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中华乳腺病杂志(电子版)

中华乳腺病杂志(电子版) ›› 2013, Vol. 07 ›› Issue (04) : 263 -268. doi: 10.3877/cma. j. issn.1674-0807.2013.04.006

论著

Factors determining cosmetic results after periareolar excisional biopsy of benign breast lesions
ZHANG Zhi-qiang1,2, FENG Li-yong1,2, LI Wen-jie1,2, CHEN Yang1,2, DAI Wen-jie1,2, LIN Le-min1,2,†(), LIU Yan3,†()   
  1. 1.Department of Thyroid and Breast Surgery,First Affiliated Hospital of Harbin Medical University, Harbin
    2.150001, China
    3.Department of Biostatistics, School of Public Health, Harbin Medical University,Harbin 150081, China
  • 出版日期:2013-08-01
  • 通信作者: LIN Le-min, LIU Yan
  • Published:2013-08-01
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ZHANG Zhi-qiang, FENG Li-yong, LI Wen-jie, CHEN Yang, DAI Wen-jie, LIN Le-min, LIU Yan. Factors determining cosmetic results after periareolar excisional biopsy of benign breast lesions[J/OL]. 中华乳腺病杂志(电子版), 2013, 07(04): 263-268.

Objective

To assess the factors that determine cosmetic results after periareolar excisional biopsy for the management of Breast Imaging- Reporting and Data System (BI-RADS) 3 and 4 breast lesions.

Methods

Potential risk factors for adverse cosmetic results of incision after periareolar excisional biopsy were evaluated in 74 patients (7 people had bilateral breast operations) undergoing a single biopsy after suspicion of a malignant lesion that subsequently proved to be benign. The overall cosmetic result was evaluated using a modification of the European Organisation for Research and Treatment of Comcer(EORTC) cosmetic indices individually scored 6 months after the breast excisional biopsy.To evaluate the factors affecting cosmetic outcome of incision, an analysis of variance was undertaken using the Kruskal-Wallis test for continuous variables and the chi-squared and Fisher exact tests for categorical variables. Based on cosmetic outcome of incision as dependent variables, and patient’s age, incision location, scar color respectively as independent variables,multivariate analysis was performed with logistic regression for screening the factors.

Results

Out of 81 operated breasts, the cosmetic result of incision was rated as excellent (0 score) in 19 (23.46%), good(1 score) in 38 (46.91%), fair (2 scores) in 14 (17.28%), and poor (3 scores) in 10 (12.34%).Univariate analysis shows that age,incision location and scar color affected cosmetic result. Older patients,with no scar or white scar, and the inferior or lateral periareolar incision had better cosmetic outcomes of incision.Patients more than 45 years had better cosmetic outcomes of incision than those less than 31 years (P =0.0231). Patients with the inferior or lateral periareolar incision obtained better cosmetic outcomes than those with the superior or medial incision. Patients with no scar obtained better cosmetic outcomes than those with white scar or red scar.

Conclusions

The cosmetic outcomes after periareolar excisional biopsy of benign breast lesions are excellent or good in most of cases. Age, incision location and scar color all affect cosmetic results of incision.

关键词: Breast diseases, Biopsy, Cosmetic techniques
Figure 1 Periareolar hemicircular incisions
Table 1 Assignment of the factors affecting cosmetic outcome of incision
Variable Assignment explanation
Independent variable
Age (years) ＜31=1,31～38=2,39～44=3,＞45=4
Incision location Inferior or lateral=1,superior or medial=2
Scar color No scar=0,white scar=1,red scar=2
Dependent variable
Cosmetic outcome 0 score=1,1 score=2,2 score=3,3 score=4
Figure 2 Surgical scar at 4 grades
Table 2 Cosmetic outcome at 6-month follow-up
Assessment Number of operated breastsa Percentage
Excellent 19 23.46
Good 38 46.91
Fair 14 17.28
Poor 10 12.34
Figure 3 The appearrance of breast with different scar colors
Table 3 The impact of age, incision location and scar color on cosmetic outcome[n(%)]
Variable group Breasts 0 score 1 score 2 scores 3 scores χ 2 value P value
Age(years) 9.52 0.02
＜31 18 3(16.67) 5(27.78) 7(38.89) 3(16.67)
31-38 21 4(19.05) 9(42.86) 3(14.29) 5(23.81)
39-44 17 3(17.65) 10(58.82) 3(17.65) 1(5.88)
≥45 25 9(36.00) 14(56.00) 1(4.00) 1(4.00)
Incision location 15.08 0.00
Inferior 11 7(63.64) 4(36.36) 0(0.00) 0(0.00)
Lateral 25 5(20.00) 16(64.00) 3(12.00) 1(4.00)
Superior 37 6(16.22) 16(43.24) 6(16.22) 9(24.32)
Medial 8 1(12.50) 2(25.00) 5(62.50) 0(0.00)
Scar color 45.09 0.00
No scar 20 16(80.00) 4(20.00) 0(0.00) 0(0.00)
White scar 42 3(7.14) 28(66.67) 11(26.19) 0(0.00)
Red scar 19 0(0.00) 6(31.58) 3(15.79) 10(52.63)
Table 4 Comparison of age in different incision locations
Incision location Breasts Age(years,x¯±s) Age[n(%)]
＜31 years 31-38 years 39-44 years ≥45 years
Inferior 11 40.55±12.84 3(27.27) 2(18.18) 2(18.18) 4(36.36)
Lateral 25 40.68±9.32 4(16.00) 5(20.00) 7(28.00) 9(36.00)
Superior 37 37.95±10.40 8(21.62) 12(32.43) 7(18.92) 10(27.03)
Medial 8 33.88±13.51 3(37.50) 2(25.00) 1(12.50) 2(25.00)
Table 5 Comparison of scar colors in different incision locationn(%)
Incision location Breasts No scar White scar Red scar χ 2 value P value
Inferior 11 9(81.82) 1(9.09) 1(9.09) 16.11 0.00
Lateral 25 6(24.00) 15(60.00) 4(16.00)
Superior 37 5(13.51) 20(54.05) 12(32.43)
Medial 8 0(0.00) 6(75.00) 2(25.00)
Table 6 Comparison of age in different cosmetic outcome of incision and scar colors
Variable Breasts Age(x¯±s,years) F value P value
Cosmetic outcome of incision 5.91 0.00
0 score 19 40.95±9.74
1 score 38 41.97±10.66
2 score 14 30.07±9.99ab
3 score 10 34.40±5.85
Scar color 3.64 0.03
No scar 20 40.55±12.84
White scar 42 40.68±9.32
Red scar 19 37.95±10.40c
Table 7 The results of univariate logistic regression analysis affecting the cosmetic outcomes
Factor dummy Estimate Standard error Wald Chi-square P value Standardized estimate Odds ratio estimates(95%CI)
Age(years) -0.5877 0.1932 9.2496 0.0024 -0.3719 0.556(0.380-0.811)
31～39 -0.3730 0.5926 0.3961 0.5291 -0.3730 0.689(0.216-2.200)
39～45 -0.9046 0.6363 2.0206 0.1552 -0.2044 0.405(0.116-1.409)
＞45 -1.7485 0.6082 8.2656 0.0040 -1.7485 0.174(0.053-0.573)
Incison location 1.4295 0.4521 9.9989 0.0016 0.3941 4.177(1.722-10.131)
Scar color 3.1825 0.4650 46.8418 ＜0.0001 1.2249 24.107(9.690-59.972)
White scar 2.9745 0.6765 19.3320 ＜0.0001 0.8245 19.580(5.199-73.731)
Red scar 5.5498 0.8610 41.5529 ＜0.0001 1.3046 257.198(47.580-＞999.999)
Table 8 The results of multivariate logistic regression analysis affecting the cosmetic outcomes
Factor Estimate Standard error Wald Chi-square P value Standardized estimate Odds ratio estimates(95%CI)
Age＞45years -1.1976 0.5480 4.7759 0.0289 -0.3069 0.302(0.103-0.884)
Incision location 1.1734 0.5032 5.4374 0.0197 0.3235 3.233(1.206-8.668)
White scar 2.7021 0.7118 14.4102 0.0001 0.7490 14.911(3.695-60.171)
Red scar 5.3637 0.9043 35.1823 ＜0.0001 1.2608 213.520(36.284-＞999.999)
[1]
Cardoso MJ, Cardoso J, Santos AC, et al. Factors determining esthetic outcome after breast cancer conservative treatment[J].Breast J,2007,13(2):140-146.
[2]
Saarela AO, Kiviniemi HO, Rissanen TJ, et al. Cosmetic results after wire-guided biopsy of benign breast lesions[J]. J Am Coll Surg,1998,187(6):610-615.
[3]
Aaronson NK, Bartelink H, van Dongen JA, et al. Evaluation of breast conserving therapy: clinical, methodological and psychosocial perspectives [J]. Eur J Surg Oncol, 1988,14(2):133-140.
[4]
Jones J, Hunter D. Consensus methods for medical and health services research[J]. BMJ,1995,311(7001):376-380.
[5]
Ersek RA, Denton DR. Breast biopsy technique: a plea for cosmesis[J]. South Med J,1986,79(2):167-170.
[6]
Riefkohl R, Courtiss EH. Gynecomastia. In: Georgiade NG,Georgiade GS, Riefkohl R, eds. Aesthetic surgery of the breast[M]. Philadelphia: WB Saunders,1990:657-667.
[7]
Fayman MS, Potgieter E, Becker PJ. Outcome study:periareolar mammaplasty patients’ perspective [ J]. Plast Reconstr Surg,2003,111(2):676-687.
[8]
Bölke E, Peiper M, Budach W, et al. Unilateral keloid formation after bilateral breast surgery and unilateral radiation[J]. Eur J Med Res,2007,12(7):320-322.
[9]
Goppold A,Kaune KM,Buhl T,et al. 595nm pulsed dye laser combined with intralesional corticosteroids in hypertrophic symptomatic scars following breast reduction surgery[J]. Eur J Dermatol,2011,21(2):262-263.
[10]
Shrotria S. The peri-areolar incision--gateway to the breast![J]. Eur J Surg Oncol,2001,27(6):601-603.
[11]
Noguchi M, Inokuchi M, Ohno Y, et al. Oncological and cosmetic outcome in breast cancer patients undergoing “moving window” operation [J]. Breast Cancer Res Treat, 2011,129(3):849-856.
[12]
Biggers BD, Lamont JP, Etufugh CN, et al. Inframammary approach for removal of giant juvenile fibroadenomas[J]. J Am Coll Surg,2009,208(6):e1-e4.
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