Oncoplastic Breast Surgery Taking "Center" Stage-Managing Centrally Located Breast Tumors in Indian Cohort

Background: Centrally located breast tumors (CLBTs) present unique challenges in surgical management, requiring a delicate balance between oncological outcomes and cosmetic preservation. Oncoplastic techniques have emerged as a promising solution, allowing larger excisions while maintaining cosmetic appearance and function. This study aims to evaluate the surgical management of CLBT using oncoplastic breast surgery (OBS) treated at a single surgeon center in India. Methods: Among 138 patients with CLBT who underwent OBS, diagnosis and staging adhered to NCCN guidelines, with treatment decisions made via a multidisciplinary tumor board and patient counseling. Intraoperative ultrasound, specimen mammography, and frozen-section evaluation guided resection margins and axillary staging. Results: The median patient age was 52.7 years. Seventy-three percent of patients had unifocal disease, with 67% presenting at the cT2-cT3 stage, and 50% being clinically node-positive. Level 1 OBS was used in 21.73% of cases, Level 2 in 42.75%, and Level 3 in 35%, with 28% qualifying as extreme oncoplasty. Post-surgical complications were observed in 13% cases. Cosmetic outcomes were good to excellent in 94% of cases. At a median follow-up of 57 months, overall survival (OS) was 91.93%, and disease-free survival (DFS) was 88.17%. The BREAST-Q PROM response rate was 94%, with high satisfaction across all domains. Conclusions: This study highlights the safety and efficacy of OBS in CLBT. Key factors such as multidisciplinary management, meticulous surgical planning, and rigorous intraoperative rad-path assessment contributed to its success. These findings highlight the potential of OBS to optimize outcomes and enhance quality of life, even in difficult cases and resource-limited settings.