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Positive Margins After Oncoplastic Surgery for Breast Cancer.

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Level II oncoplastic surgery (OPS) for breast cancer allows large resections with good cosmetic outcomes. While positive margins occur in 11.9%, further breast-conserving surgery is often possible.

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Plastic Surgery

Background:

  • Oncoplastic techniques enable large breast resections in breast-conserving surgery (BCS) while maintaining cosmetic results.
  • Level II oncoplastic techniques, based on mammoplasties, allow resection of over 20% of breast volume.
  • Managing positive margins after Level II oncoplastic surgery (OPS) presents a clinical challenge.

Purpose of the Study:

  • To evaluate the outcomes of Level II oncoplastic techniques regarding positive margin rates.
  • To identify risk factors associated with positive margins in Level II OPS.
  • To assess the feasibility of re-excision for positive margins in Level II OPS.

Main Methods:

  • A retrospective review of 277 Level II OPS procedures performed between 2004 and 2013.
  • Mammoplasty technique selection was guided by tumor location and the 'quadrant per quadrant atlas'.
  • Analysis of patient data to determine positive margin rates and associated risk factors.

Main Results:

  • A total of 277 Level II OPS were performed on 272 patients, with a mean tumor size of 26 mm.
  • The overall positive margin rate was 11.9%, with invasive lobular carcinoma identified as a significant risk factor in multivariate analysis.
  • A second operation was required in 33 cases due to positive margins, achieving a final breast conservation rate of 91%.

Conclusions:

  • Level II OPS achieves a low positive margin rate even with large tumor resections.
  • Patients with positive margins after Level II OPS can often undergo a second breast-conserving surgery if sufficient breast volume remains.