Extreme oncoplastic conservation is a safe new alternative to mastectomy

Abstract

Objectives: Extreme oncoplastic breast conserving surgery (eOPBCS) allows breast conservation for tumours ≥ 50 mm, but long-term outcomes are unclear. We investigated early complications and the longer-term clinical and oncological outcomes following eOPBCS to assess the clinical utility and safety of this technique.

Materials and methods: A prospectively collected database of all eOPBCS procedures (1993-2016) using LD miniflaps (LDm) and therapeutic mammoplasties (TM) was interrogated and cross-checked with hospital records to establish length of follow up (FU), clinical outcomes (complications, revisions), local recurrence (LR) and survival.

Results: Ninety eOPBCS procedures (62 LDm, 28 TM) performed for large tumours (mean 67 [50-177] mm) were identified, overall FU 80 (10-308) months (LDm 91 [13-308], TM 54 [10-120] months). Forty two per cent were node positive, and 2 were benign (benign cases excluded from LR and FU analysis). Eleven patients required surgery for involved excision margins (LDm 3 re-excisions and 2 mastectomies, TM 6 mastectomies). Surgery for complications and subsequent revision was required in 6% and 37% of LDm and 18% and 7% of TM patients, respectively. Seven patients developed LR (LDm 5 versus TM 2) giving a predicted 5 and 10 year LR rate of 1.1% and 16%.

Conclusion: Long-term FU of this unique series has confirmed that eOPBCS is a safe procedure for patients with bulky tumours normally treated by mastectomy, without risking local control. TM patients experienced more early complications but LDm patients required more revisions over a more prolonged period of FU.

Keywords: Breast cancer; Breast-conserving surgery; Extreme oncoplasty; Latissimus dorsi mini-flap; Local recurrence; Therapeutic mammoplasty.