Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Plastic and Reconstructive Surgical Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Ann Surg Oncol. 2023 Nov;30(12):7091-7098. doi: 10.1245/s10434-023-13962-x. Epub 2023 Aug 9.
Oncoplastic breast surgery (OBS) combines plastic surgery techniques with conventional breast-conserving surgery (BCS) and expands BCS eligibility. Limited data are available on patient-reported outcomes (PROs) after OBS. Here we compare long-term PROs after OBS and BCS utilizing the BREAST-Q.
Women undergoing OBS or BCS between 2006 and 2019 who completed ≥ 1 long-term BREAST-Q survey 3-5 years postoperatively were identified. Baseline characteristics were compared between women who underwent OBS/BCS. Women who underwent OBS were paired with those who underwent BCS using 1:2 propensity matching [by age, body mass index (BMI), race, T stage, and multifocality]. BREAST-Q scores were compared preoperatively and 3-5 years postoperatively.
A total of 297 patients were included for analysis (99 OBS/198 BCS). Women who underwent OBS were younger (p < 0.001) and had higher BMI (p = 0.005) and multifocal disease incidence (p = 0.004). There was no difference between groups in nodal stage, re-excision rates, axillary surgery, chemotherapy, endocrine therapy, or radiotherapy. After propensity matching preoperatively, women who underwent OBS reported lower psychosocial well-being (63 versus 100, p = 0.039) but similar breast satisfaction and sexual well-being compared with women who underwent BCS; however, only three patients who underwent BCS had preoperative BREAST-Q scores available for review. In long-term follow-up, women who underwent OBS reported lower psychosocial scores (74 versus 93, p = 0.011) 4 years postoperatively, but not at 5 years (76 versus 77, p = 0.83). There was no difference in long-term breast satisfaction or sexual well-being.
Women who undergo OBS present with a larger disease burden and may represent a group of non-traditional BCS candidates; they reported similar long-term breast satisfaction and sexual well-being compared with women who undergo BCS. While women who underwent OBS reported lower psychosocial well-being scores preoperatively and during a portion of the follow-up period, this difference was no longer seen at 5 years postoperatively.
肿瘤整形乳房切除术（OBS）将整形手术技术与传统的保乳手术（BCS）相结合，并扩大了 BCS 的适应证。目前关于 OBS 后患者报告结局（PROs）的资料有限。本研究利用 BREAST-Q 比较了 OBS 和 BCS 后的长期 PROs。
本研究纳入了 2006 年至 2019 年间接受 OBS 或 BCS 治疗且术后 3-5 年完成至少 1 次长期 BREAST-Q 调查的患者。比较了 OBS/BCS 组患者的基线特征。对接受 OBS 的患者进行 1:2 倾向匹配（按年龄、体重指数（BMI）、种族、T 分期和多灶性），以匹配接受 BCS 的患者。比较了术前和术后 3-5 年的 BREAST-Q 评分。
共纳入 297 例患者进行分析（99 例 OBS/198 例 BCS）。接受 OBS 的患者年龄更小（p < 0.001），BMI 更高（p = 0.005），多发病灶发生率更高（p = 0.004）。两组患者在淋巴结分期、再次切除术率、腋窝手术、化疗、内分泌治疗或放疗方面无差异。术前倾向匹配后，与接受 BCS 的患者相比，接受 OBS 的患者报告的心理社会健康状况较低（63 分与 100 分，p = 0.039），但乳房满意度和性健康状况相似；然而，仅有 3 例接受 BCS 的患者的术前 BREAST-Q 评分可供回顾。在长期随访中，接受 OBS 的患者报告术后 4 年时心理社会评分较低（74 分与 93 分，p = 0.011），但术后 5 年时无差异（76 分与 77 分，p = 0.83）。长期乳房满意度和性健康状况无差异。
接受 OBS 的患者疾病负担更大，可能代表了一组非传统的 BCS 候选者；与接受 BCS 的患者相比，他们报告了相似的长期乳房满意度和性健康状况。虽然接受 OBS 的患者在术前和随访的部分阶段报告的心理社会健康状况评分较低，但在术后 5 年时这种差异不再存在。
