Long-term quality of life and aesthetic outcomes after breast conserving surgery in patients with breast cancer

M Zwakman; A Tan; C Boersma; J H G Klinkenbijl; E M Noorda; T R de Jong; A B Francken

doi:10.1016/j.ejso.2022.02.011

Long-term quality of life and aesthetic outcomes after breast conserving surgery in patients with breast cancer

Eur J Surg Oncol. 2022 Aug;48(8):1692-1698. doi: 10.1016/j.ejso.2022.02.011. Epub 2022 Feb 12.

Authors

M Zwakman¹, A Tan², C Boersma³, J H G Klinkenbijl⁴, E M Noorda³, T R de Jong⁵, A B Francken³

Affiliations

¹ Department of Surgery, Isala Hospital, Dr. van Heesweg 2, Zwolle, the Netherlands. Electronic address: m.zwakman@isala.nl.
² Department of Plastic Surgery, OLVG Hospital, Oosterpark 9, Amsterdam, the Netherlands.
³ Department of Surgery, Isala Hospital, Dr. van Heesweg 2, Zwolle, the Netherlands.
⁴ Department of Surgery, Gelre Hospital, Albert Schweitzerlaan 31, Apeldoorn, the Netherlands.
⁵ Department of Plastic Surgery, Isala Hospital, Dr. van Heesweg 2, Zwolle, the Netherlands.

PMID: 35241322
DOI: 10.1016/j.ejso.2022.02.011

Abstract

Introduction: Breast surgery has become less invasive without compromising survival and aimed at improving quality of life (QoL) in terms of satisfaction with cosmesis. Despite that, short-term patient-perceived aesthetic results after breast-conserving surgery (BCS) can still be displeasing. Long-term analysis regarding contentment with cosmesis are lacking and could be different, considering that over time, patients' priorities might change and a different thought-out judgment could be given. The goal of this study is to describe long-term results in QoL after BCS and to identify possible predictors for disappointing aesthetic results.

Methods: In this retrospective cohort study, the long-term outcomes of QoL, patient-reported outcome measurements and aesthetic outcomes were investigated 4.5-10.8 years after BCS. In total, 104 patients received standardized questionnaires from the European Organisation of Research and Treatment of Cancer. The aesthetic results after BCS were evaluated subjectively through a diverse panel of healthcare observers. Objective assessment of the aesthetic results was done using the BCCT.core system of evaluating standardised breast photographs. Factors influencing aesthetic outcome were statistically analysed.

Results: QoL was high in around 75% of the patients. Correlation between QoL and aesthetic outcomes was found according to Spearman's correlation (r = 0.262, p = 0.007). Significant factors negatively influencing patient reported aesthetic outcomes were sentinel node procedure (p = 0.016), axillary lymph node dissection (p = 0.004), chemotherapy (p = 0.001), and hormonal therapy (p = 0.001).

Conclusion: The majority of the patients have acceptable QoL after BCS during long-term follow-up. Unacceptable aesthetic outcomes after BCS are associated with lower QoL and are influenced by sentinel node procedure, axillary lymph node dissection, chemotherapy, and hormonal therapy.

Keywords: Aesthetic outcomes; Breast conserving surgery; Long-term quality of life.

MeSH terms

Breast Neoplasms* / pathology
Breast Neoplasms* / surgery
Esthetics
Female
Humans
Mastectomy, Segmental* / methods
Quality of Life
Retrospective Studies