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Study supports cosmetic surgery for women with breast cancer

Robin Wulffson MD's picture
breast cancer, cosmetic surgery, breast reduction surgery

Breast cancer is the leading cause of breast cancer in the United States. A diagnosis of breast cancer is devastating to any woman. In addition to the fear of an untimely death is the concern regarding permanent disfigurement. A new study, however, has reported that breast cancer surgery can be conducted with an excellent cosmetic result.

Researchers at the University of California published the results of their study online on March 30 in the Annals of Surgery.

Malignant breast tumors larger than 4 cm in diameter are commonly treated by a mastectomy rather than a lumpectomy, or partial removal of breast tissue; however, the researchers considered that the total breast size in relation to the tumor should also be taken into consideration because the relative size of the tumor in large-breasted women is less.

Therefore, the objective of their study was to assess the value of performing a partial mastectomy and reduction mammoplasty concurrent with breast cancer surgery for a wide range of tumor sizes. They set out to compare outcomes and postoperative complications on the basis of tumor size. They evaluated whether an approach combining partial mastectomy with reduction mammoplasty could be safe for women with tumors larger than 4 cm in diameter.

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The authors reviewed breast cancer cases from 2000 to 2009 in breast cancer patients who had undergone concurrent reduction mammoplasty at the university. They analyzed clinical characteristics at diagnosis, pathologic data, and follow-up data. A total of 85 simultaneous partial mastectomy/reduction mammoplasty procedures were performed on 79 patients. Of the 85 tumors, 25 (29.4%) were larger than 4 cm. The median follow-up was 39 months (10-130 months).

Among the group, 75 patients (94.9%) achieved successful breast conservation; however, four patients (5.1%) underwent a mastectomy. A repeat operation to clear margins was required in 13 patients (16.4%); two of these patients required multiple procedures to clear the margins. Two patients experienced a local recurrence during the follow-up period; one underwent re-excision and the other underwent mastectomy. The overall complication rate was 14.1% (four 4 major complications (4.7%) requiring an unplanned return to the operating room and need for hospital readmission, and eight minor wound-related complications (9.4%). Neither recurrence nor complication rates were increased in patients with tumors greater than 4 cm when compared with tumors less than or equal to 4 cm.

The authors concluded that a partial mastectomy with concurrent reduction mammoplasty technique is a viable option for breast conservation even for larger tumors; the procedure is both safe and provides an excellent cosmetic result. They added that a combined effort between breast surgeons and reconstructive surgeons has a high probability of success with low recurrence rates. They noted that in carefully selected patients, this approach may be preferable to mastectomy and breast reconstruction, particularly when post-mastectomy radiation therapy is anticipated.

Reference: Annals of Surgery

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