title: Change of Patient-Reported Aesthetic Outcome Over Time and Identification of Factors Characterizing Poor Aesthetic Outcome After Breast-Conserving Therapy: Long-Term Results of a Prospective Cohort Study.
abstract: BACKGROUND
  We analyzed the change of aesthetic outcome (AO) over time and explored factors characterizing poor AO after breast-conserving surgery (BCS).
  
  
  METHODS
  This prospective single-center cohort study included 849 patients preoperatively planned for BCS between September 2007 and December 2011. Long-term follow-up was made once in 2013. AO was measured by the Aesthetic Status (AS) of the Breast Cancer Treatment Outcome Scale questionnaire. Clinical, surgical, and pathologic variables were evaluated to identify predictors of poor AO. We applied single factor variance analyses and univariable logistic regression analyses for outcome analysis.
  
  
  RESULTS
  The long-term follow-up rate in 2013 was 73 % (621 nonrecurrent with final BCS). A poor or fair AO was reported in 30 (4.8 %) and 98 (15.8 %) of these 621 patients, respectively. Single factor variance analysis showed a negative impact of higher specimen weight on AO (p < 0.001). Univariable logistic regression analysis revealed the following risk factors for poor AO: radial breast incision [odds ratio (OR) 1.97], periareolar incision (OR 1.85), fishmouth-shaped incision with resection of the nipple-areola complex (OR 8.12), impaired wound healing (OR 3.14), and seroma (OR 2.16). No patient rating her AO as fair or poor shortly after BCS improved in the long-term follow-up.
  
  
  CONCLUSIONS
  The incidence of poor AO is relatively rare but increases in the long-term follow-up. Patients experiencing poor AO after BCS are likely to remain unsatisfied with the outcome over time. Factors predicting unfavorable AO can assist preoperative planning with regards to the choice between simple breast conserving techniques or more complex oncoplastic procedures.
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany. andre.hennigs@med.uni-heidelberg.de.
authors.forename: André
authors.initials: A
authors.lastname: Hennigs
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Hannah
authors.initials: H
authors.lastname: Biehl
authors.affiliation: Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Rauch
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Golatta
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Patrik
authors.initials: P
authors.lastname: Tabatabai
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Domschke
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Schott
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Wallwiener
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Schütz
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
authors.affiliation: Department of Gynecology, University Breast Unit, Im Neunheimer Feld 440, Heidelberg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Heil
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy / Q000009:adverse effects*; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D057566:Self Report; D049291:Seroma / Q000209:etiology*; D011795:Surveys and Questionnaires; D014945:Wound Healing