Management of the post-breast-conserving therapy defect: extended follow-up and reclassification.
BACKGROUND
Suboptimal aesthetic outcomes after conservative therapy for breast cancer are not uncommon, with reported rates up to 30 percent, of which 5 percent may be considered severe. With radiotherapy being an essential component of breast-conserving therapy, surgical correction of deformities is challenging, and guidance as to reparative technique selection is currently limited.


METHODS
One hundred forty-one patients have undergone surgical correction of breast-conserving therapy-induced deformity since its inception at our institution in 1991. This consecutive series has been analyzed with respect to surgical procedure, complications, revisional surgery, and aesthetic outcome (with a five-point scale) to July of 2008.


RESULTS
The overall aesthetic result was considered to be at least satisfactory in 94.5 percent at 1 year and in 88.8 percent at 5 years. Secondary surgery was required in 19.1 percent and a third procedure was required in 6.4 percent. Complications were encountered in 14.2 percent. A classification into five grades of deformity was found to be practical and effective for surgical planning.


CONCLUSIONS
Reparative surgery for aesthetic deformity in scarred and irradiated breasts is able to produce satisfactory aesthetic results; however, revisional surgery and complications are not inconsiderable, and the authors hope the new classification based on their long-term experience will provide practical guidance for surgical planning to other surgeons encountering such patients.
Fitoussi
Alfred D
AD
Department of Surgery, Institut Curie, Paris, France. alfred.fitoussi@curie.net
Berry
M G
MG
Couturaud
Benoit
B
Falcou
Marie-Christine
MC
Salmon
Rémy J
RJ
D000328:Adult; D000368:Aged; D000465:Algorithms; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D004954:Esthetics; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D017060:Patient Satisfaction; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D016896:Treatment Outcome