Breast Conservation Project: Clinical Outcomes of Extreme Oncoplastic Breast-Conserving Therapy Versus Mastectomy for Large and Multiple Lesions.

Publication Title

Annals of surgical oncology : the official journal of the Society of Surgical Oncology

Authors

Katherine M Jackson, Department of Surgical Oncology, Providence Saint John's Cancer Institute, Santa Monica, CA, USAFollow
Janelle-Cheri Millen, Department of Surgical Oncology, Providence Saint John's Cancer Institute, Santa Monica, CA, USAFollow
Nicketti Handy, Providence Saint John's Cancer Institute, Santa Monica, CA, USAFollow
Javier I Orozco, Department of Translational Molecular Medicine, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, USAFollow
Stacey Stern, Providence Saint John's Cancer Institute, Santa Monica, CA, USAFollow
Crystal E Fancher, Saint John's Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USA.Follow
Janie Grumley, John Wayne Cancer Institute, Providence Saint John's Health Center, Santa Monica, CA, USAFollow

Document Type

Article

Publication Date

7-24-2024

Keywords

california; santa monica; sjci

Abstract

INTRODUCTION: Patients with multiple or large malignant breast lesions are classically considered mastectomy candidates, but extreme oncoplastic breast-conservation surgery (eOBCS) has become an alternative approach. There is a paucity of outcomes data comparing eOBCS with mastectomy.

METHODS: We reviewed our prospectively maintained, single-institution database. We included patients with non-metastatic breast cancer with multiple ipsilateral or single large (= 5 cm) malignant breast lesions identified preoperatively who underwent either eOBCS or mastectomy. Patient demographics, clinicopathologic features, and surgical, oncologic, and cosmetic outcomes were evaluated.

RESULTS: Seventy-six (88%) patients underwent eOBCS and 10 (12%) underwent mastectomy. Median follow-up was 24.8 months. Mastectomy patients had larger lesions than eOBCS patients (median 70 mm vs. 32.5 mm; p = 0.06). Six (60%) index mastectomy patients underwent at least one additional surgery. For eOBCS patients, 34 (44%) required re-excision, 7 of whom underwent more than one subsequent surgery to obtain negative margins, and 6 (7.9%) ultimately underwent mastectomy. For patients undergoing additional surgery (n = 40), median time between index and final operation was 315 days for mastectomy versus 21 days for eOBCS patients (p < 0.001). Mastectomy patients more frequently experienced complications (p = 0.001) and underwent cosmetic revision (p < 0.001). There was no difference in cosmetic scores, and eOBCS patients reported less pain (p = 0.009). There were two local and three distant recurrences in the eOBCS cohort and one distant recurrence in the mastectomy group.

CONCLUSION: Breast conservation was attainable in over 90% of eOBCS patients. Increased postoperative complications and discomfort and longer duration of surgical treatment in mastectomy patients without oncologic superiority should drive informed patient discussions.

Area of Special Interest

Cancer

Area of Special Interest

Women & Children

Specialty/Research Institute

Oncology

Specialty/Research Institute

Surgery

DOI

10.1245/s10434-024-15799-4