Simultaneous Symmetry Procedure in Patients Undergoing Oncoplastic Breast-Conserving Surgery: An Evaluation of Patient Desire and Revision Rates.

Publication Title

Annals of surgical oncology : the official journal of the Society of Surgical Oncology

Authors

Janelle-Cheri Millen, Department of Surgical Oncology, Providence Saint John's Cancer Institute, Santa Monica, CA, USAFollow
Katherine M Jackson, Department of Surgical Oncology, Providence Saint John's Cancer Institute, Santa Monica, CA, USAFollow
Stacey Stern, Department of Statistics, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Javier I Orozco, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USAFollow
Crystal E Fancher, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Janie Grumley, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USAFollow

Document Type

Article

Publication Date

10-1-2023

Keywords

california; sjci; Female; Humans; Breast Neoplasms; Combined Modality Therapy; Mammaplasty; Mastectomy; Mastectomy, Segmental; Retrospective Studies

Abstract

INTRODUCTION: In the era of oncoplastic breast conserving-surgery (OBCS), cosmetic outcomes and the desire for symmetry have become essential elements of the surgical management of breast cancer (BC). The timing of contralateral symmetry procedures remains a controversial topic. Simultaneous symmetry procedures (SSP) in OBCS have not been routinely offered due to the perceived risk of delayed asymmetry, potentially increasing the need for delayed cosmetic revision. This study evaluates the rate of revision after SSP in patients undergoing OBCS.

METHODS: We reviewed our institutional prospectively maintained database identifying all BC patients treated surgically since our introduction of oncoplastic surgery in 2018. We routinely offer SSP when appropriate. Descriptive statistics evaluated oncoplastic surgical techniques, SSP offerings and procedures, perioperative complications, and revision rates after treatment completion.

RESULTS: Between 2018 and 2022, 485 breast cancer patients underwent partial mastectomy, and 396 (82%) underwent OBCS. Of the 313 patients offered SSP, 272 (87%) accepted. The margin reexcision rate of this cohort was 20%. Of the 272 patients with SSP, 152 (56%) underwent intraoperative radiation therapy (IORT), and 105 (39%) had adjuvant external beam radiation therapy. Three patients (1%) experienced complications involving the symmetry side. No patients with complications experienced a delay in adjuvant therapies or requested cosmetic revisions. Three patients (1%) desired surgical revisions due to asymmetry.

CONCLUSIONS: Symmetry procedures at the time of OBCS are widely accepted by patients and rarely require delayed cosmetic revision. Simultaneous symmetry procedures should be routinely discussed with patients during the surgical planning of OBCS.

Area of Special Interest

Cancer

Area of Special Interest

Women & Children

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

DOI

10.1245/s10434-023-13893-7