Breast Density and Aesthetic Outcomes of Volume Displacement Oncoplastic Techniques for Breast Cancer

Mohamed M. Farag, Mohamed I. Abdel Aziz, Ayman M. Essawy

Oncoplastic breast surgery (OBS) is an evolving comprehensive surgical approach for the management of early breast cancer; it has been recently expanded to include a wide range of volume displacement and volume replacement procedures performed by surgeons to optimize both shape and volume of the breast following breast cancer surgery. Many studies have analyzed the role of many influencing factors including breast density on the final aesthetic outcome of the volume displacement techniques. From June 2016 to September 2018, 200 patients presented with unilateral primary breast cancer including multifocal and post neoadjuvant cases with predicted excision volume (PEV) less than 20% managed with volume displacement oncoplastic technique and fulfilling the other eligibility criteria of the breast conservative therapy; were enrolled in this prospective study. Breast density (BD) was determined by the mammography according to American College of Radiology (ACR) density score; aesthetic outcomes were objectively evaluated one year after surgery by the semi-automated Breast Cancer Conservative Treatment (BCCT) core software. Patients’ age has ranged from 27 to 74 years old (mean 43.4 ± 4.6 years), breast volume from 375 to 1140 cc (mean 735.5 ± 124.2 cc), and specimen volume from 64 to 220 cc (mean 120.3 ± 37.5 cc); total aesthetic results according to the objective BCCT core assessment were excellent in 41.5% (83 cases), good in 29.5% (59 cases), fair in 19.5% (39 cases), and poor in 9.5% (19 cases). Patients with high breast density ACR C and ACR D have achieved acceptable aesthetic results (excellent and good BCCT core outcomes) at a rate of 90% and 80% respectively in contrast to the low density breasts ACR B and ACR A (52% and 40% respectively). Breast density is one of the influencing factors of the aesthetic results of the volume displacement OBS; its preoperative value can refer to the most suitable oncoplastic surgical technique for each patient, expect the forthcoming postoperative complications, discrepancy and the necessity for contralateral symmetrization. Volume displacement OBS gives high aesthetic results with the high breast density and less acceptable results with the low one.