Determinants of aesthetic outcome after breast conserving surgery: A prospective cohort study

Purpose To evaluate the impact of patient, tumor and surgical factors affecting pre-radiotherapy (RT) aesthetic outcome. Methods The study cohort comprised of 377 patients planned for adjuvant RT from March 2020 to October 2021 after breast conserving surgery (BCS) at Tata Memorial Centre. Patient and physician rated cosmesis pre-RT and at each visit up to 2 years were recorded. Currently we report only pre-RT cosmetic outcome. Results The median size of breast, tumor-bed and breast-tumor ratio were 700 cc (130–1603), 80 cc (17.9–216) and 11.68% (1.88–34.07) respectively. Oncoplastic breast surgery (OPBS) was done in 40.8% patients, 23% patients had prior history of breast surgery while post-operative complications were documented in 4.5%. The proportion of excellent-good (E-G) cosmesis was 80%, 74.5% and 69.7% by physician, patients and BCCT.core (Breast Cancer Conservation Treatment. cosmetic results) respectively. On multivariate analysis , overall cosmesis by physician was found to be better in women with large breast (p-0.002, OR-0.431, CI 0.253–0.735); without prior history of breast surgery (p-0.007, OR-0.456, CI 0.257–0.809); and age less than 60 years (p-0.019, OR-2.492, CI 1.162–5.344). According to patient reported outcome, breast-tumor ratio (p-0.038, OR-1.04, CI 1.002–1.079) and post operative complication (p-0.025, OR-3.2, CI 1.15–8.85) were the predominant factors affecting overall cosmesis. Favorable cosmesis by BCCT.core was attributed to age less than 60 years (p-0.013, OR-2.366, CI 1.162–4.816) and prior history of breast surgery (p-0.022, OR-0.427, CI 0.206–0.886). Conclusion Large majority of patients have E-G cosmetic outcome. Various patient and tumor related factors were found to correlate with it.