Patient-Reported Impact of Oncoplastic Breast Conservation Compared to Mastectomy with Reconstruction: A Systematic Review PROMs in O-BCS vs M-R
Abstract
Background: Given the oncologic safety and clinical benefits of oncoplastic breast conservation surgery (O-BCS), we conducted a systematic review to evaluate patient-reported outcomes including breast satisfaction and physical, psychosocial and sexual wellbeing in those undergoing O-BCS compared to mastectomy and reconstruction (M-R). This aimed to inform clinical decision making for patients with breast cancer not suitable for standard breast conservation.
Methods: According to PRISMA Guidelines, we identified studies from MEDLINE, Embase, Pubmed and Google Scholar. Studies were included where they compared patient-reported outcomes between O-BCS and M-R using a validated assessment tool such as the BREAST-Q questionnaire. The quality of studies was appraised using the Newcastle-Ottawa-Scale (NOS).
Results: Out of the 3434 citations identified by our search, a total of 11 studies were deemed suitable for inclusion and 9 studies used the validated BREAST-Q assessment tool. There were a total of 1808 O-BCS and 1413 M-R patients. All studies showed improved or equivalent breast satisfaction, psychosocial wellbeing and sexual wellbeing after O-BCS. Physical wellbeing was reported to be superior in the mastectomy with reconstruction (M-R) group. The findings are limited by the moderate to high risk of bias, heterogeneity, variation in outcome measures, differing follow-up durations and differences in adjustment.
Conclusion: Given the potentially positive impact on patient-reported outcomes, where indicated and feasible, oncoplastic breast conserving surgery should be offered as a valid surgical alternative to mastectomy and reconstruction as part of a patient-centred individualized treatment approach for breast cancer.
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References
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