Abstract
Introduction
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.
Patient and 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).
Conclusion
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.
Keywords
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Article info
Publication history
Published online: November 17, 2016
Accepted:
October 31,
2016
Identification
Copyright
© 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
