27 Outcomes following oncoplastic breast surgery The inter-observer agreement between laymen was fair to moderate, with a significant kappa value of 0.288, 0.478 and 0.372 for global aesthetic judgment, symmetry of the breast and scarring respectively. The agreement between specialists was also fair to moderate, with a kappa of 0.497, 0.236 and 0.357 for global aesthetic judgment, symmetry of the breast and scarring respectively. No significant agreement for areola-nipple symmetry was observed. Subgroup analysis between patients who underwent OPS with volume replacement versus volume displacement is presented in Table 4, showing a significantly higher symmetry score in the volume replacement group, according to the specialist and the laymen (median 3.0 vs 2.5 (P=0.020) and median 3.0 vs 1.75 (P=0.031) respectively). Cosmetic outcomes scored by the panel in patients with and without complications were compared. The laymen provided a significantly higher score for global aesthetic judgment in patients without complications (median 3 (IQR: 2.0-3.5) vs 2 (IQR: 1.0-3.0), P=0.046). The specialists provided a significantly higher score for symmetry in patients without complications (median 2.5 (IQR: 2.0-3.0) vs 2.5 (IQR: 1.5-2.0), P=0.002). In the other categories, no significant differences were observed. DISCUSSION In this study, postoperative complication rates, patient-reported outcomes and cosmetic outcomes were evaluated after OPS with volume displacement or volume replacement techniques, as well as the influence of the occurrence of complications on these outcomes. An overall clinically relevant complication rate of 18.7% was found in this study. Overall, patients were satisfied after their surgery. Cosmetic outcomes were scored as good to excellent by both patients and the panel in 60-86%. These results emphasize that OPS should be considered in eligible patients planned for oncological breast surgery. The occurrence of complications following breast surgery has a major impact on the patient’s life19, 20 and oncological treatment, as it might delay the start of adjuvant chemo or radiotherapy.21, 22 The current literature shows several studies about complication rates after OPS. However, these studies used various or no complication scoring systems and studies about the influence of complications on patient satisfaction are limited. Mattingly et al reported a total complication rate of 33.9% of which in 20.3% an intervention was required,23 in contrast to the substantially lower percentage of 4%, found in this current study. The study of Kronowitz et al reported a complication rate of 24% after immediate reconstructions, however, the severity of complications was not specified.24 2
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