Breast-conserving therapy for breast cancer: Cosmetic results and options for delayed reconstruction

Vera L Negenborn, José H Volders, Nicole M A Krekel, Max H Haloua, Mark-Bram Bouman, Marlon E Buncamper, Frank B Niessen, Hay A H Winters, Caroline B Terwee, Sybren Meijer, M Petrousjka van den Tol

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OBJECTIVES: Optimisation of the cosmetic outcome after breast-conserving therapy (BCT) is important. We aimed to determine the cosmetic outcome following BCT and factors influencing this cosmesis and identify the most favourable options for delayed breast reconstruction.

MATERIALS AND METHODS: Four reconstructive surgeons evaluated the cosmetic outcome of 109 patients after BCT. Additionally, the surgeons indicated which patients were amenable for delayed reconstruction and the preferred type of reconstruction. The inter- and intra-observer agreement of the surgeons was rated.

RESULTS: The mean overall cosmetic outcome was rated as fair (2.7/4.0, SD 0.9, 1.0-4.0). Risk factors for a poor cosmesis were larger breast size (OR 3.81, p = 0.040), larger tumour (OR 1.63, p = 0.028) and axillary lymph node dissection (ALND) (OR 3.09, p = 0.013). Reconstruction of the ipsilateral side was recommended in 55.6% and 94.5% and contralateral reconstruction in 16.7% and 73.3% of patients with good and poor cosmesis, respectively. Flap reconstruction and lipofilling were most commonly reported for the ipsilateral, and breast reduction for the contralateral breast, with reasonable improvement expected (2.2/4.0, SD 0.5, 1.08-3.3). The inter- (0.5-0.7) and intra-observer (0.63-0.79) agreement of the cosmesis was moderate to good, however, poor regarding the recommended reconstruction techniques (mainly < 0.50).

CONCLUSION: Cosmetic outcome after BCT is influenced by breast and tumour size and ALND. Although several reconstructive options are available, the optimal method for revision surgery has not yet been determined. Future studies are necessary to obtain evidence-based guidelines for reconstructive surgery after BCT.

Original languageEnglish
Pages (from-to)1336-1344
Number of pages9
JournalJournal of Plastic, Reconstructive and Aesthetic Surgery
Issue number10
Publication statusPublished - Oct 2017


  • Adult
  • Axilla
  • Breast Neoplasms
  • Esthetics
  • Female
  • Humans
  • Journal Article
  • Lymph Node Excision
  • Lymph Nodes
  • Mammaplasty
  • Mastectomy, Segmental
  • Middle Aged
  • Netherlands
  • Patient Outcome Assessment
  • Patient Preference
  • Patient Selection
  • Postoperative Complications
  • Professional Practice
  • Quality Improvement
  • Time-to-Treatment
  • Tumor Burden

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