Oncological Safety, Surgical Outcome and Patient Satisfaction of Oncoplastic Breast Conserving Surgery with Contralateral Balancing Reduction Mammoplasty

Introduction: Oncoplastic breast conserving surgery (OBCS) is considered a cornerstone in the management of locally invasive breast cancer. We evaluated patient reported outcomes of OBCS with contralateral balancing breast reduction mammoplasty and reviewed its oncologic outcomes and complications. Methods: This is mixed method study design using retrospective chart review and prospective cohort study. Subject underwent OBCS and contralateral balancing breast reduction mammoplasty were enrolled between October 2014 and December 2017. Patient demographics were reviewed. Pre-operative and post-operative outcome and satisfaction was determined using BREAST-QTM, Impact of Events scale, Hospital Anxiety and Depression Scale and Rosenberg self-esteem scale. Outcome measures included clinicopathologic characteristics, complications, margin status, local recurrence, tumor histopathologies, duration of follow-up, patient satisfaction, self-esteem, event related stress and quality of life. Results: A total of 48 subjects were included in this study. Average age was 56, with a body mass index 29.11 kg/m2, over a mean follow up of 72.5 weeks. Complete excision with negative margins was obtained in 42 patients (87.5%), positive margins in 6 patients (12.5%), all who had re-excision with repeat lumpectomy. No subjects had local recurrence. Thirteen patients developed minor complications, defined as being managed as an outpatient. No patients developed major complications requiring inpatient admission. Patient reported outcomes and satisfaction questionnaires were given to 18 subjects. Post-surgery BREAST-QTM26 scores demonstrated improvement in satisfaction with breasts, nipples and sexual well-being. There was a decrease in satisfaction with physical well-being of the chest as well as psychosocial well-being but this was not statistically significant. There was high satisfaction with overall outcome with average score of 80.8%. Women also reported satisfaction with care with average scores of 82.7% for surgeon, 93.7% for medical staff and 99.4% for office staff. For the Rosenberg self-esteem scale, the results were similar for 3- and 12-month post- operative, with an average score of 25.3 and 25.4 respectively; indicating maintenance of normal self-esteem post operatively. The Impact of events scale showed statistically significant difference at 12- post-operative (25.1) when compared to pre-operative scores, pre-operative (41.7) 12-month post-operative; p<0.003. The results indicate that subjects had lower event-related stress. There was no significant change in Hospital Anxiety and Depression Scale. Conclusion: Our study has shown that the patient who undergo oncoplastic breast conserving surgery (OBCS) have high patient reported outcomes with acceptable oncologic outcomes and complication rates. This is safe, well tolerated and provides good cosmetic outcomes to be performed with contralateral balancing breast reduction mammoplasty. Level of Evidence: Therapeutic, III.