American Association of Plastic Surgeons Meeting 2022

The Impact Of Oncoplastic Reduction On Initiation Of Adjuvant Radiation And Need For Re-excision: A Database Evaluation

INTRO:

Breast cancer is the leading cause of cancer-related mortality for women globally (1). Breast conservation therapy (BCT) via lumpectomy and adjuvant radiation therapy is currently a mainstay of treatment, ensuring effective oncologic resection while also preventing excessive loss of breast tissue.

Unfortunately, selective excision of cancerous tissue can negatively affect breast symmetry, leading to suboptimal aesthetic outcomes and reduced patient satisfaction (2, 3). Oncoplastic reduction offers a solution to this aesthetic problem and has been hypothesized to reduce rates of margin re-excision and cancer recurrence in both the affected and contralateral breast (4).

Currently, little is known about the impact of oncoplastic reduction on the rate of post-operative complications or its effect on the initiation of adjuvant radiation therapy. Considering the rise of oncoplastic reduction and a gap in the literature, this study leverages national data to analyze outcomes. Using the retrospective Clinformatics® database, we compared the impact of BCT ± oncoplastic reduction on complication rates, timing of adjuvant radiation therapy, and margin re-excision.

METHODS:

Data Collection

•Database: Clinformatics Data Mart (retrospective)

•Years included: 2003 – 2020

Patient Information

•Inclusion criteria: Adult females with a breast cancer diagnosis and a minimum of 6 months continuous enrollment before and after the index procedure who also received adjuvant radiotherapy in the post-surgical year

•Number of patients who met inclusion criteria: 53,165

•Surgical intervention: BCT ± oncoplastic reduction

•Sample size (intervention group, OCT): 1,552 (2.9%)

•Sample size (comparison group): 51,613 (97.1%)

•Relevant covariates: Patient age, year of surgery, comorbidities (Elixhauser index), diabetes, obesity, weight loss diagnosis

Analysis

•Outcome measures: Rate of non-surgical complications, rate of surgical complications, time to adjuvant radiation, rate of subsequent lumpectomy or conversion to completion mastectomy (proxy for positive margins)

•Statistical analysis: Chi squared, multivariate logistic regression

•Statistical outputs: Odds ratio, P value (<0.05)

FINDINGS:

•Patients undergoing BCT + OCR are 2.7x more likely to experience a complication compared to BCT alone (Figure 1).

•Patients undergoing BCT + OCR are 0.5x as likely to need re-excision of margins compared to BCT alone (Figure 2).

•There is no significant impact of OCR on time to adjuvant radiation therapy (Figure 3).

CONCLUSION:

In patients undergoing breast conservation therapy for the treatment of breast cancer, oncoplastic reduction decreases rates of positive margins requiring re-excision without impacting time to adjuvant radiation therapy, despite increased rates of complications relative to lumpectomy alone. Given the rise of BCT, this study’s results are increasingly relevant for both physician decision-making and patient counseling.

American Association of Plastic Surgeons Meeting 2022

The Impact Of Oncoplastic Reduction On Initiation Of Adjuvant Radiation And Need For Re-excision: A Database Evaluation

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