 80 and over; Bilateral breast reduction; Breast cancer; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; BREAST-Q; Clavien Dindo classification; Esthetics; Female; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Mammaplasty - methods; Middle Aged; Patient Satisfaction; Postoperative Complications; Surgery; Surveys and Questionnaires; Therapeutic mammoplasty; Treatment Outcome; Bilateral breast reduction; Breast cancer; Clavien Dindo classification; BREAST-Q; Therapeutic mammoplasty
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.08.013

Abstract Introduction Bilateral mammoplasty (BM) can optimise oncological safety and aesthetic outcomes in women with large or ptotic breasts whose tumour to breast volume ratio or tumour location pose a challenge to standard breast conserving therapy (BCT) and for whom mastectomy (with or without reconstruction) may be the only alternative. Methods We undertook a comprehensive analysis of surgical outcomes (complications according to the Clavien Dindo classification), acute radiation morbidity (Radiation Therapy Oncology Group classification), oncological outcomes, and patient satisfaction (BREAST-Q questionnaire) in women who underwent BM for breast cancer (BC) from June 2009-November 2014. Results 168 women were included. Median age was 55 years (range:33-84) and median tumour size at imaging 35mm (range:0-170). Median specimen weight was 242g (range 39-1824). The wise pattern technique was used in 87.5% of procedures. At least one complication occurred in 68 (40.5%) women most of which were Clavien Dindo grade 1. Grade 3 complications were infrequent (8.9 %) but occurred mainly on the therapeutic mammoplasty (TM) side ( p <0.05). Complications were associated with higher BMI, specimen weight and longer time to radiotherapy ( p <0.05). Median follow-up was 37 months (range: 13-77). Local recurrence occurred in 3(1.8%), distant metastases in 5(3.0%), and 10(6.0%) women have died. Tumour size ≥4 cm was associated with a higher rate of distant recurrence and margin involvement ( p <0.05). The median score for ‘satisfaction with breasts’ was 77 (range: 0-100). Conclusions This study provides concurrent data on surgical, oncological and patient-reported outcomes. It offers evidence that BM is an effective treatment for breast cancer in large- or ptotic-breasted women, particularly if mastectomy is the alternative.