Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised

TLDR

Cosmetic outcome after breast‑conserving surgery is influenced by breast size, excised specimen weight, and psychosocial adjustment. The study evaluated whether the estimated percentage of breast volume excised (EPBVE) predicts cosmetic outcome and patient satisfaction. A cohort of 151 women who had undergone breast‑conserving surgery completed satisfaction questionnaires, had cosmetic outcomes assessed by an independent panel, and had breast volume estimated from mammograms. EPBVE strongly correlated with both subjective cosmetic assessment and patient satisfaction, with satisfaction rates of 83.5 % when EPBVE was below 10 % versus 37.0 % when above 10 %, and tumor location also influencing outcomes; thus, pre‑operative EPBVE calculation can guide reshaping decisions.

Abstract

Abstract Background The cosmetic outcome after breast-conserving surgery correlates with psychosocial adjustment. Previous studies have shown that, among other factors, cosmesis is dependent on breast size and weight of the wide local excision specimen. This study assessed cosmetic outcome relative to a combination of these factors—the estimated percentage of breast volume excised (EPBVE). Methods The study group consisted of 151 women who had undergone breast-conserving surgery. All had previously completed a patient satisfaction questionnaire and an independent panel had assessed cosmetic outcome. Their mammograms were reviewed and breast volume was estimated. A validation series showed cone volume on the oblique mammogram to predict true breast weight most accurately (r = 0·93). Results Both subjective cosmetic assessment and patient satisfaction correlated strongly with EPBVE. Overall, when the EPBVE was below 10 per cent, 83·5 per cent of patients were very satisfied with their appearance and only 3·1 per cent were not satisfied, compared with 37·0 and 16·7 per cent respectively if the EPBVE was more than 10 per cent. However, tumour location in the breast was also an important factor; cosmetic outcome was worse for medial tumours. Conclusion The percentage of breast volume excised was an important determinant of cosmesis and patient satisfaction after breast-conserving surgery. Calculating the EPBVE before surgery may help select women in whom breast reshaping or volume replacement should be considered.