Introduction: Since NSABP-BO6 demonstrated the equivalent survival outcome in between patients undergoing Modified Radical Mastectomy v. Lumpectomy and Radiation, increasing numbers of patients are seeking breast conservation therapy as a primary mode of breast cancer treatment. Traditionally, only patients that have undergone total mastectomy have been referred for reconstruction. Our hypothesis is that many patients treated with breast conservation therapy have suboptimal cosmesis and should be referred for reconstruction.

Methods: After obtaining IRB approval and patient consent, patients identified as having had breast conservation therapy (1999-2004) were interviewed and photographed. Physician aesthetic score, patient aesthetic score, patient satisfaction, and change in body image (measured with a questionnaire), were obtained. Forty-six patients were consented for this study.

Results: Thirteen of forty-six patients (28.3%) were unsatisfied with their cosmetic result. Statistical analysis revealed that women who were dissatisfied with their cosmetic result were more likely to have a negative change in their body image when compared to patients who were satisfied with their cosmetic result (46.2 % v 6.1%, p=0.02). Additionally dissatisfied patients were more likely to rate their cosmetic result as poor (15.4 % v 0%, p=0.007) and were more likely to consider reconstruction (46.2% v 9.1%, p=0.01) when compared to satisfied patients. Evaluation of demographics, location of tumor, volume of tissue resected, and TNM stage failed to predict suboptimal cosmetic results. Additionally, we found poor correlation between physician aesthetic scores and patient aesthetic scores.

Conclusion: Twenty-eight percent of patients in this study were dissatisfied with their cosmetic result. Furthermore, a large portion of these patients would consider reconstruction if it were offered. While this study is unable to provide prognostic factors for poor outcome, it confirms our hypothesis and indicates that many patients who have undergone breast conservation therapy should be referred for possible reconstruction.