title: Predictors of breast asymmetry after breast-conserving operation for breast cancer.
abstract: BACKGROUND
  Although breast-conserving surgery is the standard of care for early-stage breast cancer, many women report breast asymmetry after this procedure. Risk factors for poor esthetic outcomes are not well understood.
  
  
  METHODS
  A self-administered survey was sent to patients who underwent lumpectomy (n = 898) at the University of Michigan Medical Center between January 2002 and May 2006 (n = 714, response rate = 79.5%). Breast asymmetry was assessed using items from the Breast Cancer Treatment and Outcomes Survey. Responses were summed to generate a score, and linear regression was used to generate adjusted breast asymmetry scores by patient-related factors (age, body mass index [BMI], tumor size, and tumor position in the breast) and treatment factors (reexcision lumpectomy, radiation therapy, and postoperative seroma).
  
  
  RESULTS
  Patient-related risk factors for breast asymmetry included younger age (asymmetry score: 18.7 versus 16.2, p = 0.03), higher BMI (17.1 versus 19.2, p = 0.007), and larger tumors (16.7 versus 19.1, p = 0.01). Resection of superior medial tumors and inferior lateral tumors was also associated with substantially higher asymmetry. Treatment-related risk factors for asymmetry included reexcision lumpectomy (18.1 versus 16.9, p = 0.013), postoperative seroma (19.3 versus 17.2, p = 0.005), and radiation therapy (17.9 versus 15.0, p = 0.008). Increasing breast asymmetry score was associated with a higher odds of desiring breast reconstruction (odds ratio = 1.2, 95% CI, 1.13 to 1.30).
  
  
  CONCLUSIONS
  Both patient- and treatment-related factors place women at risk for poor esthetic outcomes after breast-conserving surgery. Oncoplastic and reconstructive options should be considered for those at a higher risk for poor esthetic outcomes at the time of consultation.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA. filip@med.umich.edu
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Waljee
authors.forename: Emily S
authors.initials: ES
authors.lastname: Hu
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Newman
authors.forename: Amy K
authors.initials: AK
authors.lastname: Alderman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000473:pathology* / Q000523:psychology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016462:Mammaplasty; D015412:Mastectomy, Segmental; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D012959:Socioeconomic Factors; D016896:Treatment Outcome