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A Meta-Analysis Comparing Breast Conservation Therapy Alone to the Oncoplastic Technique

Losken, Albert MD*; Dugal, Claire S. MD*; Styblo, Toncred M. MD; Carlson, Grant W. MD*

doi: 10.1097/SAP.0b013e3182605598
Breast Surgery

Abstract: When immediate reconstruction is applied to breast conservation therapy (BCT), the benefits extend well beyond the minimization of poor cosmetic results. The purpose of this analysis was to compare literature outcomes between BCT alone and BCT with the oncoplastic approach.

Methods: A meta-analysis was performed in PubMed using key words “oncoplastic,” “partial breast reconstruction,” and “breast conservation therapy.” Case reports, series with less than 10 patients, and those with less than 1-year follow-up were excluded from the analysis. The 3 comparative groups included BCT with oncoplastic reduction techniques (Group A), BCT with oncoplastic flap techniques (Group B), and BCT alone (Group C).

Results: Comparisons were made on 3165 patients in the BCT with oncoplastic group (Groups A and B, 41 papers) and 5494 patients in the BCT alone group (Group C, 20 papers). Demographics were similar, and tumor size was larger in the oncoplastic group (2.7 vs 1.2 cm). The weight of the lumpectomy specimen was 4 times larger in the oncoplastic group. The positive margin rate was significantly lower in the oncoplastic group (12% vs 21%, P < 0.0001). Reexcision was more common in the BCT alone group (14.6% vs 4%, P < 0.0001), however, completion mastectomy was more common in the oncoplastic group (6.5% vs 3.79%, P < 0.0001). The average follow-up was longer in the BCT alone group (64 vs 37 months). Local recurrence was 4% in the oncoplastic group and 7% in the BCT alone group. Satisfaction with the aesthetic outcome was significantly higher in the oncoplastic group (89.5% vs 82.9%, P < 0.001).

Conclusions: The oncoplastic approach to BCT allows a generous resection with subsequent reduction in positive margins. The true value on local recurrence remains to be determined. Patients are more satisfied with outcomes when the oncoplastic approach is used.

From the Divisions of *Plastic and Reconstructive Surgery and †Surgical Oncology, Emory University, Atlanta, GA.

Received February 26, 2012, and accepted for publication, after revision, May 14, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Albert Losken MD, Division of Plastic and Reconstructive Surgery, Emory University, 550 Peachtree St NE, Suite 84300, Atlanta, GA 30308. E-mail: alosken@emory.edu.

© 2014 by Lippincott Williams & Wilkins