Oncoplastic Surgery Versus Mastectomy: Complications and Survival Outcomes

Gabriel De la Cruz Ku; Anshumi Desai; Carly Wareham; Akash Koul; David Posawatz; George Youssef; Sarah M Persing; Salvatore Nardello; Abhishek Chatterjee

doi:10.1016/j.jss.2025.05.012

Oncoplastic Surgery Versus Mastectomy: Complications and Survival Outcomes

J Surg Res. 2025 Jun 26:312:119-135. doi: 10.1016/j.jss.2025.05.012. Online ahead of print.

Authors

Gabriel De la Cruz Ku¹, Anshumi Desai², Carly Wareham³, Akash Koul³, David Posawatz³, George Youssef³, Sarah M Persing⁴, Salvatore Nardello⁵, Abhishek Chatterjee⁶

Affiliations

¹ Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts; Universidad Cientifica del Sur, Lima, Peru.
² Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Medical School, Miami, Florida.
³ Department of Surgery, Tufts Medical Center, Boston, Massachusetts.
⁴ Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts; Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts.
⁵ Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts.
⁶ Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts; Division of Surgical Oncology, Department of Surgery, Tufts Medical Center, Boston, Massachusetts. Electronic address: achatterjee1@tuftsmedicalcenter.org.

PMID: 40578062
DOI: 10.1016/j.jss.2025.05.012

Abstract

Introduction: We aimed to compare the associated risk factors for and frequency of postoperative complications between oncoplastic surgery (OPS) and mastectomy (MT). As a secondary objective, we determined differences between the two approaches related to breast cancer-specific survival (BCSS).

Materials and methods: Patients with breast cancer included in the Surveillance, Epidemiology, and End Results Cancer File from 2012 to 2017 and from the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020 were identified. We included females with breast cancer who underwent OPS with radiotherapy (OPS+RT) and mastectomy without radiotherapy (MT-RT).

Results: A total of 151,449 and 53,649 patients were identified from the National Surgical Quality Improvement Program database and Surveillance, Epidemiology, and End Results Cancer File. MT was associated with a higher risk of overall complications (odds ratio [OR] = 2.147, P < 0.001), surgical complications (OR = 2.501, P < 0.001), and wound complications (OR = 1.673, P < 0.001). Survival analysis demonstrated a superior 5-y BCSS for OPS+RT compared to MT-RT (98.1% versus 93.8%, P < 0.001). Multivariate analysis identified MT-RT as a negative prognostic factor for BCSS (hazard ratio = 2.140, P = 0.009).

Conclusions: OPS demonstrated a lower incidence of overall, surgical, and wound complications compared to MT, as well as improved BCSS among patients with early breast cancer.

Keywords: Breast cancer; Breast reconstruction; Complications; Mastectomy; Oncoplastic surgery; Outcomes; Survival.