Aim: To analyse the overall cosmetic outcome according to patient self-assessment in relation to the fractionation received.

Materials and methods: A questionnaire, drawn up on the basis of subjective rating scales of cosmesis and of acute and late toxicity RTOG/EORTC, EORTC QLQ-C30 (v3) and LENT SOMA, was applied to patients with early-stage breast cancer who received radiotherapy with tangential fields between June 2014 and July 2015. Self-perception of cosmesis, changes in the treated breast, pain and fractionation used (hypofractionation (HF) 42.56 Gy in 16 fractions or conventional fractionation (CF) 50 Gy in 25 fractions) were evaluated.

Results: Three hundred and fifty-two questionnaires were obtained. The median age was 58 years. 45% of patients reported ‘excellent’ cosmesis, 53% ‘good’, and 2% ‘poor’ cosmesis. Cosmesis was considered ‘excellent/good’ by 98% of patients. No statistically significant difference was found in overall cosmesis according to fractionation received (p = 0.6).

The most frequent alteration was ‘difference between both breasts’ (77%), and 48% reported change in normal breast colour.

Fifteen percent of patients who are younger than 58 years reported a change of normal breast colour affecting cosmesis compared to 9% of patients older than 58 years (p = 0.04).

Complications affecting breast cosmesis were reported by 9% of patients with stages I-II compared with 2% with cancer in situ (DCIS) (p = 0.04); 14% in stages I-II referred colour change affecting cosmesis compared to 6% of those with DCIS (p = 0.03).

Ninety-four percent of patients stated that they would accept treatment again.

Conclusions: No difference in cosmetic results was found between HF and CF in our patients. Great satisfaction regarding cosmetic outcome of cancer treatment was reported, given by 98% of excellent/good cosmesis, and 94% of patients who would receive treatment again.