Abstract
PurposeThe latissimus dorsi muscle has long been used in breast cancer (BC) patients for reconstruction. This study aimed to compare early stage BC patients who had partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (MI) with respect to quality of life (QoL), cosmetic outcome (CO), and survival rates.Patients and methodsThe data of patients who underwent PM + MLDF (Group 1) and M + I (Group 2) between January 2010 and January 2018 were evaluated. Both groups were compared in terms of demographics, clinical and pathological characteristics, surgical morbidity, survival, quality of life, and cosmetic results. The EORTC-QLQ C30 and EORTC-QLO BR23 questionnaires and the Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale were used to assess the quality of life and the cosmetic outcome, respectively.ResultsA total of 317 patients were included in the study, 242 (76.3%) of them in group 1 and 75 (23.6%) of them in group 2. Median follow-up time was 56 (14–116) months. There were no differences identified between the groups in terms of tumor histology, hormonal receptors and HER-2 positivity, surgical morbidity, and 5-year overall and disease-free survival. Group 2 patients were significantly younger than group 1 (p = 0.003). The multifocality/multicentricity rate was higher in group 2 (p ≤ 0.001), whereas tumor size (p = 0.009), body mass index (BMI, p = 0.006), histological grade (p ≤ 0.001), lymph node positivity (p = 0.002), axillary lymph node dissection (ALND) rate (p = 0.005), and presence of lympho-vascular invasion (LVI, p = 0.013) were significantly higher in group 1. When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in PM + MLDF group whereas physical function score was significantly better in M + I group (p = 0.012). When both groups were examined in terms of cosmesis with JBCS Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01).DiscussionThe results of this study indicate that in comparison to M + I procedure, the PM + MLDF procedure provides significantly superior results in terms of body image and cosmetic result with similar morbidity and oncologic outcomes. In selected patients with small breasts and a high tumor/breast ratio, PM + MLDF may be an alternative to subcutaneous mastectomy and implant.
Highlights
Breast cancer (BC) is the most common cancer and cause for cancer-related death among women worldwide [1, 2]
When the quality of life was assessed by using the EORTC QLQ C30 and BR23 questionnaires, it was seen that the body image perception (p < 0.001) and nausea/vomiting score (p = 0.024) were significantly better in partial mastectomy (PM) + mini latissimus dorsi flap (MLDF) group whereas physical function score was significantly better in M + I group (p = 0.012)
When both groups were examined in terms of cosmesis with Japanese Breast Cancer Society (JBCS) Cosmetic Evaluation Scale, good cosmetic evaluation score was significantly higher in patients in MLDF group (p = 0.01)
Summary
Breast cancer (BC) is the most common cancer and cause for cancer-related death among women worldwide [1, 2]. New effective chemotherapeutic drugs have prolonged the life expectancy of patients and reduced locoregional recurrence rates [3]. Along with these improvements, cosmetic outcomes and oncoplastic breast surgery (OBS) have gained more importance [4]. To be able to ensure a good cosmetic result, intra-glandular or autogenous muscle flaps have been used to replace volume loss following wide excision [6, 7]. Small volume losses where the breast tumor is small can be successfully repaired using intra-glandular flaps (volume replacement). For large volume losses especially in patients with small breast and large tumor, autogenous muscle flaps may be used to fill the tumor cavity (volume displacement)
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