Volumetric breast density is essential for predicting cosmetic outcome at the late stage after breast-conserving surgery

Eur J Surg Oncol. 2016 Apr;42(4):481-8. doi: 10.1016/j.ejso.2016.01.004. Epub 2016 Jan 22.


Background: The critical issue related to breast-conserving therapy (BCT) is that cosmetic outcomes deteriorate with long-term follow-up. There is little research for breast density as a predictor of cosmetic outcomes at the late stage after BCT. To improve the long-term quality of life after BCT of breast cancer patients, the correlation of volumetric breast density (VBD) and cosmetic outcome at the late stage after BCT was evaluated.

Study design: Breast volume, fibroglandular tissue volume, adipose tissue volume, and VBD were calculated on mammography using image analysis software (Volpara(®)) in 151 patients with BCT. Furthermore, the correlation of breast density and the change of breast volume over time was analyzed on mammography in 99 patients who were followed-up long-term after BCT.

Results: On multivariate analysis, VBD was a predictor of cosmetic outcome after BCT with percent breast volume excised (PBVE). Decreased adipose tissue volume and increased fibrosis were more common in patients with VBD < 15%. Furthermore, remnant breast volume continued to decrease over time in low breast density patients during long-term follow-up. 93% of patients with VBD ≥ 15% and PBVE < 10% had a better cosmetic outcome, while 60% of patients with VBD < 15% and PBVE ≥ 10% had a worse cosmetic outcome after BCT.

Conclusions: While PBVE was involved in cosmetic outcome at the early stage after BCT, VBD was associated with cosmetic outcome at the late stage after BCT. Thus, a combination of VBD and PBVE could predict cosmetic outcome after BCT and contribute to the selection for the appropriate BCT.

Keywords: Breast cancer; Breast density; Breast-conserving surgery; Cosmetic outcome.

MeSH terms

  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / psychology
  • Breast Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Mammography
  • Mastectomy, Segmental / methods*
  • Mastectomy, Segmental / psychology
  • Middle Aged
  • Organ Size
  • Postoperative Period
  • Prognosis
  • Quality of Life*
  • ROC Curve
  • Retrospective Studies
  • Time Factors