Al-Ghazal SK, Fallowfield L, Blamey RWComparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer 36: 1938-1943
The aim of this study was to assess and compare the psychological outcome and satisfaction of patients whom underwent wide local excision, mastectomy alone and mastectomy with breast reconstruction. A total of 577 patients had different types of operations for primary breast cancer (254 (44%) had wide local excision, 202 (35%) had simple mastectomy and 121 (21%) had breast reconstruction). Psychosocial morbidity and satisfaction were studied retrospectively using self-evaluation questionnaires. The three different surgical groups were cross-matched into four different age group. Significant statistical differences existed between the three procedures regarding satisfaction and psychosocial morbidity (anxiety, depression, body image, sexuality and self-esteem) in favour of wide local excision followed by breast reconstruction. Greatest morbidity was seen in the mastectomy group. Patient satisfaction of cosmetic outcome and psychosocial aspects was greater with wide local excision than with breast reconstruction or mastectomy. However, since wide local excision is indicated in only a group of patients, breast reconstruction should be an option available to patients requiring mastectomy.
"This study evaluates differences in cosmetic outcome between African American and white women who have undergone BCT for breast cancer and begins the process of developing qualitative measures to evaluate cosmetic outcome in this patient population. It is important to identify which factors contribute to poor cosmesis as there is evidence that suggests body image, psychosocial morbidity, and self-esteem influence cosmetic results following BCT.16,23,24 Thus, by evaluating specific causes of poor cosmesis, it may be possible to modify treatment regimens to maximize quality of life outcomes while still maintaining oncologic efficacy. "
[Show abstract][Hide abstract] ABSTRACT: Background:
One of the primary benefits of breast conserving therapy (BCT) is the potential ability to preserve the aesthetic appearance of the breast. However, current literature and clinical experience suggest that the aesthetic benefits of BCT may not be equally shared among ethnic groups. This is a pilot study that uses novel techniques to evaluate the cosmetic outcomes of African American and white women following BCT.
A total of 21 participants (10 African American and 11 white) completed the study. Cosmetic outcomes following BCT were evaluated by a multidisciplinary team using both quantitative and qualitative measures, including 3-dimensional photographic analysis and a pilot questionnaire. Preliminary measures were taken to evaluate the validity of the questionnaire.
There were no statistically significant differences in objective measures of breast symmetry between African American patients and white patients (P > 0.05 in all cases). However, all raters reported the African American patients to have worse breast symmetry and appearance when compared with white patients. Interrater reliability was found to be fair with regard to the nipple complex questions [intraclass correlation (ICC), 0.56], good with regard to the breast mound questions (ICC, 0.66), and poor with regard to the scar appearance questions (ICC = 0.32).
Although generalizing the results of this study is limited by the small sample size, it seems that there is a difference in the perception of cosmetic outcomes between white and African American patients. The novel techniques of cosmetic evaluation used in this study show promise toward identifying variables that can affect cosmetic outcome following BCT.
"Mastectomy and reconstruction rates vary widely from between countries, regionally within countries and over time, making it difficult to produce meaningful comparisons . Nevertheless, what emerges across all studies is that the majority patients do not have reconstruction following mastectomy (Table 1) (Kruper et al. 2011; Jeevan et al. 2010; Hvilsom et al. 2011; Morrow et al. 2001; Reaby 1998; Baxter et al. 2005; Yu et al. 2007; Meyer-Marcotty et al. 2007; Fallbjork et al. 2010; Al-Allak et al. 2010; Al-Ghazal et al. 2000; Harcourt et al. 2003; Christian et al. 2006; Joslyn 2005; Rowland et al. "
[Show abstract][Hide abstract] ABSTRACT: Background
The aims of the study were to investigate the factors associated with not having breast reconstruction following mastectomy and to assess patient satisfaction with information on reconstruction.
Patients and methods
We analysed a historical cohort of 1937 consecutive patients who underwent mastectomy at Institut Curie between January 2004 and February 2007. Their sociodemographic and clinicobiological characteristics were recorded in a prospective database. A questionnaire was sent to 10% of nonreconstructed patients.
The proportion of patients with invasive cancer was 82.7%. The rate of nonreconstruction in patients with in situ and invasive cancer was 34.6% and 74.9%, respectively. On multivariate analysis, only employment outside the home was associated with reconstruction in patients with in situ cancer (p < 0.001). In patients with invasive cancer, employment status (p < 0.001) and smoking (p = 0.045) were associated with reconstruction, while age > 50, ASA score >1, radiotherapy (p < 0.0001) and metastatic status (p = 0.018) were associated with nonreconstruction. For 80% of questionnaire responders, nonreconstruction was a personal choice, mainly for the following reasons: refusal of further surgery, acceptance of body asymmetry, risk of complications and advanced age. Information on reconstruction was entirely unsatisfactory or inadequate for 62% of patients.
Better understanding the factors that influence decision of nonreconstruction can help us adapt the information to serve the patient’s personal needs.
"Survival from breast cancer has certainly improved  , and it follows, therefore, that there are more patients alive now, having survived breast cancer, than at any other time. Aesthetic concerns and expectations are understandably higher on patients' agenda than previously and remain a source of psychological morbidity after mastectomy or if the results from breast conservation surgery are poor  . Thus the importance of the oncoplastic approach, defined as the application of plastic surgery techniques of partial breast reconstruction at the time of breast cancer surgery, to optimising the oncological and cosmetic outcomes of breast conservation, has never been more keenly felt    "
[Show abstract][Hide abstract] ABSTRACT: Breast conservation surgery is available to the vast majority of women with breast cancer. The combination of neoadjuvant therapies and oncoplastic surgical techniques allows even large tumours to be managed with a breast-conserving approach. The relationship between breast size and the volume of tissue to be excised determines the need for volume displacement or replacement. Such an approach can also be used in the management of carefully selected cases of multifocal or multicentric breast cancer. The role of novel techniques, such as endoscopic breast surgery and radiofrequency ablation, is yet to be precisely defined.
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