Analysis of Clinical Outcomes Following Implementation of a Newly Developed Breast-Conserving Surgical Technique

Introduction. Advances in surgical management of breast cancer have substantially improved postoperative quality of life. Aim. This study compares short-term and long-term outcomes associated with a newly developed breast-conserving surgical technique in routine clinical practice.

Materials and methods. A retrospective review was conducted of medical records from 194 women with histologically confirmed breast cancer treated at the Samara Regional Oncology Center (Samara, Russia) between 2011 and 2020. Based on the extent and characteristics of surgical intervention, patients were stratified into two groups: a control group (n = 96) that underwent standard breast-conserving surgery and a main group (n = 98) that was treated using a newly developed method for determining surgical volume. The technique involved securing the free edge of the lateral thoracoaxillary dermal-fat flap in the axillary region along the anatomical course of the long thoracic nerve. Operative time and intraoperative blood loss were recorded. Disease-free and overall survival were analyzed using the Kaplan–Meier method. Quality of life was assessed using the Breast-Q questionnaire preoperatively and 6 months after treatment. Parametric and non-parametric statistical methods were applied, with significance set at p < 0.05.

Results and discussion. Mean operative time was 76.3 ± 23.3 minutes in the control group and 65.5 ± 18.3 minutes in the main group (p < 0.001). Blood loss averaged 53.1 ± 26.2 mL and 49.0 ± 14.3 mL, respectively (p = 0.18). Persistent non-infected seroma occurred in 19 patients in the control group and 7 patients in the main group (p = 0.009). The developed technique was associated with a statistically significant reduction in postoperative complications, while long-term oncologic outcomes did not differ between groups.

Conclusion. Use of the newly developed breast-conserving technique significantly reduces postoperative complication rates without compromising long-term treatment outcomes.

1. Cardoso F., Paluch-Shimon S., Senkus E., Curigliano G., Aapro M.S., André F., et al. 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5). Ann Oncol. 2020;31(12):1623–49. DOI: 10.1016/j.annonc.2020.09.010

2. Derouane F., van Marcke C., Berlière M., Gerday A., Fellah L., Leconte I., et al. Predictive biomarkers of response to neoadjuvant chemotherapy in breast cancer: current and future perspectives for precision medicine. Cancers (Basel). 2022;14(16):3876. DOI: 10.3390/cancers14163876

3. Burstein H.J., Curigliano G., Thürlimann B., Weber W.P., Poortmans P., Regan M.M., et al. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann Oncol. 2021;32(10):1216–35. DOI: 10.1016/j.annonc.2021.06.023

4. Stankowski-Drengler T.J., Livingston-Rosanoff D., Schumacher J.R., Hanlon B.M., Hitchcock M.E., Neuman H.B. Breast cancer outcomes of neoadjuvant versus adjuvant chemotherapy by receptor subtype: a scoping review. J Surg Res. 2020;254:83–90. DOI: 10.1016/j.jss.2020.04.011

5. Agostinetto E., Gligorov J., Piccart M. Systemic therapy for early-stage breast cancer: learning from the past to build the future. Nat Rev Clin Oncol. 2022;19(12):763–74. DOI: 10.1038/s41571-022-00687-1

6. Volchenko A.A., Pak D.D., Usov F.N. Repair plastic surgery in patients with breast cancer. Tumors of female reproductive system. 2011;3:29–32 (In Russ.).

7. Tkachev M.V. Selection of the volume of surgical treatment for patients diagnosed with breast cancer: Russian Federation Certificate of state registration of the database No. 2017621170. 2017 Oct. 10 (In Russ.).

8. Dines L.M., Stellander A.K.L., Schmidt V.J., Rose M. Oncoplastic breast surgery for patients with breast cancer. Ugeskr Laeger. 2023;185(34):V11220669. PMID: 37622607

9. Thiessen F.E.F., Tjalma W.A.A., Tondu T. Breast reconstruction after breast conservation therapy for breast cancer. Eur J Obstet Gynecol Reprod Biol. 2018;230:233–8. DOI: 10.1016/j.ejogrb.2018.03.049

10. Timerbulatov V.M., Timerbulatov Sh.V., Timerbulatov M.V. Classification of surgical complications. Pirogov Russian journal of surgery. 2018;9:61–5 (In Russ.). DOI: 10.17116/hirurgia201809162

11. Arora N., Patel R., Sohi G., Merchant S., Martou G. A scoping review of the application of breast-q in surgical research. JPRAS Open. 2023;37:9–23. DOI: 10.1016/j.jpra.2023.04.005

12. Christiansen P., Mele M., Bodilsen A., Rocco N., Zachariae R. Breast-conserving surgery or mastectomy?: Impact on survival. Ann Surg Open. 2022;3(4):e205. DOI: 10.1097/AS9.0000000000000205

13. Bundred J.R., Michael S., Stuart B., Cutress R.I., Beckmann K., Holleczek B., et al. Margin status and survival outcomes after breast cancer conservation surgery: prospectively registered systematic review and meta-analysis. BMJ. 2022;378:e070346. DOI: 10.1136/bmj-2022-070346

14. Vasilyeva E., Nichol A., Bakos B., Barton A., Goecke M., Lam E., et al. Breast conserving surgery combined with radiation therapy offers improved survival over mastectomy in early-stage breast cancer. Am J Surg. 2024;231:70–3. DOI: 10.1016/j.amjsurg.2023.05.005

15. Chen Q., Qu L., He Y., Deng Y., Zhou Q., Yi W. Comparative effectiveness of nipple-sparing mastectomy and breast-conserving surgery on long-term prognosis in breast cancer. Front Endocrinol (Lausanne). 2023;14:1222651. DOI: 10.3389/fendo.2023.1222651

16. Ahmed G.A., Baron D.H., Agrawal A. Oncologic and cosmetic outcomes of oncoplastic breast-conserving surgery after neoadjuvant systemic therapy: systematic review and meta-analysis. Breast Cancer Res Treat. 2025;209(2):229–52. DOI: 10.1007/s10549-024-07566-6

17. Chua Wern Ee M., Lee Shi Hui A., Chew W.H., Cua-Delos Santos E.E., Li Siwei S., Xian S.M., et al. Oncological outcomes following extreme oncoplastic breast conserving surgery (eOPBCS) for locally advanced breast cancer (LABC): A systematic review and meta-analysis. Breast. 2025;79:103869. DOI: 10.1016/j.breast.2024.103869

18. Tian R., Zheng Y., Liu R., Jiang C., Zheng H. Efficacy and safety of oncoplastic breast-conserving surgery versus conventional breast-conserving surgery: An updated meta-analysis. Breast. 2024:103784. DOI: 10.1016/j.breast.2024.103784

19. Torras I., Cebrecos I., Castillo H., Mension E. Evolution of breast conserving surgery-current implementation of oncoplastic techniques in breast conserving surgery: a literature review. Gland Surg. 2024;13(3):412–25. DOI: 10.21037/gs-23-454

20. Reid A., Thomas R., Pieri A., Critchley A., Kalra L., Carter J., et al. The impact of advanced oncoplastic surgery on breast-conserving surgery rates: A retrospective cohort study of 3,875 breast cancer procedures at a tertiary referral centre. Breast. 2024;78:103814. DOI: 10.1016/j.breast.2024.103814

21. Morrow M., Van Zee K.J., Solin L.J., Houssami N., Chavez-MacGregor M., Harris J.R., et al. Society of surgical oncology - American society for radiation oncology-American society of clinical oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. Ann Surg Oncol. 2016;23(12):3801–10. DOI: 10.1245/s10434-016-5449-z

22. de Boniface J., Frisell J., Andersson Y., Bergkvist L., Ahlgren J., Rydén L., et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized SENOMAC trial. BMC Oncol. 2017;17:379. DOI 10.1186/s12885-017-3361-y

23. Reitsamer R., Peintinger F. Prepectoral implant placement and complete coverage with porcine acellular dermal matrix: A new technique for direct-to-implant breast reconstruction after nipple-sparing mastectomy. J Plast Reconstr Aesthet Surg. 2015;68(2):162–7. DOI: 10.1016/j.bjps.2014.10.012

24. Jagsi R., Griffith K.A., Harris E.E., Wright J.L., Recht A., Taghian A.G., et al. Omission of radiotherapy after breast-conserving surgery for women with breast cancer with low clinical and genomic risk: 5-year outcomes of IDEA. J Clin Oncol. 2024;42(4):390–8. DOI: 10.1200/JCO.23.02270

25. Moo T.A., Sanford R., Dang C., Morrow M. Overview of breast cancer therapy. PET Clin. 2018;13(3):339–54. DOI: 10.1016/j.cpet.2018.02.006

26. Weber W.P., Soysal S.D., El-Tamer M., Sacchini V., Knauer M., Tausch C., et al. First international consensus conference on standardization of oncoplastic breast conserving surgery. Breast Cancer Res Treat. 2017;165(1):139–49. DOI: 10.1007/s10549-017-4314-5

27. McLaughlin S.A., DeSnyder S.M., Klimberg S., Alatriste M., Boccardo F., Smith M.L., et al. Considerations for clinicians in the diagnosis, prevention, and treatment of breast cancer-related lymphedema, recommendations from an expert panel: Part 2: preventive and therapeutic options. Ann Surg Oncol. 2017;24(10):2827–35. DOI: 10.1245/s10434-017-5964-6

28. Giuliano A.E., Ballman K.V., McCall L., Beitsch P.D., Brennan M.B., Kelemen P.R., et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial. JAMA. 2017;318(10):918–26. DOI: 10.1001/jama.2017.11470

29. Agrawal S.K., Imran M.M., Sethi S., Yadav S.K., Agarwal P., Sharma D. Sentinel lymph node biopsy vs. axillary lymph node dissection for early-stage breast cancer and sentinel lymph node metastasis: an updated systematic review and meta-analysis with special focus on locoregional recurrence and regional node irradiation. Breast Cancer (Auckl). 2025;19:11782234251335409. DOI: 10.1177/11782234251335409