title: Volumetric breast density is essential for predicting cosmetic outcome at the late stage after breast-conserving surgery.
abstract: BACKGROUND
  The critical issue related to breast-conserving therapy (BCT) is that cosmetic outcomes deteriorate with long-term follow-up. There is little research for breast density as a predictor of cosmetic outcomes at the late stage after BCT. To improve the long-term quality of life after BCT of breast cancer patients, the correlation of volumetric breast density (VBD) and cosmetic outcome at the late stage after BCT was evaluated.
  
  
  METHODS
  Breast volume, fibroglandular tissue volume, adipose tissue volume, and VBD were calculated on mammography using image analysis software (Volpara(®)) in 151 patients with BCT. Furthermore, the correlation of breast density and the change of breast volume over time was analyzed on mammography in 99 patients who were followed-up long-term after BCT.
  
  
  RESULTS
  On multivariate analysis, VBD was a predictor of cosmetic outcome after BCT with percent breast volume excised (PBVE). Decreased adipose tissue volume and increased fibrosis were more common in patients with VBD < 15%. Furthermore, remnant breast volume continued to decrease over time in low breast density patients during long-term follow-up. 93% of patients with VBD ≥ 15% and PBVE < 10% had a better cosmetic outcome, while 60% of patients with VBD < 15% and PBVE ≥ 10% had a worse cosmetic outcome after BCT.
  
  
  CONCLUSIONS
  While PBVE was involved in cosmetic outcome at the early stage after BCT, VBD was associated with cosmetic outcome at the late stage after BCT. Thus, a combination of VBD and PBVE could predict cosmetic outcome after BCT and contribute to the selection for the appropriate BCT.
authors: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: N
authors: N
authors: Shiina
authors: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan. Electronic address: sakaki@faculty.chiba-u.jp.
authors: M
authors: M
authors: Sakakibara
authors: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: K
authors: K
authors: Fujisaki
authors: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: T
authors: T
authors: Iwase
authors: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: T
authors: T
authors: Nagashima
authors: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: T
authors: T
authors: Sangai
authors: Department of Plastic, Reconstructive & Aesthetic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: Y
authors: Y
authors: Kubota
authors: Department of Plastic, Reconstructive & Aesthetic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: S
authors: S
authors: Akita
authors: Department of Radiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: H
authors: H
authors: Takishima
authors: Department of General Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuoku, Chiba 260-8677, Japan.
authors: M
authors: M
authors: Miyazaki
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D015412:Mastectomy, Segmental / Q000379:methods* / Q000523:psychology; D008875:Middle Aged; D009929:Organ Size; D011184:Postoperative Period; D011379:Prognosis; D011788:Quality of Life; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors
keywords: Breast cancer; Breast density; Breast-conserving surgery; Cosmetic outcome