title: Do reexcisions impair aesthetic outcome in breast conservation surgery? Exploratory analysis of a prospective cohort study.
abstract: OBJECTIVE
  Reexcision is a clinically relevant aspect of oncological breast conservation surgery. The influence of reexcision on aesthetic outcome is described differently in the literature. Our aim was to analyze this question in a well-defined cohort with standardized study instruments.
  
  
  METHODS
  A total of 439 patients from a prospectively followed cohort were included in this analysis. Aesthetic results were assessed by the Breast Cancer Treatment Outcome Scale (BCTOS) aesthetic status. Dates of assessments were shortly after surgical interventions and before surgery. Group comparison was performed between patients with reexcisions (80 cases; 18%) and patients without reexcision (359 cases; 82%). We considered variables of differing distribution between the two groups that could hypothetically influence BCTOS aesthetic status in a nonparametric analysis of covariance (ANCOVA).
  
  
  RESULTS
  The aesthetic status of patients with reexcisions was found to be significantly worse than for patients with a single breast conservation surgery (P < 0.0001) when tested by a nonparametric ANCOVA model. Because patients with reexcisions had more noninvasive tumors (25% vs. 8%, P = 0.0001) and tumors were larger in patients with reexcision (P = 0.01), we included these variables as possible covariates in the multivariate model. The model was adjusted for the BCTOS aesthetic status before and shortly after the first surgery.
  
  
  CONCLUSIONS
  Our findings suggest that reexcision in breast conservation surgery impairs aesthetic outcome, at least when assessed shortly after surgery.
authors.affiliation: University Breast Unit Heidelberg, Heidelberg, Germany. joerg.heil@med.uni-heidelberg.de
authors.forename: Joerg
authors.initials: J
authors.lastname: Heil
authors.forename: Kathrin
authors.initials: K
authors.lastname: Breitkreuz
authors.forename: Michael
authors.initials: M
authors.lastname: Golatta
authors.forename: Elena
authors.initials: E
authors.lastname: Czink
authors.forename: Julia
authors.initials: J
authors.lastname: Dahlkamp
authors.forename: Joachim
authors.initials: J
authors.lastname: Rom
authors.forename: Florian
authors.initials: F
authors.lastname: Schuetz
authors.forename: Maria
authors.initials: M
authors.lastname: Blumenstein
authors.forename: Geraldine
authors.initials: G
authors.lastname: Rauch
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011446:Prospective Studies; D012086:Reoperation; D013518:Surgery, Plastic; D016896:Treatment Outcome