Bilateral mammoplasty for cancer: Surgical, oncological and patient-reported outcomes.
BACKGROUND
Bilateral mammoplasty (BM) can optimise oncological safety and aesthetic outcomes in women with large or ptotic breasts whose tumour to breast volume ratio or tumour location pose a challenge to standard breast-conserving therapy (BCT) and for whom mastectomy (with or without reconstruction) may be the only alternative.


METHODS
We undertook a comprehensive analysis of surgical outcomes (complications according to the Clavien Dindo classification), acute radiation morbidity (Radiation Therapy Oncology Group classification), oncological outcomes, and patient satisfaction (BREAST-Q questionnaire) in women who underwent BM for breast cancer (BC) from June 2009-November 2014.


RESULTS
168 women were included. Median age was 55 years (range:33-84) and median tumour size at imaging 35 mm (range:0-170). Median specimen weight was 242 g (range 39-1824). The wise pattern technique was used in 87.5% of procedures. At least one complication occurred in 68 (40.5%) women, mostly Clavien Dindo grade 1. Grade 3 complications were infrequent (8.9%) but occurred mainly on the therapeutic mammoplasty (TM) side (p < 0.05). Complications were associated with higher BMI, specimen weight and longer time to radiotherapy (p < 0.05). Median follow-up was 37 months (range: 13-77). Local recurrence occurred in 3 (1.8%), distant metastases in 5 (3.0%), and 10 (6.0%) women have died. The median score for 'satisfaction with breasts' was 77 (range: 0-100).


CONCLUSIONS
This study provides concurrent data on surgical, oncological and patient-reported outcomes. It offers evidence that BM is an effective treatment for breast cancer in large- or ptotic-breasted women.
Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK; University of Naples Federico II, Department of Medicine and Surgery, Via S. Pansini 5, 80131, Naples, Italy.
R
R
Di Micco
Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK.
R L
RL
O'Connell
Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK.
P A
PA
Barry
Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
N
N
Roche
Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK.
F A
FA
MacNeill
Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK.
J E
JE
Rusby
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
BREAST-Q; Bilateral breast reduction; Breast cancer; Clavien Dindo classification; Therapeutic mammoplasty