title: The use of reduction mammaplasty with breast conservation therapy: an analysis of timing and outcomes.
abstract: BACKGROUND
  Oncoplastic reduction mammaplasty is often used to prevent or correct breast conservation therapy deformities. The purpose of this review was to evaluate surgical outcomes, patient satisfaction, and aesthetic outcomes of this procedure when performed before or after radiation therapy.
  
  
  METHODS
  Breast cancer patients treated with breast conservation therapy and reduction mammaplasty between 2005 and 2012 were divided into immediate reconstruction, delayed immediate reconstruction, and delayed reconstruction. Greater than 6-month follow-up was required for inclusion. Patient demographics and clinical outcomes, including complications, patient satisfaction, and aesthetic result, were queried. Patient satisfaction was determined using the BREAST-Q survey. Postoperative photographs were used to rate aesthetic outcomes blinded to the timing of the procedure.
  
  
  RESULTS
  Patients in the immediate reconstruction group had fewer complications (immediate reconstruction, 20.5 percent; delayed immediate reconstruction, 33.3 percent; delayed reconstruction, 60.0 percent; p < 0.001) and asymmetry (immediate reconstruction, 8.5 percent; delayed immediate reconstruction, 44.4 percent; delayed reconstruction, 24.0 percent; p < 0.001), and required fewer procedures to complete the reconstruction (immediate reconstruction, 1.2; delayed immediate reconstruction, 2.4; delayed reconstruction, 2.2; p < 0.001). Delayed reconstruction resulted in higher complication and fat necrosis rates (immediate reconstruction, 0.9 percent; delayed immediate reconstruction, 0.0 percent; delayed reconstruction, 8.0 percent; p = 0.047). Although patient satisfaction and aesthetic outcomes were better in the immediate reconstruction group, this difference was not statistically significant.
  
  
  CONCLUSIONS
  Oncoplastic reduction techniques performed before radiation therapy result in fewer complications. Good patient satisfaction and aesthetic outcomes can be achieved when reduction is performed before or after radiation therapy, but patient selection and education are important.
  
  
  METHODS
  Therapeutic, III.
authors.affiliation: Atlanta, Ga. From Emory Division of Plastic and Reconstructive Surgery.
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Egro
authors.forename: Ximena
authors.initials: X
authors.lastname: Pinell-White
authors.forename: Alexandra Marie
authors.initials: AM
authors.lastname: Hart
authors.forename: Albert
authors.initials: A
authors.lastname: Losken
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome