How Much Breast Can We Safely Take? Percentage of Breast Volume Excision as an Objective Guide to Cosmetic Outcome in Oncoplastic Breast Surgery
Authors: Dr. Umme Humyra Kaneta, Dr. AKM Minhaz Bhuiyan, Dr. Hasan Shahriar Md. Nuruzzaman, Dr. Mushtaque Ahmed Jalali
Institution: National Institute of Cancer Research & Hospital, Dhaka, Bangladesh
Introduction
The choice of oncoplastic breast surgery (OPBS) technique is often based on subjective assessment of breast size and the anticipated surgical defect. Quantifying the proportion of breast tissue removed may provide an objective basis for surgical planning and help anticipate cosmetic outcomes. This study evaluated the relationship between percentage breast volume excision (PBVE) and postoperative cosmesis.
Methods
This prospective observational study included 82 breast cancer patients undergoing OPBS at National Institute of Cancer Research and Hospital, Mohakhali, Dhaka, between July 2023 and December 2024. Preoperative breast volume was estimated using anthropometry and tumor diameter by ultrasonography. Pre-operative prediction of PBVE was made using a pre-setted chart. Following tumour excision with adequate margins, fresh specimen weight was recorded and PBVE was calculated using the preoperative breast volume. Patients were categorized into Level I (<20%), Level II (20–50%) and Level III (>50%) excision groups. Postoperative cosmetic outcome was assessed using a standardized scoring system.
Results
The mean preoperative breast volume was 599.76 cc. Sixty-six patients (80.5%) underwent Level I, 12 (14.6%) Level II and 4 (4.9%) Level III excision. Cosmetic scores ranged from 7–16, with 78.1% of patients achieving good-to-excellent cosmesis. Good-to-excellent cosmetic outcomes were observed in 58/66 patients (87.9%) in the Level I group and 10/12 (83.3%) in the Level II group. Overall, PBVE category was significantly associated with cosmetic outcome (p<0.001).
Conclusion
PBVE offers a simple quantitative framework for relating the extent of breast tissue excision to postoperative cosmetic outcome. Incorporating PBVE into OPBS planning may reduce reliance on subjective assessment and support more consistent selection of oncoplastic techniques. In LMIC settings, this low-cost approach may provide a practical tool for objective surgical planning while integrating oncological and aesthetic considerations.
