Review: Volumetric breast density is essential for predicting cosmetic outcome at the late stage after breast-conserving surgery
Breast conserving therapy (BCT) is a less radical and more cost-effective alternative to mastectomy and breast reconstruction and is often a preferable treatment for many patients during the treatment of breast cancer. However, in some patients BCT can be associated with unfavourable cosmetic outcomes (such as fibrosis, edema and reduced remaining breast volume, among others) at either early or late stage after treatment. Thus, it would be beneficial to be able to predict patients who will react unfavourably so they can be directed towards alternate therapy.
This is what Shiina et al. set out to explore. They found that low volumetric breast density (Volpara density of less than 15%) and large percentage breast volume excised (PBVE; greater than 10%) correlated with the worst cosmetic outcome at an early stage following BCT. Low VBD was associated with significantly decreased breast volume (due to loss of fatty tissue) and increased fibrosis. Additionally, large PBVE and lower breast density (BI-RADS A-C) both corresponded to the worst long-term outcome after BCT.
This study is the first to relate breast density to late-stage cosmetic outcome following BCT. The results regarding low breast density and high excision volume are instrumental for making recommendations which patients are more suited for reconstruction surgery or other treatment methods. Although not without limitations (such as the use of different techniques for measuring breast density in early- versus late-stage outcome, as well as the relatively small number of patients), this study nevertheless serves an intriguing example of how breast density comes into play not only in the development, but also the treatment of breast cancer.