Identifying the Variables for Oncoplastic Reconstruction: Preoperative Assessment Tool for Breast Conserving Treatment.
Sagit Meshulam-Derazon, Dafna Shilo Yaacobi, Merav A Ben-David, Alex Lvovsky, Amir Hadanny, Oren Ganor, Avraham Amir, Dean Ad-El, Maya Wertman
Author Information
Sagit Meshulam-Derazon: Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel.
Dafna Shilo Yaacobi: Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel. Dafna.yaacobi@icloud.com. ORCID
Merav A Ben-David: Radiation Oncology Department, Assuta Medical Center, Tel-Aviv, Israel AND Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Alex Lvovsky: Head of Forensic Identification Department, Israel Defense Forces, Medical Corps, Tel Aviv, Israel.
Amir Hadanny: Yitzhak Shamir Medical Center, Affiliated with the Tel Aviv University School of medicine, Zriffin, Israel.
Oren Ganor: Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA.
Avraham Amir: Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel.
Dean Ad-El: Department of Plastic Surgery and Burns, Rabin Medical Center, Petach Tikvah, Israel, affiliated to Sackler School of Medicine, Tel-Aviv University, 39th Jabutinsky St. Petah Tikva, 4941492, Tel Aviv, Israel.
Maya Wertman: Department of Surgery, Kaplan Medical Center, Rehovot and the Hebrew University Medical School, Jerusalem, Israel.
BACKGROUND: A wide range of surgical techniques has been described for breast conservation treatment (Oncoplasty) based on breast size and shape, as well as tumor size and location. However, there is a lack of standardization regarding the indications for oncoplastic reconstruction. This study aims to identify the presurgical parameters associated with poor cosmetic outcomes post-breast conserving treatment. We hope this preoperative model can assist in evaluating whether there is a need for oncoplastic intervention. METHODS: The study group involved 136-adult females (age 35-77) who previously undergone breast conserving surgery and radiation, without oncoplastic intervention between 2007 and 2017. Patient demographics, medical and physical parameters were collected, and each patient filled Breast-Q-questionnaire and six angles' photographs were taken. Patients' photographs were evaluated by 15 board-certified plastic surgeons. Both univariate and multivariate logistic regression analysis was performed to identify potential confounders for poor outcome in each of the experts' and patients' average-grades. RESULTS: Our analysis identified several variables correlated with poor surgical outcome: high BMI, high chest-wall-circumference, high breast-width and larger volume-removed. The general-aesthetic-result as evaluated by our experts was favorably influenced by an upper lateral quadrant tumor while the breast shape was negatively influenced by a lower medial quadrant tumor. Interestingly, no correlation was found between the patients' and panel's evaluations, nor did we find any clinically significant parameter related to the patients' reported well-being. CONCLUSION: Patients with high BMI, high chest-wall-circumference, large breast-width and larger inferomedial tumors could benefit from early plastic surgery evaluation and intervention. Patient's psychosocial well-being as well as sexual well-being are independent from positive surgical outcome evaluated by plastic surgeons. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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