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The American Society of Breast Surgeons.
Annals of Surgical Oncology

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Oncoplastic Level 2 Mammoplasty for Large DCIS: 5-Year Results

R. F. D. van la Parra MD, PhD, K. B. Clough MD, C. Lejalle-Alaeddine MD, B. Poulet MD, I. Sarfati MD, C. Nos MD
Breast Oncology
Volume 26, Issue 8 / August , 2019

Abstract

Background

Oncoplastic surgery (OPS) allows wider resections with immediate breast reshaping by mammoplasty. This study reviews our experience with level 2 mammoplasties in patients with histology-proven pure ductal carcinoma in situ (DCIS).

Method

From a prospectively maintained database of 392 consecutive oncoplastic level 2 mammoplasties, 68 patients presented with pure DCIS. Involved margin rates and locoregional recurrence rates were calculated, with 76 months (0–166 months) median follow-up.

Results

The mean pathological tumor size was 34 mm (median 26 mm, range 2–106 mm). The mean resection weight was 191 g (median 131 g, range 40–1150 g). Margins were clear in 58 cases (85.3%) and involved in 10 cases (14.7%). Margins were involved in 1 out of 54 (1.9%) cases with tumor size under 50 mm and in 9 out of 14 (64.3%) cases with tumor size higher than 50 mm (p < 0.001). On multivariable analysis, only tumor size > 50 mm [odds ratio (OR) 95.400; p < 0.001] was independently associated with involved margins. Seven patients had mastectomy. The overall breast conservation rate was 89.4%, and 100% for tumors less than 5 cm. There were three local recurrences. The 5-year cumulative incidence for local recurrence was 5.5% (0–11.5%).

Conclusions

OPS is a safe solution for large DCIS up to 50 mm, with an involved margin rate of only 1.9%, and can thus reduce the mastectomy rate in this group. As margin involvement significantly increases for tumors larger than 5 cm, better preoperative localization and/or wider excisions are necessary in this group.

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