Promoting Oncological Safety: Extreme Oncoplasty as an Alternative to Mastectomy-Insights From a Single-Center Experience in Low and Middle-Income Country.

Background: Extreme oncoplastic breast-conserving surgery (eOBCS), euphemism for radical conservation, expands the indications of breast conservation for tumor that typically requires a mastectomy. Existing data show no discernible survival differences between mastectomy and breast-conserving surgery; however, limited evidence exists regarding local recurrences between these groups. We report the oncological outcomes of eOBCS in terms of margin safety and disease recurrence at our institute. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.

Methodology: 47 patients underwent eOBCS between July'17 and June'22. Mean follow-up was 54 (24-84) months. Primary endpoints were the resection margin status and need for reoperation. Secondary endpoints were 5-year local and distant recurrence free and overall survivals. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.

Results: Mean age at diagnosis was 46.8 (±13.2) years. IDC (70.2%) was the commonest histological type. 32% of cancers were >5 cm in size, 30% were multifocal, and 40.4% were node positive. 25% were triple negative whereas, 7% were Her2Neu positive. Therapeutic mammoplasty (44.4%) was the frequently performed surgical procedure followed by local rotational flaps (27.6%). Mean pretreatment mammographic tumor size was 50 mm (±7.5) mm. 40.4% of the patients qualified for neoadjuvant therapies and 91.5% received radiation. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.

Conclusion: eOBCS is an innovative and aesthetically promising surgical technique enabling successful breast conservation in patients necessitating mastectomy. Our data substantiate the oncological safety of eOBCS; however, it requires appropriate patient selection and multidisciplinary planning.