Preserving the Nipple-Areola Complex in Centrally Located Breast Cancer: Trade-offs Among Oncoplastic Techniques

BackgroundCentrally located breast tumors pose surgical challenges in achieving oncologic margin safety and acceptable aesthetic outcomes due to their proximity to the nipple-areola complex. Although mastectomy has traditionally been preferred, advances in oncoplastic breast-conserving surgery have enabled oncologically safe breast conservation with nipple-areola complex preservation.MethodsWe retrospectively analyzed 291 patients who underwent oncoplastic breast-conserving surgery with nipple-areola complex preservation between October 2022-June 2025. Tumors were located retroareolarly or within 2 cm of the areolar margin. Patients with nipple-areola complex involvement, nipple excision, central mastectomy, or benign or pure ductal carcinoma in situ were excluded. Patients were grouped according to surgical technique (donut, racquet, batwing, reduction mammoplasty), and clinicopathological features, complication rates, surgical margins, and patient-reported satisfaction were evaluated.ResultsThe overall complication rate was 14.4%, and reoperation due to complications occurred in 1.03% of patients. The re-excision rate for positive surgical margins was 7.2%, with the highest rate observed in the batwing group (16.7%). Racquet mammoplasty achieved the widest margins (>2 cm) in 15.8% of cases but was associated with the highest complication rates and the lowest patient satisfaction. In contrast, reduction mammoplasty resulted in the highest aesthetic satisfaction, with 91.7% of patients rating outcomes as "excellent" or "good."ConclusionWhile racquet mammoplasty provides wider surgical margins, it is associated with lower patient satisfaction and higher complication-related reoperation rates. Reduction mammoplasty offers the most favorable balance between aesthetic outcomes and patient satisfaction, emphasizing the importance of individualized surgical planning in centrally located breast tumors. These findings are consistent with established benchmarks reported in the literature.