Expanding the Boundaries of Breast Conservation: Oncoplastic Surgery in Multifocal and Multicentric Breast Cancer

The development of oncoplastic surgical techniques has reshaped the management of multifocal and multicentric breast cancers. Previously treated mainly with mastectomy due to concerns about positive margins and local recurrence, these cases can now be safely managed with breast-conserving surgery (BCS) through advances in imaging, adjuvant therapy, and surgical methods.

We retrospectively reviewed the data from 2,155 patients who underwent breast cancer surgery at a tertiary surgical oncology center between October 2022 and May 2025. A total of 246 patients were identified as having multicentric or multifocal disease. While 68 patients underwent BCS, 178 received mastectomy. Demographic, radiological, histopathological, and surgical data were evaluated. Complications were categorized as minor or major, and aesthetic satisfaction was assessed using a structured questionnaire.

Among 1,253 BCS patients, 5.4% (n = 68) had multifocal or multicentric disease. The median age was 55 years. Negative surgical margins were achieved in 90% of patients during the initial surgery. Re-excision was performed in 5 patients (7.4%), and completion mastectomy was required in 2 patients (2.9%). The overall complication rate was 19%, with reoperation due to complications required in only one patient (1.5%). Of 46 patients evaluated, 90% rated their aesthetic outcome as "excellent" or "good."

Oncoplastic BCS is a safe and effective option for well-selected patients with multifocal or multicentric breast cancer. With modern imaging, multidisciplinary evaluation, and experienced surgical teams, high rates of negative margins and satisfactory cosmetic outcomes can be achieved.