This report outlines key recommendations and considerations for breast-conserving surgery (BCS) and oncoplastic breast surgery (OBS). BCS is indicated for patients with biopsy-proven ductal carcinoma in situ (DCIS) or invasive carcinoma, where tumor-to-breast size ratio permits complete resection with negative margins and acceptable cosmetic outcomes. Suitable candidates typically have unifocal or limited multifocal disease confined to a single quadrant and prefer to preserve their breast. Extended indications for OBS include cases with large tumor-to-breast volume ratios, tumors located in cosmetically sensitive regions (such as central or inferior breast areas), multifocal or multicentric disease (e.g., multiple foci separated by at least 2 cm), and patient desire to avoid mastectomy while maintaining good aesthetic results.
Absolute contraindications for BCS involve pregnancy in the first trimester, diffuse suspicious microcalcifications, persistent positive margins after re-excision, inflammatory breast cancer (T4d), homozygous ATM mutations (ataxia-telangiectasia syndrome), and multicentric disease unsuitable for oncoplastic techniques. Relative contraindications include collagen vascular diseases (requiring individualized assessment with radiation considerations), prior radiation history, and germline TP53 mutations such as Li-Fraumeni syndrome.
Preoperative planning involves comprehensive imaging with bilateral mammography, supplemental ultrasound, or MRI as needed, and precise localization via clip placement at biopsy. Multidisciplinary coordination is essential, especially for multifocal or multicentric disease, along with familiarity with localization devices and intraoperative imaging techniques.
Technical considerations emphasize achieving clear margins, defined as “no ink on tumor” for invasive cancers and at least 2 mm for DCIS, following established guidelines. Incisions should optimize aesthetic outcomes, and skin-sparing approaches may be employed if mastectomy is a possibility. All known malignant foci should be excised, with cavity markers placed for radiation planning. Removal must be confirmed via specimen imaging.
OBS enables resection of 20–50% of breast tissue with immediate reconstruction, potentially reducing re-excision rates, margin positivity, and visible scarring, while maintaining complication rates comparable to standard BCS. This approach offers both oncologic safety and improved cosmetic results.
Reference:
ASBRS Breast Conserving Surgery Guideline Summary – Guideline Central. (n.d.). https://www.guidelinecentral.com/guideline/5135367/#section-5135381
