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Patient-reported aesthetic outcomes in oncoplastic breast surgery compared with conventional breast-conserving surgery: a systematic review and meta-analysis

2024; Brazilian Society of Mastology; Linguagem: Inglês

10.29289/259453942024v34s1012

2594-5408

Maria Clara Ramos Miranda, Charles Karel Martins Santos, Gabriel Alves Barbosa, Melissa Silva Mariano, Giovanna Martins Milhomem, Asafe Ribeiro Dias da Silva, Itamar Fernandes Souza Júnior, Otaviano Ottoni da Silva Netto,

Body Image and Dysmorphia Studies

Objective: We aimed to compare the aesthetic and surgical satisfaction of oncoplastic breast surgery (OBS) to conventional breast-conserving surgery (CBCS). Methodology: This meta-analysis (PROSPERO: CRD42024521223) followed PRISMA and PICO guidelines. PubMed, Embase, Scopus, Web of Science, and Cochrane databases were searched for randomized trials and non-randomized studies comparing OBS to CBCS for female breast cancer patients and reporting outcomes of patient-reported aesthetic results, overall satisfaction, complications, and re-excision. A random-effects model was performed in the R software. Heterogeneity was assessed using I² statistics. Continuous and dichotomous data were presented as standardized mean difference (SMD) and odds ratio (OR), respectively. Confidence interval (CI) was defined at 95%. Results: A total of 36 non-randomized studies were included, along with 9,453 patients, with 3,578 undergoing OBS. OBS yielded better patient-reported aesthetic outcomes compared with CBCS, notably in satisfaction with breast reconstruction (SMD 0.68; 95%CI 0.126–1.227; p=0.016; I²=89%) and psychosocial well-being (SMD 0.23; 95%CI 0.003–0.459; p=0.047; I²=49%). Physical and sexual well-being showed no significant difference. Overall satisfaction favored OBS (OR 3.08; 95%CI 1.58–6.01; p<0.001; I²=82%), despite higher postoperative complications (OR 1.27; 95%CI 1.003– 1.589; p=0.047; I²=9%). There was no significant difference in infections, seromas, and hematomas; however, OBS showed a higher risk of skin/nipple-areola complex necrosis (OR 2.56; 95%CI 1.28–5.11; p=0.008; I²=0%). Regarding the need for a second surgery, OBS had fewer re-excisions (OR 0.46; 95%CI 0.34–0.62; p<0.0001 ;I²=45%). Conclusion: OBS shows better aesthetic and satisfaction outcomes than CBCS, with reduced re-excisions. Nonetheless, postoperative complications require careful evaluation.