Northeastern Society of Plastic Surgeons

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Association Between Tumor-to-Breast Volume Ratio and Patient-Reported Outcomes After Oncoplastic Breast Conserving Surgery
Casey Zhang*1, Alberto Vera2, Kelly Murphy1, Hamid Alhmari1, Michael Calcaterra3, Carolyn De La Cruz1, Michael Gimbel1, Vu T. Nguyen1, John Vargo2, Priscilla McAuliffe4, Brodie Parent1
1Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA; 2Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA; 3University of Pittsburgh School of Medicine, Pittsburgh, PA; 4Department of Breast Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA

Introduction
Oncoplastic breast conserving surgery (OBCS) can offer oncologically safe and cosmetically satisfying results for patients with breast cancer. However, the relative oncologic safety of high tumor-burden oncoplastic resections is largely unknown. The aim of this study is to investigate the association between tumor-to-breast volume ratio, recurrence and surgical complications in OBCS. Secondarily, we aim to assess the relationship between tumor-to-breast ratio and quality of life.

Methods
A retrospective review was performed of all women who underwent OBCS for breast cancer between 2010 and 2023. Patient satisfaction was measured with the BREAST-Q questionnaire.
Tumor-to-breast ratio was calculated by dividing lumpectomy specimen volume by total breast volume, which was derived from volumetric assessment of CT scans using radiation oncology contouring simulation software. Surgical complications, re-excision, local recurrence and revision procedures were noted. Univariate logistic regression was performed to assess the association of tumor-to-breast ratio with surgical complications.

Results
This study included 192 patients, of which 65 (34%) completed the Breast-Q. Median tumor-to-breast volume ratio was 7.3% (IQR 3.6-12.5). Tumor-to-breast ratio was not associated with an increased likelihood of complications requiring re-operation (OR 1.00, p=0.99) or increased likelihood of requiring re-excision (OR 1.03, p=0.08). Increased tumor-to-breast volume was not associated with increased likelihood of cancer recurrence (OR 0.98, p=0.62). There was no association between tumor-to-breast ratio and Breast-Q Scores for Psychosocial Well-Being (mean ± SD, 71.8 ± 21.3), Physical Well-being (44.5 ± 23.4), and Overall Satisfaction (61.7 ± 28.2). Cancer worry was significantly different between tumor-to-breast ratio quartiles (p=0.03).

Conclusion
OBCS remains safe as tumor-to-breast volume ratio increases, with no discernable difference in quality of life outcomes as it relates to psychosocial, physical well-being, and overall satisfaction.
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