Extreme oncoplastic mammoplasty: a safe procedure that limits indications of mastectomy

Background
Extreme oncoplastic breast surgery is a breast-conserving operation, using oncoplastic techniques, in a patient who, in most physicians’ opinions, requires a mastectomy. These are generally large, greater than 5 cm, multifocal or multicentric tumors. This study aims to evaluate the oncologic safety and esthetic outcomes of extreme oncoplastic therapeutic mammoplasty in patients potentially required mastectomy at the first surgical opinion.
Patients and methods
This study included 36 female patients who presented to Breast and Endocrine Surgery Unit, General surgery department, Assiut University Hospital, Egypt, with multifocal, multicentric, or locally advanced breast cancer (tumor span >5 cm) who were initially advised to do mastectomy and asked for breast conservation as a second opinion. The workhorse of oncoplastic techniques in our facility was the Wise pattern therapeutic reduction mammoplasty tailored according to the tumor site and breast cup size.
Results
The mean tumor span for the 36 patients enrolled in this study was 6 cm (range: 2–9 cm). The mean of the least safety margins was 1.76 cm (ranges: 0.5–5 cm), and the mean of the maximum safety margins was 5 cm (ranges 2–9.5 cm. Three cases (8.3%) had wound infection, two cases (5.6%) had wound gapping, breast seroma developed in five cases (13.9%), loss of nipple–areola complex sensation was recorded in five cases, and fat necrosis occurred in three cases (8.3%). After a median follow-up of 37 months, local recurrence rate was 5.6% (2/36) and distant metastasis rate was 5.6% (2/36). Overall score of patient satisfaction was ‘excellent’ in 20 cases (55.5%), ‘good’ in 11 cases (30.6%), and ‘fair’ in five cases (13.9%).
Conclusion
Properly selected patients who were initially scheduled for mastectomy as a standard surgical treatment of breast cancer can be safely treated by tailored therapeutic mammoplasty techniques of extreme oncoplastic breast surgery.