title: A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammaplasty.
abstract: BACKGROUND
  Oncoplastic reduction mammaplasty offers patients breast conservation with the added benefit of functional improvement in symptoms related to macromastia. The reduction can be performed in the immediate setting with the lumpectomy, in a staged-immediate fashion after final pathology has been confirmed or in a delayed fashion after completion of both lumpectomy and radiation. This study compared quality of life and aesthetic outcomes for these different cohorts.
  
  
  METHODS
  A retrospective review was carried out on 16 consecutive patients who had oncoplastic reduction mammaplasty by the senior author (M.Y.N.) between 2003 and 2009. Demographics, oncologic treatment and timing, and reduction techniques were recorded. Patients were asked to complete a questionnaire to assess quality of life and satisfaction. Preoperative and postoperative photographs were evaluated by 15 reviewers.
  
  
  RESULTS
  Over a 7-year period, five patients had immediate, six had staged-immediate, and five had delayed reduction mammaplasty. Mean patient age was 52.5 years, and mean body mass index was 31.5. The average timing of reduction was 0, 49, and 734 days for the three groups. Positive margins occurred in two patients, leading to completion mastectomy. In addition, one patient in the staged-immediate group had a recurrence that led to completion mastectomy. Complications occurred in seven (44 percent) of 16 patients. Questionnaire response was 75 percent (12 of 16), showing positive scores in all groups but no statistical significance. Objective aesthetic evaluation also revealed significant improvements within groups comparing various preoperative to postoperative parameters. Importantly, aesthetic scores for the delayed group were consistently lower across all aspects but did not reach significance.
  
  
  CONCLUSIONS
  Oncoplastic reduction mammaplasty can be safe and effective in carefully selected patients in the immediate, staged-immediate, and delayed settings.
authors: Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital, and Georgetown University School of Medicine.
authors: Ketan M
authors: KM
authors: Patel
authors: Catherine M
authors: CM
authors: Hannan
authors: Margaret E
authors: ME
authors: Gatti
authors: Maurice Y
authors: MY
authors: Nahabedian
references: Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med. 1995;333:1456–1461.
references: Clough KB, Cuminet J, Fitoussi A, et al. Cosmetic sequelae after conservative treatment for breast cancer: Classification and results of surgical correction. Ann Plast Surg. 1998;41:471–481.
references: D'Aniello C, Grimaldi L, Barbato A, et al. Cosmetic results in 242 patients treated by conservative surgery for breast cancer. Scand J Plast Reconstr Surg Hand Surg. 1999;33:419–422.
references: Waljee JF, Hu ES, Ubel PA, et al. Effect of esthetic outcome after breast-conserving surgery on psychosocial functioning and quality of life. J Clin Oncol. 2008;26:3331–3337.
references: Waljee JF, Hu ES, Newman LA, et al. Predictors of breast asymmetry after breast-conserving operation for breast cancer. J Am Coll Surg. 2008;206:274–280.
references: Clough KB, Thomas SS, Fitoussi AD, et al. Reconstruction after conservative treatment for breast cancer: Cosmetic sequelae classification revisited. Plast Reconstr Surg. 2004;114:1743–1753.
references: Cochrane RA, Valasiadou P, Wilson AR, et al. Cosmesis and satisfaction after breast-conserving surgery correlates with the percentage of breast volume excised. Br J Surg. 2003;90:1505–1509.
references: Veiga DF, Veiga-Filho J, Ribeiro LM, et al. Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery. Plast Reconstr Surg. 2010;125:811–817.
references: Sabino Neto M, Dematte MF, Freire M, et al. Self-esteem and functional capacity outcomes following reduction mammaplasty. Aesthet Surg J. 2008;28:417–420.
references: Ducic I, Iorio ML, Al-Attar A. Chronic headaches/migraines: Extending indications for breast reduction. Plast Reconstr Surg. 2010;125:44–49.
references: Spector JA, Karp NS. Reduction mammaplasty: A significant improvement at any size. Plast Reconstr Surg. 2007;120:845–850.
references: Losken A, Hamdi M. Partial breast reconstruction: Current perspectives. Plast Reconstr Surg. 2009;124:722–736.
references: Hernanz F, Regano S, Vega A, et al. Reduction mammaplasty: An advantageous option for breast conserving surgery in large-breasted patients. Surg Oncol. 2010; 19:e95–e102.
references: Kronowitz SJ, Kuerer HM, Buchholz TA, et al. A management algorithm and practical oncoplastic surgical techniques for repairing partial mastectomy defects. Plast Reconstr Surg. 2008;122:1631–1647.
references: Losken A, Styblo TM, Carlson GW, et al. Management algorithm and outcome evaluation of partial mastectomy defects treated using reduction or mastopexy techniques. Ann Plast Surg. 2007;59:235–242.
references: Kronowitz SJ, Hunt KK, Kuerer HM, et al. Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy. Plast Reconstr Surg. 2007;120:1755–1768.
references: Clough KB, Kroll SS, Audretsch W. An approach to the repair of partial mastectomy defects. Plast Reconstr Surg. 1999;104:409–420.
references: Clough KB, Lewis JS, Couturaud B, et al. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237:26–34.
references: Losken A, Pinell XA, Eskenazi B. The benefits of partial versus total breast reconstruction for women with macromastia. Plast Reconstr Surg. 2010;125:1051–1056.
references: Caruso F, Catanuto G, De Meo L, et al. Outcomes of bilateral mammoplasty for early stage breast cancer. Eur J Surg Oncol. 2008;34:1143–1147.
references: Losken A, Schaefer TG, Newell M, et al. The impact of partial breast reconstruction using reduction techniques on postoperative cancer surveillance. Plast Reconstr Surg. 2009;124:9–17.
references: Spear SL, Pelletiere CV, Wolfe AJ, et al. Experience with reduction mammaplasty combined with breast conservation therapy in the treatment of breast cancer. Plast Reconstr Surg. 2003;111:1102–1109.
references: Fitoussi AD, Berry MG, Fama F, et al. Oncoplastic breast surgery for cancer: Analysis of 540 consecutive cases [outcomes article]. Plast Reconstr Surg. 2010;125:454–462.
references: Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg. 2009;124:345–353.
references: Bajaj AK, Kon PS, Oberg KC, et al. Aesthetic outcomes in patients undergoing breast conservation therapy for the treatment of localized breast cancer. Plast Reconstr Surg. 2004;114:1442–1449.
references: Kronowitz S, Hunt K, Kuerer H, et al. Immediate versus delayed repair of partial mastectomy defects in breast conservation. Breast Cancer Res. 2009;11(Suppl 1):S8.
references: Rietjens M, Urban CA, Rey PC, et al. Long-term oncological results of breast conservative treatment with oncoplastic surgery. Breast 2007;16:387–395.
references: Song HM, Styblo TM, Carlson GW, et al. The use of oncoplastic reduction techniques to reconstruct partial mastectomy defects in women with ductal carcinoma in situ. Breast J. 2010; 16:141–146.
references: Kronowitz SJ. Practical guidelines for repair of partial mastectomy defects using the breast reduction technique in patients undergoing breast conservation therapy: Reply. Plast Reconstr Surg. 2008;122:676–677.
references: Gamboa-Bobadilla GM, Killingsworth C. Large-volume reduction mammaplasty: The effect of body mass index on postoperative complications. Ann Plast Surg. 2007;58:246–249.