LNSLNS

Both commentaries, by Penna et al. and Hernekamp et al., ask the justified question of whether breast reconstruction after mastectomy affects patients’ subjective satisfaction with the surgical outcome. One may assume—and the literature cited by Hernekamp et al. would support this—that patients are more satisfied with the cosmetic result after successful breast reconstruction than patients without reconstruction.

In our article, patients’ subjective assessments of the surgical outcome relate to the time of their initial breast cancer treatment. The routine data available to us do not allow for any further analyses. All we were able to establish was whether initially a mastectomy had been done or whether patients had had breast conserving surgery. We do not have any information on the subsequently provided reconstructive therapy, whether implant based or as flap reconstruction. For this reason we cannot comment on the different aspects of surgical breast reconstruction after mastectomy.

What we showed is from the patients’ perspective a notably higher degree of satisfaction with the surgical treatment outcome after breast conserving therapy. Similarly, significantly fewer complaints relating to arm swelling and impaired shoulder/arm function were observed after breast conserving therapy. These descriptions from patients’ perspectives are confirmed by the literature (1, 2). With regard to the adverse effects of surgical therapy, not only the method of breast surgery should be mentioned but also the axilla. Patients who had not had an axillar dissection complained significantly less often about ipsilateral arm swelling and impaired shoulder and arm function. This is also confirmed by the literature (3, 4).

We therefore wish to underline our statement that, whenever it is medically justifiable, breast conserving surgery should be the method of choice. Furthermore, also whenever it is medically justifiable, the axilla should be operated as non-radically as possible. The question raised by Penna et al. and Hernekamp et al., which is so very important in our opinion too—of the extent of which reconstructive breast surgery has a positive effect on breast cancer patients’ shoulder/arm function, arm swelling, esthetic self image, and psychosocial wellbeing—should be the subject of a separate prospective study. We wholeheartedly agree that only competent interdisciplinary advice/information, therapy planning, surgery, and systemic therapy will yield an optimal oncological and esthetic result.

DOI: 10.3238/arztebl.2015.0176

Stefan Feiten

Institut für Versorgungsforschung in der Onkologie, Koblenz

s.feiten@invo-koblenz.de

Dr. med. Jan Dünnebacke

Brustzentrum im Marienhof
Katholisches Klinikum Koblenz-Montabaur

Prof. Dr. med. Rudolf Weide

Praxisklinik für Hämatologie und Onkologie, Koblenz

Conflict of interest statement

The authors received financial support for the project from medac Gesellschaft für klinische Spezialpräparate mbH.

1.
Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D: Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J 2004; 10: 223–31. CrossRef MEDLINE
2.
Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR: Functional limitations in elderly female cancer survivors. J Natl Cancer Inst 2006; 98: 521–9. CrossRef MEDLINE
3.
Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK,
Scott-Conner C: The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors.
Ann Surg Oncol 2009; 16: 1959–72. CrossRef MEDLINE
4.
Land SR, Kopec JA, Julian TB, et al.: Patient-reported outcomes in sentinel node-negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project phase III protocol B-32. J Clin Oncol 2010; 28: 3929–36. CrossRef MEDLINE PubMed Central
5.
Feiten S, Dünnebacke J, Heymanns J, et al.: Breast cancer morbidity— questionnaire survey of patients on the long term effects of disease and adjuvant therapy. Dtsch Arztebl Int 2014; 111: 537–44. VOLLTEXT
1.Engel J, Kerr J, Schlesinger-Raab A, Sauer H, Hölzel D: Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast J 2004; 10: 223–31. CrossRef MEDLINE
2.Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR: Functional limitations in elderly female cancer survivors. J Natl Cancer Inst 2006; 98: 521–9. CrossRef MEDLINE
3.Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK,
Scott-Conner C: The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors.
Ann Surg Oncol 2009; 16: 1959–72. CrossRef MEDLINE
4.Land SR, Kopec JA, Julian TB, et al.: Patient-reported outcomes in sentinel node-negative adjuvant breast cancer patients receiving sentinel-node biopsy or axillary dissection: National Surgical Adjuvant Breast and Bowel Project phase III protocol B-32. J Clin Oncol 2010; 28: 3929–36. CrossRef MEDLINE PubMed Central
5.Feiten S, Dünnebacke J, Heymanns J, et al.: Breast cancer morbidity— questionnaire survey of patients on the long term effects of disease and adjuvant therapy. Dtsch Arztebl Int 2014; 111: 537–44. VOLLTEXT

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