Comparative analysis of level II oncoplastic surgery and conventional breast-conserving surgery in breast cancer with a ductal carcinoma in situ component.

Background: To investigate the pathological outcomes, re-excision rates, local recurrence, patient satisfaction, and cosmetic results associated with level II oncoplastic surgery (OBS) techniques compared to conventional breast-conserving surgery (BCS) in the treatment of breast cancer with a ductal carcinoma in situ (DCIS) component.

Methods: Between January 2020 and December 2023, 163 patients with invasive carcinoma associated with DCIS were deemed suitable for breast-conserving surgery. The patients were divided into two groups: those who underwent conventional BCS and those who underwent level II OBS.

Results: Forty patients underwent level II OBS, while 123 patients underwent conventional BCS. The median age was 50 (range 29-65) years for the patients in the level II OBS group and 52 (range 25-68) years for those in the conventional BCS group. Re-excision was performed in three patients (10%) in the level II OBS group compared to 37 patients (30%) in the conventional BCS group, indicating a statistically significant difference (p = 0.035). The median tumor size was 16 (range 3-45) mm in the OBS cohort and 15 (range 4-50) mm in the BCS cohort. Donut mastopexy was the most commonly performed level II oncoplastic procedure (50%). No statistically significant differences were found between the groups in terms of other demographic and histopathological parameters (e.g., tumor laterality, menopausal status, ER, PR, and HER2 positivity, and E-cadherin expression). According to the BREAST-Q survey, the patients in the OBS group reported higher satisfaction with their breasts, better psychosocial well-being, and improved sexual well-being compared to those in the BCS group, with these differences being statistically significant (p < 0.001).

Conclusion: In breast cancer with a DCIS component, patients who underwent level II OBS had significantly lower re-excision rates, higher patient satisfaction, and better cosmetic outcomes compared to those who underwent conventional BCS.