Influence of Pedicle Technique on Aesthetic Outcomes and Quality-of-Life after Oncoplastic Reduction
The concurrent approach of breast conservation therapy (BCT) and breast reduction, otherwise known as oncoplastic reduction, has become a popular treatment option for women with breast cancer who want to avoid total mastectomies. The goal of oncoplastic breast surgery, of which oncoplastic reduction is one technique, is to achieve tumor free margins and minimize breast deformity to attain the best aesthetic and functional outcomes. Oncoplastic reduction can be performed using local breast parenchymal flaps for tissue rearrangement.
Appropriately designed pedicles help to maintain tissue vascularity and native sensations. The choice of pedicle design is highly dependent on tumor location. For example, tumors in the upper quadrants typically receive an inferior pedicle approach, while tumors in the lower quadrants are best managed with a superior pedicle design. Since most breast cancers arise in the upper outer quadrant, the inferior pedicle design is most frequently used. The inferior pedicle approach may be a suitable aesthetic choice for large, ptotic breasts due to its ability to effectively remove excess breast tissue. On the other hand, the inferior pedicle design may cause unnecessary fullness to the inferior breast and loss of conical projection, in turn producing poorer aesthetics compared to other pedicle designs.
To our knowledge, there has been no study that has looked at the influence of pedicle technique on aesthetic and quality-of-life outcomes following oncoplastic reduction. The purpose of this study is to analyze the influence of pedicle technique, as well as certain patient factors, on aesthetic and quality-of-life outcomes after oncoplastic reduction.
Methods/Technique:
A retrospective chart review was performed for all patients who underwent oncoplastic reduction between 2011 to 2018 at a single tertiary care institution. Data was collected on patient demographics, preoperative breast size, previous surgeries, oncological history, and pedicle design for oncoplastic reduction. Aesthetic evaluation of each breast was performed using a validated aesthetic grading scale. Photos were graded by four independent members of our research team (blinded to treatment group) – grading symmetry, shape, and overall appearance of each breast on a scale of 1-5. Patient satisfaction was determined through postoperative Breast-Q surveys (breast conserving therapy modules). Analysis of variance (ANOVA) was used to compared aesthetic and Breast-Q scores among the different pedicle groups. Multiple regression analyses were performed for aesthetic and Breast-Q scores with various patient factors. A p-value ≤0.05 was considered statistically significant.
Results/Complications:
A total of 225 patients (240 breasts) were evaluated. Among them, 223 (98.66%) had available information on pedicle technique used during oncoplastic reduction. Average age was 58 ± 9.2 years, BMI 32.7 ± 6.8 kg/m2, and breast specimen weight 133.2 ± 129 g. The inferior pedicle approach was the most frequently utilized method in 174 (78.02%) patients. A superomedial pedicle approach was used in 20 (8.97%) patients, superior in 17 (7.62%) patients, inferomedial in 5 (2.24%) patients, superolateral in 1 (0.45%) patient, inferolateral in 1 (0.45%) patient, and “other” pedicle approaches in 5 (2.24%) patients. Ninety-two (40.88%) patients were aesthetically evaluated based on postoperative photos, and 40 (17.77%) had completed postoperative Breast-Q surveys.
There were no significant differences in BMI, preoperative ptosis grade, preoperative cup size, and breast specimen weight among patients who received different pedicle approaches. With one exception, there were no significant differences in aesthetic and Breast-Q scores among patients who received different pedicle approaches. The one exception is that the inferior pedicle approach was associated with a higher “satisfaction with breast” Breast-Q score (p=0.0174). Multiple regression analyses of aesthetic and Breast-Q scores showed no significant correlation with BMI, preoperative ptosis grade, preoperative cup size, and breast specimen weight. However, BMI was found to be negatively correlated with the “overall appearance” score on the aesthetic grading scale (p=0.0385).
Conclusion:
The choice of pedicle design in oncoplastic reduction has no significant influence on postoperative aesthetic outcomes in terms of breast symmetry, nipple-areolar complex symmetry, and overall appearance. The inferior pedicle approach may be associated with higher patient satisfaction with breast after oncoplastic reduction. BMI, preoperative ptosis grade, preoperative cup size, and breast specimen weight have no significant impact on patient satisfaction with breast and self-reported wellbeing measures after oncoplastic reduction. However, increasing BMI may have a negative influence on overall aesthetic outcomes.