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Related Experiment Video

Updated: Mar 26, 2026

Endoscopic Bilateral Nipple-sparing Mastectomy via a Single Axillary Incision with Immediate Pre-pectoral Implant-based Breast Reconstruction
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Identifying Factors and Techniques to Decrease the Positive Margin Rate in Partial Mastectomies: Have We Missed the

Sara B Edwards1, I Michael Leitman1, Aaron J Wengrofsky1

  • 1Department of Surgery, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York.

The Breast Journal
|February 9, 2016
PubMed
Summary
This summary is machine-generated.

Positive margins in breast conservation therapy (BCT) are common. Using single needle localization and excising additional tissue, especially for ductal carcinoma in situ (DCIS), can improve outcomes and reduce re-excision rates.

Keywords:
bracketingbreastductal carcinoma in situintraductal carcinomalumpectomymarginsneedle localizationpartial mastectomyre-excision

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Area of Science:

  • Oncology
  • Surgical Oncology
  • Breast Surgery

Background:

  • Breast conservation therapy (BCT) aims to preserve breast tissue while removing cancerous tumors.
  • Positive margins after partial mastectomy are a significant concern, leading to re-excision or mastectomy.
  • Current risk factor identification for positive margins primarily relies on histology and demographics.

Purpose of the Study:

  • To identify modifiable risk factors for positive margins and residual disease in patients undergoing partial mastectomy.
  • To evaluate the impact of tumor localization techniques and excision strategies on margin status.

Main Methods:

  • Retrospective review of 567 partial mastectomies performed between 2009 and 2012.
  • Analysis of 414 neoplasm cases, examining localization methods, intraoperative assessment, excision techniques, and re-excision/mastectomy rates.
  • Correlation of margin status with histology, including ductal carcinoma in situ (DCIS).

Main Results:

  • 23% of patients had positive margins; 25% had margins between 0.1-0.9 mm.
  • Residual tumor was found in 61 cases, frequently associated with positive margins or close margins.
  • Ductal carcinoma in situ (DCIS) was present in 85% of residual disease cases, significantly increasing re-excision and mastectomy rates.
  • Multi-needle tumor localization increased the likelihood of positive margins 2-3 fold compared to single-needle localization.
  • Additional margin excision during initial surgery improved complete excision rates when DCIS was present.

Conclusions:

  • Careful intraoperative margin assessment and consideration for additional tissue excision or cavity shaving are crucial for improving BCT outcomes.
  • Surgeons should carefully select patients for BCT, especially those with multifocal or multicentric disease.
  • Patients requiring bracketing for tumor localization have a higher risk of positive margins and residual disease and require thorough counseling.