title: Determinants for patient satisfaction regarding aesthetic outcome and skin sensitivity after breast-conserving surgery.
abstract: BACKGROUND
  With the development of new surgical techniques in breast cancer, such as oncoplastic breast surgery, increased knowledge of risk factors for poor satisfaction with conventional breast-conserving surgery (BCS) is needed in order to determine which patients to offer these techniques to. The aim of this study was to investigate patient satisfaction regarding aesthetic result and skin sensitivity in relation to patient, tumour, and treatment factors, in a consecutive sample of patients undergoing conventional BCS.
  
  
  METHODS
  Women eligible for BCS were recruited between February 1, 2008 and January 31, 2012 in a prospective setup. In all, 297 women completed a study-specific questionnaire 1 year after conventional BCS and radiotherapy. Potential risk factors for poor satisfaction were investigated using logistic regression analysis.
  
  
  RESULTS
  The great majority of the women, 84%, were satisfied or very satisfied with the overall aesthetic result. The rate of satisfaction regarding symmetry between the breasts was 68% and for skin sensitivity in the operated breast it was 67%. Excision of more than 20% of the preoperative breast volume was associated with poor satisfaction regarding overall aesthetic outcome, as was axillary clearance. A high BMI (≥30 kg/m2) seemed to affect satisfaction with symmetry negatively. Factors associated with less satisfied patients regarding skin sensitivity in the operated breast were an excision of ≥20% of preoperative breast volume, a BMI of 25-30 kg/m2, axillary clearance, and radiotherapy. Re-excision and postoperative infection were associated with lower rates of satisfaction regarding both overall aesthetic outcome and symmetry, as well as with skin sensitivity.
  
  
  CONCLUSIONS
  Several factors affect patient satisfaction after BCS. A major determinant of poor satisfaction in this study was a large excision of breast volume. If the percentage of breast volume excised is estimated to exceed 20%, other techniques, such as oncoplastic breast surgery, with or without contralateral surgery, or mastectomy with reconstruction, may be considered.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Jan Waldenströmsgata 18, 205 02, Malmö, Sweden. cecilia.dahlback@med.lu.se.|Department of Clinical Sciences, Lund University, Malmö, Sweden. cecilia.dahlback@med.lu.se.
authors.forename: Cecilia
authors.identifier: http://orcid.org/0000-0002-6663-7843
authors.initials: C
authors.lastname: Dahlbäck
authors.affiliation: Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Jan Waldenströmsgata 18, 205 02, Malmö, Sweden.|Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.affiliation: Department of Clinical Sciences, Lund University, Malmö, Sweden.|Breast Unit, Department of Surgery, Skåne University Hospital, Malmö, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Rehn
authors.affiliation: Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Jan Waldenströmsgata 18, 205 02, Malmö, Sweden.|Department of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Anita
authors.initials: A
authors.lastname: Ringberg
mesh_terms: D000368:Aged; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery*; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000009:adverse effects*; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012044:Regression Analysis; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D012867:Skin / Q000294:innervation; D012879:Skin Physiological Phenomena; D013530:Surgical Wound Infection / Q000453:epidemiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Aesthetics; Breast cancer; Breast-conserving surgery; Patient satisfaction; Sensitivity