How effective is conservative surgery for breast cancer in the long run?

This article investigated the long-term safety and effectiveness of oncoplastic breast surgery (removal of the tumor and breast reconstruction at the same time) on women survivors of breast cancer. The authors concluded that this treatment is safe and resulted in acceptable long-term outcomes. 

Breast conservative surgery (BCS; the tumor is removed but breast is left intact to preserve its natural shape) followed by breast reconstruction (creation of a breast shape using an artificial implant) has been the mainstay of breast cancer treatment in early-stage breast cancer. It has a low rate of recurrence but 25% of patients reported not being satisfied with how their breast looked afterward.

An alternative treatment approach is oncoplastic breast surgery (OBS) This involves both the removal of the tumor and breast reconstruction in one surgery. The aim is to improve how the breast looks after surgery while still safely removing the tumor. The long-term outcomes of OBS are still under investigation.

This study involved 1024 patients with breast cancer who had OBS performed. 869 (84.9%) patients had an invasive tumor (tumor growing into surrounding tissue) and 155 (15.1%) patients had an in-situ tumor (tumor confined to one place). Patients were followed up for an average of 74.2 months. The survival outcomes and side effects of the surgery were evaluated.

During follow up, 88.8% of patients had a complete removal of the tumor. 40 patients needed repeat surgery to remove the tumor and 39 patients had a mastectomy (complete breast removed). During an average of 34.2 months, 49 patients (4.7%) experienced a local relapse (cancer returning at the place of the initial tumor). 52 patients (5.07%) experience metastasis (cancer spread at a distance from the initial tumor) after an average of 34.7 months after surgery. 67 patients (6.5%) had a positive margin (cancer cells present at the edge where the tumor was removed first).  

Side effects experienced by patients included wound infections (1.7%), hematomas (10.4%; a collection of blood outside of blood vessels due to trauma) or fluid leakage onto the skin (9.2%). Cancer spread to distant areas of the body in 5.07%. 

The authors concluded that oncoplastic breast surgery is safe and resulted in acceptable long term outcomes. 

The follow-up period was only 6 years. Further studies with longer follow up periods are needed for more conclusive results.