Abstract

Introduction: Extreme oncoplastic breast surgery involves utilizing OPBS (Oncoplastic Breast Surgery) techniques to preserve the breast in a patient who, according to many surgeons, should have a mastectomy, for example, large tumors (>5cm), multifocal / multicentric tumors in A/B cup size breast.

We are reporting our early experience as a single center to assess the oncological safety and cosmetic results of intercostal perforator flap (LICAP and AICAP) and therapeutic mammoplasty as extreme OPBS measures in patients who were giving OPBS instead of the planned mastectomy at the initial surgical consultation.

Method: Retrospective analysis of patients having Extreme OPBS in cases where a mastectomy would typically be recommended. Patients were included if their imaging revealed tumors larger than 40 mm or less in A/B breast Cup or if the tumors were multifocal or multicentric.

Results: From October 2022 till November 2023, 20 patients underwent extreme OPBS. The tumor sizes range 0.7 cm to larger 7 cm, with a median of 4 cm. The Oncoplastic procedures for which these patients underwent includes LICAP performed in 8 patients, AICAP in 1 patient, mammoplasty in 10 patients, and bilateral donut mastopexy in 1 patient. In 20 patients, 8 underwent single stage symmetrizing procedures. All patients had axillary surgery such as SLNB (Sentinel Lymph Node Biopsy), TAD (Targeted Axillary Dissection) and ALND (Axillary Lymph Node Dissection). All margins were negative on final histopathology.

Conclusion: In our data, we have shown that the indications for Extreme OPBS can be safely expanded to patients who would traditionally only be considered for mastectomy based on tumor size or multicentricity. However, longer follow-up will be investigated in the future.

Galia Jadkarim