Abstract P4-07-03: LONG TERM PATIENT REPORTED OUTCOMES FOLLOWING THERAPEUTIC MAMMAPLASTY

Abstract Background: Therapeutic Mammaplasty (TM) is a safe oncoplastic surgical technique aiming to extend the boundaries of traditional breast conserving therapy (BCT) by removing larger breast volumes to reduce and/or lift the breast, without compromising cosmetic or oncological outcomes. Several systematic reviews have emphasised the paucity of Patient Reported Outcome Measures (PROMs) following TM. This study aimed to assess the long-term PROMs following TM performed in our centre over a 17-year period. Methods: Eligible women who underwent TM between 2005 and 2021 were invited to participate by returning the BREAST-Q questionnaire (combination of BCT and Reduction/Mastopexy modules). Surveys were returned by post or online from August to December 2023 (minimum 20-months post TM). Raw responses were transformed using Rasch conversion tables (0=worst;100=best) and descriptive summary statistics generated. Clinical outcome data was collected from digital hospital records/databases and analysed using descriptive summary statistics. Results: Of 246 patients who underwent TM, n=21 (8.5%) subsequently required completion mastectomy, n=15 (6.1%) developed recurrence/metastatic disease and n=22 (8.9%) died. Questionnaires were returned by n=103/188 (53.4%) participants. Only n=4/103 (3.9%) participants were current smokers at the time of surgery; n=10/103 (9.7%) were ex-smokers. Neoadjuvant treatment was given to n=31/103 (30.1%) patients. Most tumours were T1 (n=53/103, 51.5%) or T2 (n=36/103, 34.9%). Only n=19/103 (18.4%) patients had immediate contralateral symmetrizing surgery at the time of TM, but a further n=34/103 (33.0%) had delayed symmetrization surgery. Few women suffered complications (n=15/103, 14.6%), all were minor and there were no peri-operative deaths. Most women received adjuvant radiotherapy (n=95/103, 92.2%); around two thirds received adjuvant endocrine treatment (n=63/103, 61.2%). Overall, patients reported median scores of 69 (IQR 53-83.5) and 70 (IQR 54-86) for satisfaction with breasts for BCT/breast reduction modules respectively. Median wellbeing scores were physical (chest wall) 82 (IQR 66-100), physical (reduction) 72 (IQR 59-82) and psychosocial 77 (IQR 62-93) with lowest scores for sexual wellbeing 59 (IQR 36-79). Comparison was made with published long-term PROMs 12 years following immediate breast reconstruction (IBR) (Johnson et al doi:10.1093/bjs/znad276) using a minimal clinically important difference in mean scores of 4-points for satisfaction with breasts/psychosocial/sexual wellbeing and 3-points for physical wellbeing. TMs performed from 2005 to 2015 (n=40, 8-18 years previously) had significantly better mean long-term satisfaction with breasts scores (TM 72.3(BCT)/74.5(reduction) than all forms of IBR (Implant/expander 54.7; Latissimus Dorsi flap (LD) 59; Abdominal flaps 67.6). Sexual wellbeing scores were also significantly higher for TM (57.4) than for all forms of IBR (Implant/expander 44.7;LD 47.4;Abdominal 51.2). Psychosocial wellbeing scores for TM (78) were higher than both implant/expander 72.2 and LD 73.3 IBR, but comparable to abdominal flap IBR (77.6). TM physical (chest wall) wellbeing scores (80.6) were comparable to implant/expander (82.1) and LD (79.5) IBR, but significantly lower than abdominal flap IBR (87.8). Conclusions: TM has a long-lasting positive impact on quality-of-life following breast cancer treatment. Patient satisfaction with breasts, sexual and psychosocial wellbeing may be significantly higher in the long term than all types of IBR. Physical wellbeing outcomes are comparable to both implant/expander and LD flap IBR but worse than abdominal flaps in our series. With the now growing body of evidence suggesting BCT may also confer a survival advantage over mastectomy, this data suggesting that overall, quality of life is better in the long term, further supports offering oncoplastic BCT preferentially whenever it is oncologically feasible. Citation Format: Katherine Fairhurst, Harriet Cook, Joseph Vane-Daniel, Alison Hunter-Smith, Richard Sutton. LONG TERM PATIENT REPORTED OUTCOMES FOLLOWING THERAPEUTIC MAMMAPLASTY [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-07-03.