Good Cosmesis In Breast Cancer Surgery!

Cosmesis refers to the preservation, restoration of a body part in it’s original form. Breast cosmesis is an important aspect and an endpoint of breast conserving therapy. The surgeons who carry out surgeries related to breast removal or upliftment, need to be precise in getting the other breast in exact shape to maintain symmetry. Their next priority is to make everything look good in the process.
Cosmesis plays a critical role in a woman’s physical and emotional recovery. Being fully treated and getting themselves out of danger is always the first priority but once women are out of danger, they would obviously be concerned about their looks, hence good cosmesis is a necessity.

Factors Affecting Good Cosmetic Outcome
Cosmetic outcome which follows the breast-conserving surgery is dependent on various factors like:

• Location of the lump or tumor
• Weight of the specimen excised upon,
• Number of surgical procedures followed,
• Volume of breast operated upon,
• Length of scar
• Adjuvant treatment in the form of chemo or radiotherapy followed after the surgery

Though the best method to assess good cosmesis in breast cancer surgery is still not clear but there are certain objective and subjective methods in combination, known to give a fairly good assessment of cosmesis.

Methods and materials involved to determine good cosmetic outcome
The general methods followed to ensure good cosmesis are Breast Retraction Assessment (BRA) and percentage Breast Retraction Assessment (pBRA). These are the objective measurements of the amount of breast retraction, determined primarily by comparing positions of nipple in relation to the sterna notch between the treated breast and contralateral breast.

The pBRA technique has been proved to have low intra and interobserver variability. Lower values of percentage Breast Retraction Assessment have been shown to correlate with improved cosmetic outcomes, hence making percentage Breast Retraction Assessment a reliable and an objective measure of cosmesis.

How is cosmetic assessment generally done?
In a particular case, evaluation of cosmesis was done before treatment, around 6-8 weeks post-treatment, 3-4 months post treatment, 6-8 months post-treatment, then every 6 months period for next 4-5 years and finally the assessment was down to yearly basis. The qualitative evaluation of cosmesis involved comparing treated breast with the untreated breast using the rating system.

The global cosmetic result, appearance of the scar made due to surgery, breast size, breast shape, colour of the skin, location of the areola and nipple and shape of the nipple and areola. All these were scored on a 4-point scale,

• Excellent result with no difference
• Good result with slight difference
• Fair result with moderate difference
• Poor result with huge difference

Physical measurements to calculate Breast Retraction Assessment and percentage

Breast Retraction Assessment were taken in a live example, while patients were in a seated position with both arms at the side of the body. Both the assessments were determined prior to the treatment as well as at the follow-up. As Percentage Breast Retraction reports retraction in terms of percentage, so it was used for analysis. On each occasion both the patients and physician reported the perceived cause of cosmesis as mainly because of radiation, surgery, unknown or no significant change.