Re-excision Rate after Partial Mastectomy in Oncoplastic Breast Conserving Surgery: A Single Institutional Experience and Review of the Literature"
Martin Benjamin, MD1, Catherine Sinnott, MD2, Sheina Bawa, MD2, David Kaufman, MD, FACS3, Katie Guarino, PA2, Tommaso Addona, MD, FACS2.
1Nassau University Medical Center, Hempstead, NY, USA, 2Long Island Plastic Surgical Group, Garden City, NY, USA, 3Breast Care Specialists, Bethpage, NY, USA.
BACKGROUND: Applying oncoplastic techniques to breast conservation therapy is believed to improve cosmetic and oncologic outcomes, compared to standard breast conservation therapy alone. This study aimed to perform a comprehensive review of the literature comparing outcomes of oncoplastic breast conservation therapy (BCT+R) to that of standard breast conservation therapy alone (BCT). A secondary objective was to compare these results to outcomes after oncoplastic breast conservation therapy performed at our institution (BCT+r).
METHODS: A literature search was performed in PubMed using key words, “oncoplastic,” “partial breast reconstruction,” and “breast conservation therapy.” Case reports, case series and studies with less than 10 patients and studies that did not report re-excision rates were excluded. A retrospective chart review was performed from 2011 to 2017 of all cases of oncoplastic breast conservation therapy performed at our institution by a single reconstructive surgeon. Outcomes were assessed by comparing re-excision rates between the three comparison groups (BCT, BCT+R, BCT+r).
RESULTS: The BCT group was made of 5965 patients (22 papers) and the BCT+R group comprised 2564 patients (41 papers). Re-excision rates in the BCT+R group were lower (4.0%) than the BCT group (17.2%, p=0.0001). 172 patients comprised the BCT+r group and underwent oncoplastic breast conservation therapy during the study period at our institution. The re-excision rate in the BCT+r group was 1.7% and was significantly lower than the BCT group (p=0.0001) and lower but not significantly different from the BCT+R group (p=0.2113).
CONCLUSIONS: Oncoplastic breast conservation therapy leads to lower re-excision rates compared to standard breast conservation therapy. Oncoplastic breast conservation therapy may improve oncologic outcomes compared to standard breast conservation therapy by allowing for more extensive resection without compromising aesthetic results. The findings suggest that a comprehensive surgical team-based approach can aid in reducing the morbidity from an oncologic breast resection while maximizing breast aesthetic outcomes.
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