Impact of Oncoplastic Breast Surgery on Rate of Complications, Time to Adjuvant Treatment, and Risk of Recurrence

Ida Oberhauser; Jasmin Zeindler; Mathilde Ritter; Jeremy Levy; Giacomo Montagna; Robert Mechera; Savas Deniz Soysal; Liliana Castrezana López; Veronica D'Amico; Elisabeth Artemis Kappos; Fabienne Dominique Schwab; Madleina Müller; Christian Kurzeder; Martin Haug; Walter Paul Weber

doi:10.1159/000511728

Impact of Oncoplastic Breast Surgery on Rate of Complications, Time to Adjuvant Treatment, and Risk of Recurrence

Breast Care (Basel). 2021 Oct;16(5):452-460. doi: 10.1159/000511728. Epub 2020 Nov 25.

Authors

Ida Oberhauser^{1

2

3}, Jasmin Zeindler^{1

2

3}, Mathilde Ritter^{1

2

3}, Jeremy Levy⁴, Giacomo Montagna^{1

2

5}, Robert Mechera^{1

2

3}, Savas Deniz Soysal^{1

2

3}, Liliana Castrezana López^{1

2

3}, Veronica D'Amico^{1

2

3}, Elisabeth Artemis Kappos^{1

2

6}, Fabienne Dominique Schwab^{1

2

5}, Madleina Müller^{1

2

5}, Christian Kurzeder^{1

2

5}, Martin Haug^{1

2

6}, Walter Paul Weber^{1

2

3}

Affiliations

¹ Breast Center, University Hospital of Basel, Basel, Switzerland.
² University of Basel, Basel, Switzerland.
³ Department of Breast Surgery, University Hospital of Basel, Basel, Switzerland.
⁴ Biometrical Practice BIOP, Basel, Switzerland.
⁵ Department of Obstetrics and Gynecology, University Hospital of Basel, Basel, Switzerland.
⁶ Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland.

Abstract

Background: The aim of this study was to compare the risk of complications and recurrence between oncoplastic and conventional breast surgery.

Methods: This is a retrospective analysis of a consecutive series of 436 patients with stage I-III breast cancer who underwent surgery at the University Hospital of Basel between 2011 and 2018.

Results: The nipple/skin-sparing mastectomy (NSM/SSM) group showed significantly more delayed wound healing (32.7 vs. 5.8%, p < 0.001) and skin necrosis (13.9 vs. 1.9%, p = 0.020) compared to conventional mastectomy (CM), which corresponded to significantly higher odds of short-term complications (OR 2.34, 95% CI 1.02-5.35, p = 0.044). The incidence rate of long-term morbidity in oncoplastic breast-conserving surgery (OBCS) was significantly higher compared to conventional breast-conserving surgery (CBCS; 25.5 vs. 11.3 per 100 patient years [PY], p < 0.001), in particular concerning chronic pain (13.3 vs. 6.6, p = 0.011) and lymphedema (4.1 vs. 0.4, p = 0.003). Seroma as a long-term morbidity occurred more often in the CM group compared to the NSM/SSM group (5.8 vs. 0.5 per 100 PY, p = 0.004). Patients received adjuvant treatment earlier after CM compared to NSM/SSM (HR 1.83, 95% CI 1.05-3.19, p = 0.034). There were no significant differences in the incidence of positive margins nor in the odds of recurrence after OBCS versus CBCS and after NSM/SSM versus CM.

Conclusions: Even though the present study confirmed expected differences in complications and morbidity, it suggested that oncoplastic surgery is oncologically safe. Patients undergoing NSM/SSM should be followed closely to allow early detection and treatment of frequently associated complications and ensure timely start of adjuvant therapy.

Keywords: Breast cancer; Complications of breast cancer surgery; Delay of treatment; Oncoplastic breast surgery; Recurrence of breast cancer.