At the recent Breast Cancer Trials Annual Scientific Meeting in Hobart Professor Shelley Potter from Bristol presented results from the ANTHEM study. This looked at clinical and patient-reported outcomes for women offered oncoplastic breast-conserving surgery vs mastectomy with or without immediate reconstruction.
Currently in the United Kingdom, 40% of women diagnosed with breast cancer each year undergo a mastectomy, but of these only one in four receives a reconstruction. Professor Potter noted that breast cancer patients live for many years with the consequences of surgery decisions; it is important to get it right.
ANTHEM was a multicentre, UK-based trial with 362 participants. Of these, 81% chose oncoplastic breast-conserving surgery and 19% chose mastectomy (with or without reconstruction). All participants answered a BREAST-Q questionnaire which measured various aspects of satisfaction and quality of life before and after their surgery.
Oncoplastic breast-conserving surgery techniques mean that breast-conserving surgery (‘lumpectomies’) can be performed even when quite large tumours need to be removed. Plastic surgical volume displacement or replacement techniques are used to lift, reduce or reconstruct the breast mound. Examples include the chest wall perforator flap technique, which uses skin and fat from the chest wall (under the arm or breast), and therapeutic mammoplasty, which is an adaptation of a breast reduction technique and therefore suitable for big breasts.
ANTHEM’s results showed that those who received reconstruction immediately after their mastectomy had significantly more complications (infections etc.) than those who had a simple mastectomy or oncoplastic breast-conserving surgery.
Those who received oncoplastic breast-conserving surgery with volume displacement reported significant improvements in baseline ‘satisfaction with breasts’ and psychosocial wellbeing at three and 12 months. Those who had therapeutic mammoplasty reported significant increases in satisfaction with their breasts at three and 12 months, compared with baseline. In contrast, those with simple mastectomies reported decreased satisfaction at three and 12 months, compared with baseline.
Those who had therapeutic mammoplasty or chest wall perforator flap surgery both reported a significant decrease in ‘physical wellbeing - chest’ at three months (cf baseline) and even less at 12 months. Those who had chest wall perforator flap surgery also reported a significant decrease in sexual wellbeing at three and 12 months.
Professor Potter concluded that more research on the long-term clinical, oncological and patient-reported outcomes of oncoplastic breast-conserving surgery are needed. “Oncoplastic breast-conserving surgery is likely to be a better option than mastectomy for many women, but the outcomes of volume replacement and volume displacement techniques differ.”
She said that often women assume that mastectomy is the only option. Sometimes women choose mastectomy over other types of surgery, but there is evidence that many overestimate the benefits of mastectomy in treating cancer, and they underestimate the reconstruction process. Fear of recurrence can be a factor in patients’ surgery decisions, and some people do not want two operations.
Professor Potter finished her presentation with the message that “Women need accurate, balanced, evidence-based information” and that “Oncoplastic breast-conserving surgery should be offered as an alternative to mastectomy in all women for whom it is technically feasible.”
16 August 2025
