title: Predictors of early poor aesthetic outcome after breast-conserving surgery in patients with breast cancer: initial results of a prospective cohort study at a single institution.
abstract: OBJECTIVE
  The aim of this study was to explore features of patients reporting early poor aesthetic outcome after simple breast-conserving surgery.
  
  
  METHODS
  We prospectively evaluated 709 patients shortly after breast-conserving surgery. Aesthetic outcome was measured by aesthetic status scores of the Breast Cancer Treatment Outcome Scale. Clinical, surgical, and pathologic variables were assessed to identify predictors of poor aesthetic outcome.
  
  
  RESULTS
  Poor aesthetic outcome was reported by 46 (6.5%) patients, and 209 (29%) patients reported an intermediate aesthetic outcome. A single factor analysis of variance showed a negative impact of higher specimen weight (P < 0.001). Univariate logistic regression analysis revealed the following significant risk factors for poor aesthetic outcome: 12 o'clock positioning of tumor localization, a tumor behind the nipple areolar complex (NAC), fishmouth-shaped incision with resection of the NAC, quadrantectomy, central segmental resection, and pT stages 3 and 4. Multivariate logistic regression analysis indicated statistically independent associations between poor aesthetic outcome and tumor position in the inner half of the breast or behind the NAC, quadrantectomy, and pT stages 3 and 4.
  
  
  CONCLUSIONS
  Poor aesthetic outcome is relatively rare shortly after breast-conserving surgery, but predictable in specific situations.
authors.affiliation: Breast Unit, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Foersterling
authors.forename: Michael
authors.initials: M
authors.lastname: Golatta
authors.forename: Andre
authors.initials: A
authors.lastname: Hennigs
authors.forename: Sophie
authors.initials: S
authors.lastname: Schulz
authors.forename: Geraldine
authors.initials: G
authors.lastname: Rauch
authors.forename: Sarah
authors.initials: S
authors.lastname: Schott
authors.forename: Christoph
authors.initials: C
authors.lastname: Domschke
authors.forename: Florian
authors.initials: F
authors.lastname: Schuetz
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
authors.forename: Joerg
authors.initials: J
authors.lastname: Heil
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: aesthetic outcome; breast neoplasms; oncoplastic surgery