Aesthetic outcomes in women undergoing breast-conserving therapy followed by mastectomy and microsurgical reconstruction

Background In women with early‐stage breast cancer, breast‐conserving therapy (BCT) provides comparable survival to mastectomy. BCT has the advantage of preserving most of the breast, its skin envelope and the nipple–areola complex. However, deformity may result from the excision of significant amounts of breast tissue, as well as radiation therapy. Several studies have compared patients who underwent BCT to different patients who underwent mastectomy and reconstruction, and found superior aesthetic outcomes in the latter group. Our goal in this study was to compare the aesthetic outcomes in the same women who underwent BCT followed by mastectomy and reconstruction. Methods Between 2007 and 2012, 42 women with a history of BCT developed cancer recurrence and underwent mastectomy and microsurgical breast reconstruction at our institution. Photographs before and after mastectomy and reconstruction were rated by a panel of nine judges (two independent plastic surgeons, three surgical oncologists, one radiation oncologist, one medical oncologist, and two medical students), using a validated scale Results Overall, patients received a significantly higher aesthetic score after mastectomy and reconstruction than after BCT. The greatest areas of aesthetic improvement were breast volume, contour, and projection. Patients whose lumpectomy was in the lower inner quadrant, those undergoing bilateral mastectomy and reconstruction and those completing all stages of their reconstruction had the greatest aesthetic improvement Conclusions When advising patients with early‐stage breast cancer, the superior aesthetic outcome of mastectomy and microsurgical reconstruction compared to BCT must be weighed against disadvantages such as loss of sensation, length of surgery, and donor‐site morbidity. © 2014 Wiley Periodicals, Inc. Microsurgery 35:21–28, 2015.