Santos Gabriela, Urban Cicero, Edelweiss Maria Isabel, Zucca-Matthes Gustavo, de Oliveira Vilmar Marques, Arana Gabriel Hubner, Iera Marco, Rietjens Mario, de Lima Rubens Silveira, Spautz Cleverton, Kuroda Flávia, Anselmi Karina, Capp Edison
Post-Graduation Medical Program, UFRGS, Porto Alegre, Brazil.
Ann Surg Oncol. 2015 Aug;22(8):2500-8. doi: 10.1245/s10434-014-4301-6. Epub 2014 Dec 18.
Lumpectomy may result in major deformities and asymmetries in approximately one-third of patients. Although oncoplastic surgery (OP) could be a useful alternative to avoid them, lack of strong data is causing some debate. The purpose of this study was to compare aesthetic outcomes in patients undergoing OP versus lumpectomy using three different assessment methods.
A total of 122 patients were included in this cross-sectional multicentric study; 57 underwent OP (46.7 %), and 65 underwent lumpectomy (53.3 %). Two breast surgeons and two plastic surgeons from different institutions using the Garbay scale independently evaluated aesthetic outcomes. BCCT.core software was applied in both groups, and the patients evaluated their aesthetic outcomes answering a questionnaire about their satisfaction rate.
OP group had a higher proportion of excellent aesthetic results according to the BCCT.core software analysis (p = 0.028) and the specialists (p = 0.002). Multifactorial analyses showed that age ≥70 years (RP = 6.02; 95 % confidence interval [CI] 1.73-21.0; p = 0.005), tumors in the medial, inferior, and central quadrants (RP = 4.21; 95 % CI 1.88-9.44; p < 0.001), and large breasts (RP = 7.55; 95 % CI 2.48-23.0; p < 0.001) were significant risk factors for poor aesthetic outcomes after lumpectomy. The patients classified their results as better than those by the specialists and by the software, with no statistical difference between the groups.
Excellent aesthetic results were more frequent in the OP group according to BCCT.core software analysis and specialists. In addition, some clinical conditions and tumor locations in the breast can be considered risky factors for poor aesthetic outcomes in lumpectomy.
在大约三分之一的患者中，乳房肿瘤切除术可能会导致严重的畸形和不对称。尽管肿瘤整形手术（OP）可能是避免这些问题的一种有效替代方法，但由于缺乏有力的数据，引发了一些争议。本研究的目的是使用三种不同的评估方法比较接受OP与乳房肿瘤切除术患者的美学效果。
本横断面多中心研究共纳入122例患者；57例行OP（46.7%），65例行乳房肿瘤切除术（53.3%）。来自不同机构的两名乳腺外科医生和两名整形外科医生使用加尔贝量表独立评估美学效果。两组均应用BCCT.core软件，患者通过回答关于满意度的问卷来评估自己的美学效果。
根据BCCT.core软件分析（p = 0.028）和专家评估（p = 0.002），OP组具有更高比例的优秀美学效果。多因素分析显示，年龄≥70岁（相对风险[RP]=6.02；95%置信区间[CI]1.73 - 21.0；p = 0.005）、肿瘤位于内侧、下方和中央象限（RP = 4.21；95%CI 1.88 - 9.44；p < 0.001）以及乳房较大（RP = 7.55；95%CI 2.48 - 23.0；p < 0.001）是乳房肿瘤切除术后美学效果不佳的显著风险因素。患者对自己结果的评价优于专家和软件的评价，两组之间无统计学差异。
根据BCCT.core软件分析和专家评估，OP组更常获得优秀的美学效果。此外，乳房的一些临床情况和肿瘤位置可被视为乳房肿瘤切除术美学效果不佳的风险因素。
