de Oliveira-Junior Idam, da Costa Vieira René Aloísio, Biller Gabriele, Sarri Almir José, da Silva Fabíola Cristina Brandini, Nahás Eliana Aguiar Petri
Postgraduate Program of Tocogynecology, Botucatu Medical School, Sao Paulo State University, UNESP, Sao Paulo, Brazil.
Postgraduate Program of Oncology, Barretos Cancer Hospital, Sao Paulo, Brazil.
Front Oncol. 2023 Jul 24;13:1071127. doi: 10.3389/fonc.2023.1071127. eCollection 2023.
Oncoplastic surgery (OS) has expanded the indications for breast-conserving surgery associated with an adequate aesthetic result. However, few studies have described the factors associated with unsatisfactory cosmetic outcomes from this surgical modality.
This is a cross-sectional prospective study that included patients undergoing breast-conserving surgery (BCS) with or without OS. The patients self-evaluated the cosmetic results of the breasts posttreatment and had them photographed. The photos were analyzed by BCCT.core. Individual and treatment factors (local and systemic) for all patients were evaluated. These factors were dichotomized according to the use of OS and to the cosmetic result (satisfactory and unsatisfactory). Categorical variables were tested for association with surgical outcome using the chi-square test while numerical variables using the Mann-Whitney U test. Variables with p <0,2 were selected for multivariate analysis.
Of the 300 patients evaluated, 72 (24,0%) underwent OS. According to the patient self-evaluations, an unsatisfactory cosmetic result from OS was significantly associated with younger age at diagnosis, higher body mass index (BMI) at the time of evaluation, larger tumor size and greater weight of the surgical specimen. According to the BCCT.core, only the laterality of the tumor (left) was significantly associated with an unsatisfactory cosmetic result. In logistic regression, considering OS as a control variable, the risk of an unsatisfactory outcome according to patient self-evaluation was related to the tumor ≥ T2 odds ratio (OR) 1,85 (1,027-3,34) and age at diagnosis < 40 [OR 5,0 (1,84-13,95)]. However, according to the software, the variables were associated with an increased risk of an unsatisfactory outcome were the time interval between surgery and evaluation [OR 1,27 (1,16-1,39)], the presence of lymphedema [OR 2,97 (1,36-6,46)], surgical wound infection [OR 3,6 (1,22-11,16)], tumor location on the left side [OR 3,06 (1,69-5,53)], overweight [OR 2,93 (1,48-5,8)] and obesity [OR 2,52 (1,2-5,31)].
There is no standard methodology for breast cosmesis evaluation, which influences the factors associated with unsatisfactory results. Younger patients and those with increased BMI, left breast cancer and extensive resections tend to present with unsatisfactory cosmetic results when OS is performed.
肿瘤整形手术（OS）扩大了保乳手术的适应证范围，并能带来满意的美学效果。然而，很少有研究描述这种手术方式导致美容效果不理想的相关因素。
这是一项横断面前瞻性研究，纳入了接受或未接受OS的保乳手术（BCS）患者。患者对术后乳房的美容效果进行自我评估，并拍摄照片。照片由BCCT.core进行分析。评估所有患者的个体和治疗因素（局部和全身）。根据是否使用OS以及美容效果（满意和不满意）将这些因素进行二分法分类。分类变量使用卡方检验来检测与手术结果的相关性，数值变量使用曼-惠特尼U检验。p<0.2的变量被选入多因素分析。
在评估的300例患者中，72例（24.0%）接受了OS。根据患者的自我评估，OS美容效果不满意与诊断时年龄较小、评估时较高的体重指数（BMI）、较大的肿瘤大小以及手术标本的较大重量显著相关。根据BCCT.core，只有肿瘤的侧别（左侧）与美容效果不满意显著相关。在逻辑回归中，将OS作为对照变量，根据患者自我评估，美容效果不满意的风险与肿瘤≥T2比值比（OR）1.85（1.027 - 3.34）以及诊断时年龄<40岁[OR 5.0（1.84 - 13.95）]有关。然而，根据该软件，与美容效果不满意风险增加相关的变量有手术与评估之间的时间间隔[OR 1.27（1.16 - 1.39）]、淋巴水肿的存在[OR 2.97（1.36 - 6.46）]、手术伤口感染[OR 3.6（1.22 - 11.16）]、肿瘤位于左侧[OR 3.06（1.69 - 5.53）]、超重[OR 2.93（1.48 - 5.8）]和肥胖[OR 2.52（1.2 - 5.31）]。
乳房美容评估没有标准方法，这影响了与不满意结果相关的因素。当进行OS时，年轻患者、BMI增加的患者、左侧乳腺癌患者以及广泛切除的患者往往会出现不满意的美容效果。
