Factors influencing cosmetic outcome of breast-conserving treatment in breast cancer: a narrative review

Background: A deformed breast following Breast-Conserving Treatment (BCT) is influenced by an array of factors encompassing final cosmesis. This overview examines the factors that may influence cosmetic outcome for BCT patients. Methods: Literature search was performed using PubMed and EMBASE databases. Research articles published in English (1990-2018) pertaining to patients that had previously undergone unilateral BCT for breast cancer were included. Results: 42 articles were used for our final analysis that utilized subjective and objective tools to assess cosmetic outcome. Factors can be allocated as patient, tumor, surgery, radiotherapy or systemic therapy associated. Based on significance in both univariable as well as multivariable analysis and frequency of reporting, extensiveness of primary tumor resection, tumor size, tumor location, adjuvant radiotherapy and adjuvant chemotherapy, were the factors affecting cosmetic outcome the most. Conclusions: In this study, we reviewed and discussed several patient-, tumor- and treatment related factors affecting cosmetic outcome. Many different tools, either subjective or objective, are observed worldwide.