How does oncoplastic surgery compare with standard partial mastectomy? A systematic review of patient reported outcomes
Sydney Char, BS1, Joshua A. Bloom, MD2, Zachary Erlichman, BS1, Michael Jonczyk, MD, MSCTS2, Abhishek Chatterjee, MD, MBA, FACS2, Lifei Guo, MD, PhD, FACS3
1Tufts University School of Medicine, Boston, MA, 2Tufts Medical Center, Boston, MA, 3Lahey Hospital & Medical Center, Burlington, MA
Background: Many breast conservation surgical options exist for breast cancer. Surgical choices can have lasting impacts on a patientís life, so patient satisfaction is important to assess. Patient reported outcome measures (PROMs) provide important tools when evaluating surgical modalities. This systematic review aims to evaluate how patients describe breast conservation surgical choices in standard partial mastectomy and oncoplastic surgery options. Methods: A PubMed PRISMA search was performed for studies discussing standard partial mastectomy (PM) or oncoplastic surgery (OPS) and measurement of preoperative and postoperative patient-reported outcomes using the BREAST-Q or other validated PROMs. We further categorized OPS into volume displacement and volume replacement categories. Articles in non-English languages, not involving PM or OPS, or not measuring patient-reported outcomes were excluded. Weighted proportions were generated and analyzed with a welch t-test. Result:s Of 390 articles, 43 articles met inclusion criteria, and 8784 patients were included in a pooled database. While standard PM scored well, OPS performed significantly better than PM in all postoperative BREAST-Q categories: satisfaction with breasts (74.3 vs. 65.7), psychosocial well-being (81.3 vs. 78.0), sexual well-being (61.6 vs. 54.9), and satisfaction with outcome (85.4 vs. 62.2). Level 2 volume displacement surgery had the most favorable scores. Conclusion:s Breast conservation surgical choices that include a variety of OPS and PM all score well in PROMs, with OPS significantly preferred over PM. OPS should be considered in all cases and the appropriate breast conservation surgical choice should depend on the patientís tumor presentation and anatomy.
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