title: Aesthetic and functional outcome after breast conserving surgery - Comparison between conventional and oncoplastic resection.
abstract: BACKGROUND
  Recent studies implicate that oncoplastic breast cancer surgery provides better aesthetic outcome than conventional resection. Several factors have been associated with poor aesthetic outcome. This study aims to compare patient-reported aesthetic and functional outcome after conventional and oncoplastic resection and to evaluate prognostic factors for poor aesthetic outcome in a population-based setting.
  
  
  METHODS
  637 patients having breast conserving treatment (BCT) due to unilateral primary breast cancer at a single hospital district during 2010 were included. Aesthetic and functional outcome were evaluated using two questionnaires three years after surgery.
  
  
  RESULTS
  Questionnaires were returned by 379 (59%) patients; 293 (77%) of these had conventional and 86 (23%) oncoplastic resection. Patients in oncoplastic resection group had larger tumour diameter (p < 0.001), larger resection specimens (p < 0.001), and more often multifocal tumours (p = 0.032), node positive cancer (p = 0.029) and lower quadrant tumour localization (p = 0.007). Aesthetic outcome according to BCTOS questionnaire was good in 284 (75%) patients; 52 (61%) patients in the oncoplastic group and 230 patients (81%) in the conventional resection group, p < 0.001. Larger tumour diameter (p = 0.033), multifocality (p = 0.022), weight of resection specimen (<0.001) and oncoplastic surgery (p < 0.001) were predicting poor aesthetic outcome, when all patients were included. Tumour multifocality (p = 0.013) remained predictor of poor aesthetic outcome in conventional resection group but not in oncoplastic resection group.
  
  
  CONCLUSIONS
  Patient satisfaction to aesthetic outcome after BCT is high. Conventional resection provides good aesthetic outcome in appropriately selected patients. Oncoplastic resection enables BCT in patients with larger and multifocal tumours with favourable aesthetic outcome.
authors.affiliation: Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, Finland. Electronic address: kaisu.ojala@helsinki.fi.
authors.forename: K
authors.initials: K
authors.lastname: Ojala
authors.affiliation: Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, Finland.
authors.forename: T J
authors.initials: TJ
authors.lastname: Meretoja
authors.affiliation: Breast Surgery Unit, Comprehensive Cancer Center, Helsinki University Hospital and Helsinki University, Finland.
authors.forename: M H K
authors.initials: MH
authors.lastname: Leidenius
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D004954:Esthetics; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D015412:Mastectomy, Segmental / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D017060:Patient Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D047368:Tumor Burden
keywords: Aesthetics; Breast cancer; Oncoplastic surgery; Patient satisfaction