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Extreme Oncoplasty: Replacing Mastectomy with Lumpectomy

The idea of conserving the natural breast as the default treatment for breast cancer has previously been dismissed due to contour abnormalities associated with larger tumor removal. However, a recently published study of mine examines the more recent theory of “extreme oncoplasty,” or performing a lumpectomy in patients who would normally be considered better candidates for mastectomy.

Advantages of Extreme Oncoplasty

Oncoplastic surgery carries a number of advantages over traditional mastectomy plus full breast reconstruction:

  • Cosmetic results are typically superior compared to a mastectomy followed by immediate breast reconstruction and radiation therapy.
  • Operative and post-operative complications are reduced.
  • Post-reconstruction radiation therapy is kinder to natural breast tissue than to the reconstructed breast.

Research Results

My colleagues and I looked at 245 standard patients with a median tumor size of 21 mm. After an average follow-up time of 24 months, recurrence was seen in only 1.6 percent of study participants. We also looked at 66 patients with extreme cases, or a median tumor size of 62 mm. Six patients required re-excision for wider margins and four were converted to mastectomy. A 1.5 percent recurrence was seen at the 24-month follow-up.

These numbers are encouraging for a two main reasons. First, because women who would prefer a lumpectomy instead of mastectomy may now have that option without additional concerns over the cosmetic appearance of their breast following oncoplastic surgery. Additionally, the low incidence of recurrence is reassuring for women and surgeons who previously believed that lumpectomy was a higher-risk procedure in terms of breast cancer recurrence.