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

Resumo

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.