title: Oncoplastic Breast-Conserving Surgery Reduces Mastectomy and Postoperative Re-excision Rates.
abstract: BACKGROUND
  Oncoplastic breast-conserving surgery (BCS) integrates partial mastectomy with plastic surgery techniques to facilitate breast cancer resection with clear surgical margins and preservation of breast cosmesis. In 2011, oncoplastic BCS was adopted as standard surgical treatment for breast cancer patients at Virginia Mason Medical Center, Seattle, WA.
  
  
  METHODS
  This single-institution retrospective review evaluates the mastectomy and postoperative re-excision rates before and after adoption of oncoplastic BCS. All patients undergoing surgical treatment of breast cancer were identified from institutional databases for the periods January 2009 through December 2010 [standard surgery group (SS)] and January 2013 through September 2014 [oncoplastic surgery group (OS)].
  
  
  RESULTS
  A total of 812 patients were evaluated; 425 patients were treated in the SS group compared with 387 patients in the OS group. The mastectomy rate in the SS group was 34% compared with 15% in the OS group (p < 0.001), and the average tumor size for patients undergoing BCS was 12.7 mm in the SS group compared with 15.4 mm in the OS group (p = 0.04). Despite the larger average tumor size, the postoperative re-excision rate for patients undergoing BCS in the SS group was 32% as opposed to 18% in the OS group (p < 0.001).
  
  
  CONCLUSIONS
  Oncoplastic BCS significantly reduced the rates of mastectomy and postoperative re-excision in breast cancer patients while treating larger cancers. This study suggests that use of OS techniques can effectively treat larger cancers while maximizing breast cosmesis and minimizing the need to resort to mastectomy.
authors.affiliation: Department of General, Thoracic and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
authors.forename: Angelena
authors.initials: A
authors.lastname: Crown
authors.forename: Debra G
authors.initials: DG
authors.lastname: Wechter
authors.forename: Janie W
authors.initials: JW
authors.lastname: Grumley
mesh_terms: D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000473:pathology / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011184:Postoperative Period; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C508053:ERBB2 protein, human