title: Standard wide local excision or bilateral reduction mammoplasty in large-breasted women with small tumours: Surgical and patient-reported outcomes.
abstract: BACKGROUND
  Oncoplastic breast surgery is used to extend the role of breast-conserving surgery (BCS) to women with an unfavourable tumour to breast volume ratio. However, large-breasted women with a relatively small breast cancer may be offered bilateral reduction mammoplasty (BRM) despite being suitable for standard BCS as the more complex surgery may have advantages in terms of patient satisfaction and reduced adverse effects of radiotherapy.
  
  
  METHODS
  This retrospective study evaluated surgical and patient-reported outcome measures (PROMs) in large-breasted women with early (<3 cm) breast cancer, who have undergone unilateral standard BCS or BRM.
  
  
  RESULTS
  This series included 157 women, 87 in the unilateral BCS group and 70 in the BRM group. Median age was 60.2 years (range: 33-83.9). Median follow-up was 36 months (range: 9.8-76). Tumour size, rates of axillary dissection, adjuvant chemotherapy and tumour bed irradiation boost were significantly greater in the BRM group (p < 0.05). The surgical complication rate was not significantly different (43.7% vs. 34.3%, p = 0.253). Re-excision rates were higher in the standard BCS group (p < 0.05). Time to chemotherapy was similar, but time to radiotherapy was longer after BRM surgery (p = 0.025). Despite worse prognostic factors, more complex surgery and more aggressive adjuvant treatment, patients report better satisfaction and physical functioning and fewer adverse effects of radiotherapy after BRM than standard unilateral BCS. This difference was not statistically different in this small study (p > 0.05).
  
  
  CONCLUSIONS
  Limitations of this study mean it can only be regarded as hypothesis-generating. Nonetheless, the trends merit a prospective study to investigate the optimal management of smaller breast cancers in larger-breasted women.
authors.affiliation: Royal Marsden Hospital, Downs Road, SM2 5PT Sutton, UK; University of Naples Federico II, Department of Medicine and Surgery, Via S. Pansini 5, 80131 Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Di Micco
authors.affiliation: Royal Marsden Hospital, Downs Road, SM2 5PT Sutton, UK.
authors.forename: R L
authors.initials: RL
authors.lastname: O'Connell
authors.affiliation: Royal Marsden Hospital, Downs Road, SM2 5PT Sutton, UK.
authors.forename: P A
authors.initials: PA
authors.lastname: Barry
authors.affiliation: Royal Marsden Hospital, Fulham Road, SW3 6JJ London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Roche
authors.affiliation: Royal Marsden Hospital, Fulham Road, SW3 6JJ London, UK.
authors.forename: F A
authors.initials: FA
authors.lastname: MacNeill
authors.affiliation: Royal Marsden Hospital, Downs Road, SM2 5PT Sutton, UK. Electronic address: jennifer.rusby@rmh.nhs.uk.
authors.forename: J E
authors.initials: JE
authors.lastname: Rusby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Breast cancer; Breast conserving surgery; Breast reduction; Therapeutic mammoplasty; Wide local excision