A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammaplasty

Background: Oncoplastic reduction mammaplasty offers patients breast conservation with the added benefit of functional improvement in symptoms related to macromastia. The reduction can be performed in the immediate setting with the lumpectomy, in a staged-immediate fashion after final pathology has been confirmed or in a delayed fashion after completion of both lumpectomy and radiation. This study compared quality of life and aesthetic outcomes for these different cohorts. Methods: A retrospective review was carried out on 16 consecutive patients who had oncoplastic reduction mammaplasty by the senior author (M.Y.N.) between 2003 and 2009. Demographics, oncologic treatment and timing, and reduction techniques were recorded. Patients were asked to complete a questionnaire to assess quality of life and satisfaction. Preoperative and postoperative photographs were evaluated by 15 reviewers. Results: Over a 7-year period, five patients had immediate, six had staged-immediate, and five had delayed reduction mammaplasty. Mean patient age was 52.5 years, and mean body mass index was 31.5. The average timing of reduction was 0, 49, and 734 days for the three groups. Positive margins occurred in two patients, leading to completion mastectomy. In addition, one patient in the staged-immediate group had a recurrence that led to completion mastectomy. Complications occurred in seven (44 percent) of 16 patients. Questionnaire response was 75 percent (12 of 16), showing positive scores in all groups but no statistical significance. Objective aesthetic evaluation also revealed significant improvements within groups comparing various preoperative to postoperative parameters. Importantly, aesthetic scores for the delayed group were consistently lower across all aspects but did not reach significance. Conclusion: Oncoplastic reduction mammaplasty can be safe and effective in carefully selected patients in the immediate, staged-immediate, and delayed settings.