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Breast-Conserving Therapy for Centrally Located Breast Cancer

Fitzal, Florian MD*; Mittlboeck, Martina MD; Trischler, Herwig*; Krois, Wilfried*; Nehrer, Greta MD; Deutinger, Maria MD; Jakesz, Raimund MD*; Gnant, Michael MD*

doi: 10.1097/SLA.0b013e31815b6991
Original Articles

Objective: To analyze whether breast-conserving therapy (BCT) may be an oncologically safe approach and result in a good cosmesis in patients with centrally located breast cancer (CLBC).

Summary Background Data: Only underpowered, retrospective, single-arm studies have suggested that oncoplastic BCT for CLBC may be oncologically safe and may result in a good cosmesis.

Methods: The authors retrospectively analyzed the overall and recurrence-free survival in 1485 patients with breast cancer undergoing BCT comparing CLBC with non-CLBC. Moreover, the authors described 4 different oncoplastic techniques for BCT in patients with CLBC and compared the cosmetic results with simple lumpectomy according to a recently elaborated objective cosmetic evaluation system, the Breast Symmetry Index.

Results: Kaplan-Meier curves show no significant difference in a 5-year overall, local, or distant recurrence-free survival between patients with CLBC and non-CLBC after BCT (94% vs. 96%; 100% vs. 98%; 92% vs. 90%; median follow–up, 35.3 months). The cosmetic outcome after oncoplastic BCT compared with simple lumpectomy differed significantly (Breast Symmetry Index: 22 ± 6%d vs. 44 ± 12%d; P < 0.05).

Conclusions: The results demonstrate that BCT for CLBC is oncologically safe and that oncoplastic techniques improve cosmesis.

This retrospective analysis of 1485 patients argues that breast-conserving therapy has similar oncologic results when comparing patients with centrally located breast cancer and noncentrally located breast cancer. Oncoplastic techniques significantly improve cosmetic results in patients with centrally located breast cancer.

From the Departments of *Surgery and †Statistics, Medical University of Vienna; ‡TOP-MED, Plastic and Reconstructive Surgery; and ¶Department of Plastic and Reconstructive Surgery, Rudolfstiftung Hospital, Vienna Austria.

Reprints: Florian Fitzal, MD, Professor of Surgery, Department of Surgery 21A, Waehringer Guertel 18-20, Medical University of Vienna, 1090 Vienna, Austria, Europe. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.