Cosmetic Outcomes and patient Satisfaction after Volume Displacement Oncoplastic Breast Surgery for Early Breast Cancer – a study

Purpose: Oncoplasticbreast surgery (OPS) is now considered as the ideal surgery in treatment of breast cancer. This study wasdone to evaluate the patient satisfaction and cosmetic outcome of volume displacement oncoplastic breast surgery in women treated at a tertiary care cancer hospital in south India. Methods: This is a prospective study of 23 patients who had volume displacement OPS between January 2018 and December 2019. The Patient satisfaction and Cosmetic outcome was evaluated by patients’ questionnaire and a doctor. The satisfaction was assessed by a questionnaire divided into four categories; satisfaction with breast cosmesis, satisfaction with reconstruction method, satisfaction on operative method, side effects, and preference of operative method. Results: About 90% of patients answered above the fair in cosmetic items and operative methods, only less than 5% were unhappy with severe complications such as cramps or limitations of exercise. The patients’ cosmetic satisfaction score anddoctor’s cosmetic assessment also matched. Most patients preferred breast contour over short scar regardless of age and marital status (good contour 54% vs. short scar 21%). Conclusion: Volume displacement OPS offersboth the best possible cosmetic outcome and high patient satisfaction after breast cancer surgery. Most women considers good contour better than the size of scar, meaning that volume displacement OPS is a recommendable . Key words: Breast Cancer, Oncoplastic Breast Surgery, Cosmetic Outcomes -------------------------------------------------------------------------------------------------------------------------------------Date of Submission: 29-02-2020 Date of Acceptance: 14-03-2020 -------------------------------------------------------------------------------------------------------------------------------------I. Introduction : Breast conserving surgery (BCS) is one of the standard treatments for early breast cancer. The proportion of BCS to Mastectomy has gradually grown, now accountingfor up to 70% of all breast cancer surgery worldwide [1-4]. In comparison to Mastectomy, BCS has the benefits of better cosmoses while showing no difference in the oncologic outcomes. [1,2]. However, sometimes BCS has limitations relating to oncologic (tumor volume, multifocality) and anatomic ( size, tumor-breast ratio, tumor location) features [5]. Because of these limitations, oncoplastic surgery has emerged achieving oncologic safety whilst satisfying cosmetic outcomes [6-8]. Oncoplastic surgery first described by Audrets in 1998, meant immediate reconstruction to avoid deformity after BCS. Today the term is used to include a broader aspect, which includes both immediate and delayed reconstructions [10,11]. Breast Oncoplastic surgery is divided into two large categories, including volume displacement and volume replacement. The former is resection of cancer along with reshaping breast tissue; the latter is using autologous flap or prostheses to recreate breast contour [12]. Breast oncoplastic surgery is now worldwide approved, and includes various techniques [13,14]. Indian women present with larger tumors in smaller breast, thus further magnifying the role of oncoplastic surgery. This study was performed to survey the satisfaction rates of early breast cancer patients presenting to a tertiary cancer centre in Tamilnaduwho underwent volume displacement oncoplastic surgery. II. Methods Between January 2018 and December 2019, a total of 23 patients underwent oncoplastic surgery with breast cancer at the department of Surgical Oncology at The Government Arignar Anna Memorial Cancer Hospital. Among patients, 23 patients who had agreed with this study wereenrolled in this study. Patients’ satisfaction was surveyed with a questionnaire and a doctor evaluated the cosmetic outcome. A doctor who did not participate in the surgery recorded the doctor’s judgment on the aesthetic point of view. Cosmetic Outcomes and patient Satisfaction after Volume Displacement Oncoplastic Breast Surgery . DOI: 10.9790/0853-1903074953 www.iosrjournal 50 | Page We also assessed the the patients’ acceptability of long scars, which are seen in results of oncoplastic surgery. This study was approved by the intuitional Review Board of Hospital. Volume displacement oncoplastic surgery Oncoplastic surgery is classified into three different groups based on the amount of excised tissue, skin removed and the displacement of breast fibroglandular matrix. Simple glandularadvancement (SGA) is the surgical technique which does not needfurther skin excision, and can be performed only for small mass with small resulting defects. The defect is filled with breast matrix displacement which is of small amount . Dermoglandularadvancement (DGA) is performed when the defect is relatively large volume and a further skin excision needs to be made, excising the breast mass with a surrounding margin of normal parenchyma followed with then displacement of skin and breast tissue matrix to fill in the defect . Dermoglandular rotation (DGR) requires a long skin incision with wide excision of breast parenchyma and skin, thereby resulting in a relatively large defectwhich is replaced by the rotation of another quadrant of breast matrix. Technique is selected based on tumor and breast size (excision volume) and tumor location, as judged by the operating surgeon. Questionnaire on patients’ satisfaction The questionnaire on patients’ satisfaction was carried out during the follow-up visit at least three months after surgery. The satisfaction was assessed by a questionnaire divided into five categories; satisfaction with breast cosmesis, satisfaction with reconstruction method, satisfaction on operative method, side effects, and preference of operative method. The patients’ acceptability of long surgical scar while maintaining breast contour was also assessed. Patients answered all these questions of the five-point scale (Table 1). Doctor’s cosmetic assessment Cosmetic outcome was evaluated by a doctor who was not part of the surgical team. He/ She inspected the operated breast and compared with the opposite breast with regards tobreast shape and symmetry, dimpling, nipple deviation, deformity, scar contracture either at the clinic during the patient follow up without knowledge of questionnaire results. The result was classified according to the above mentioned criteria using a four point scale [16] and scored as follows: (1) excellent = 4; treated breast was identical to untreated breast, (2) good = 3; treated breast was slightly different to untreated breast (3) fair = 2; tr breast was clearly different to untreated breast, (4) poor = 1; treated breast was seriously distorted Statistical analysis The survey on both the patients’ satisfaction and doctor’s assessment were technically analyzed on each aspect. Analysis of varianc test was used for the comparison of mean score. All statistical tests were performed by SPSS ver. 18 and P-value < 0.05 was considered as statistically significant in all results.