title: Aesthetic outcomes in breast conservation therapy.
abstract: BACKGROUND
  Since the National Surgical Adjuvant Breast and Bowel Project B06 (NSABP-B06) trial demonstrated equivalent survival outcomes between patients with breast cancer undergoing modified radical mastectomy versus lumpectomy and radiation, an increasing number of patients are seeking breast conservation therapy. Traditionally, only patients who have undergone total mastectomy have been referred for reconstruction.
  
  
  OBJECTIVE
  The purpose of the study was to determine the number of dissatisfied patients treated with breast conservation therapy who have suboptimal cosmesis and should be referred for reconstruction.
  
  
  METHODS
  After obtaining approval from the Institutional Review Board and patient consent, patients identified as more than 1 year posttreatment from breast conservation therapy (1999-2004) were interviewed and photographed. Data were gathered by use of a questionnaire that included patient aesthetic score, patient satisfaction, and change in body image. Photographs were shown to a surgical oncologist, a general surgeon, and a plastic surgeon for a physician aesthetic score.
  
  
  RESULTS
  Thirteen of 46 patients (28.3%) were dissatisfied with their cosmetic result. Women who were dissatisfied with their cosmetic result were more likely to have a negative change in their body image when compared with patients who were satisfied with their cosmetic result (46.2 % vs 6.1%, P = .02). Additionally, dissatisfied patients were more likely to rate their cosmetic result as poor (15.4 % vs 0%, P = .007) and were more likely to consider reconstruction (46.2% vs 9.1%, P = .01) when compared with satisfied patients. Risk factors to predict dissatisfaction in our patient population included age younger than 52 years and the resection of tumor from the upper inner quadrant.
  
  
  CONCLUSIONS
  Twenty-eight percent of patients in this study were dissatisfied with their cosmetic result. Furthermore, a large portion of these patients would consider reconstruction if it were offered. Although this study only identified a few broad risk factors for suboptimal cosmetic outcome, it confirms our hypothesis that many patients who have undergone breast conservation therapy should be referred for plastic surgery consultation.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, TX 78229-3900, USA. wanght@uthscsa.edu
authors.forename: Howard T
authors.initials: HT
authors.lastname: Wang
authors.forename: Constance M
authors.initials: CM
authors.lastname: Barone
authors.forename: Megan B
authors.initials: MB
authors.lastname: Steigelman
authors.forename: Morton
authors.initials: M
authors.lastname: Kahlenberg
authors.forename: Dennis
authors.initials: D
authors.lastname: Rousseau
authors.forename: Jamie
authors.initials: J
authors.lastname: Berger
authors.forename: Allison
authors.initials: A
authors.lastname: Daum
authors.forename: Delio P
authors.initials: DP
authors.lastname: Ortegon
mesh_terms: D001828:Body Image; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000523:psychology*; D015412:Mastectomy, Segmental / Q000523:psychology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires