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Oncoplastic Breast Surgery: Optimizing Resection Margins in Addition to Aesthetic Outcomes
Pooja S Yesantharao1, Mohammed S Shaheen2, Gavin Hui3,4
1Division of Plastic & Reconstructive Surgery, Stanford University School of Medicine, 770 Welch Road, Suite 400, Palo Alto, CA, 94304, USA. pyrao@stanford.edu.
Objective:
This study aims to determine whether oncoplastic surgery improves resection margins compared to lumpectomy alone in patients undergoing breast conserving therapy, as determined by re-excision rates.
Background:
Prior studies have demonstrated that oncoplastic breast surgery results in better aesthetic outcomes than lumpectomy alone in select patient cohorts. However, there is a dearth of literature on whether oncoplastic breast surgery also provides oncologic benefit.
Methods:
This is a retrospective cohort investigation of women who underwent breast conserving therapy at our institution between 2010 and 2023. Breast cancer patients who received either lumpectomy alone or oncoplastic breast surgery during this period were included. The rate of re-excision of margins within the 6-month period following the index procedure was compared between patients who underwent lumpectomy along and those who underwent oncoplastic breast surgery.
Results:
Of 4,673 study patients, 4,164 (89.6%) underwent lumpectomy alone and 488 (10.4%) underwent oncoplastic breast surgery. Oncoplastic surgery became significantly more prevalent over the course of the study period (p = 0.04). The re-excision rate was higher in the lumpectomy cohort that in the oncoplastic surgery cohort (17% vs. 13%). After adjusting for potential confounders using propensity score matching, oncoplastic surgery was associated with significantly lower odds of re-excision (OR 0.7, 95% confidence interval 0.4-1.0, p = 0.05).
Conclusions:
Oncoplastic surgery may help to better achieve clear surgical margins compared to lumpectomy alone, and an increasing number of patients are receiving oncoplastic breast surgery. This suggests that, whenever possible, efforts should be made to offer oncoplastic surgery to appropriately selected patients.
Level Of Evidence Iii:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
