Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes

Patient related cosmetic outcomes following breast cancer surgery is increasingly being reported as an integral part of patient satisfaction reported outcome. While it is patients actual outcomes that are key, incorporation of health care providers’ assessment of outcome in a combined approach may add benefit. This study described the evaluation of early outcomes of a combined cosmetic assessment programme following breast conservation surgery (BCS). 

An ethically approved prospective study was conducted at Letterkenny University Hospital and a 15-month timeframe was chosen. All consecutive patients undergoing conservative breast surgery with complete local excision, from July 2015 to October 2016 were entered into the study. Patients undergoing mastectomy and reconstruction with either implant or autologous tissue were not included. 41 patients undergoing BCS were analyzed. Objective and subjective cosmetic evaluations were carried out. Assessments used were the Breast Cancer Conservative Treatment—cosmetic results [BCCT.core 2.0] Software, a panel of 4 experts in breast surgery and the Breast Cancer Treatment Outcome Scale (BCTOS). Demographic and pathological data, breast excision weight, % breast volume excised (BVE), margin positivity, complications and re-excision were documented. Data was expressed as mean and standard deviation for normally distributed data and medians and inter quartile range for non-normal data. Scores were also dichotomized to excellent/good and fair/poor and results were analyzed. 

41 patients’ mean age is 55 ± 13 years old. Mean breast volume was 768.3 cm³ ± 440; BVE weighed 78.6g ± 42.6 (18.9 - 214.4) and %BVE 11.3% ± 5.2% (5.1 - 23.3). Re-excision rate was 2/41 (4.9%) all for positive margins. 0/41 infections or haematomas occurred. Cosmetic status of 10 - 14 days post-surgery was excellent or good by BCCT.core Software 78%, Expert panel 82.9%, BCTOS scale (92.7%), and fair or poor in 22%, 17.1% and 7.3% respectively. 

In conclusion, this study developed a robust outcomes assessment tool. Incorporation in routine breast practice may not only provide great understanding of outcomes, but combine the patients and the physician assessment.

Article by Michael Sugrue, et al, from Ireland, USA, Spain and The Netherlands.

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