Determinants of aesthetic outcome after breast conserving surgery: A prospective cohort study

To evaluate the impact of patient, tumor and surgical factors affecting pre-radiotherapy (RT) aesthetic outcome. The study cohort comprised of 377 patients planned for adjuvant RT from March 2020 to October 2021 after breast conserving surgery (BCS) at Tata Memorial Centre. Patient and physician rated cosmesis pre-RT and at each visit up to 2 years were recorded. Currently we report only pre-RT cosmetic outcome. The median size of breast, tumor-bed and breast-tumor ratio were 700 cc (130–1603), 80 cc (17.9–216) and 11.68% (1.88–34.07) respectively. Oncoplastic breast surgery (OPBS) was done in 40.8% patients, 23% patients had prior history of breast surgery while post-operative complications were documented in 4.5%. The proportion of excellent-good (E-G) cosmesis was 80%, 74.5% and 69.7% by physician, patients and BCCT.core (Breast Cancer Conservation Treatment. cosmetic results) respectively. On multivariate analysis, overall cosmesis by physician was found to be better in women with large breast (p-0.002, OR-0.431, CI 0.253–0.735); without prior history of breast surgery (p-0.007, OR-0.456, CI 0.257–0.809); and age less than 60 years (p-0.019, OR-2.492, CI 1.162–5.344). According to patient reported outcome, breast-tumor ratio (p-0.038, OR-1.04, CI 1.002–1.079) and post operative complication (p-0.025, OR-3.2, CI 1.15–8.85) were the predominant factors affecting overall cosmesis. Favorable cosmesis by BCCT.core was attributed to age less than 60 years (p-0.013, OR-2.366, CI 1.162–4.816) and prior history of breast surgery (p-0.022, OR-0.427, CI 0.206–0.886). Large majority of patients have E-G cosmetic outcome. Various patient and tumor related factors were found to correlate with it. •Vos scale is a reliable method for subjective assessment of cosmesis.•BCCT.core, an objective method of cosmetic evaluation using breast photographs is comparable well with the physician rating.•The factors like smaller breast size, older age, higher breast-tumor ratio adversely affected pre-RT cosmetic outcome.•Surgical factors like presence of postoperative complications and prior history of breast surgery worsened cosmetic outcome.•It is important to document pre-RT outcome for future longitudinal evaluation of cosmetic worsening.•This will help to evaluate the differential role of surgical and radiotherapeutic factors in worsening of cosmesis.