Oncoplastic Surgery Versus Total Breast Reconstruction in Locally Advanced and Multicentric Carcinomas. A Matched Comparative Cohort Study of Oncologic and Aesthetic Outcomes

BACKGROUND/OBJECTIVE: This study aimed to compare extreme oncoplastic surgery (EO-partial breast reconstruction for tumors > 5 cm or multicentric lesions) with extreme reconstruction (ER-mastectomy with reconstruction for tumors >5 cm or multicentric lesions). METHODS: This retrospective cohort study evaluated clinical and pathological parameters, complications, recurrence, survival, and aesthetic outcomes in 276 women, with large or multicentric breast carcinoma who underwent breast reconstruction between March 2004 and September 2025 at a private oncoplastic practice and two tertiary hospitals in Goiânia, Brazil. Data were analyzed using SPSS (version 15.0), with statistical significance set at p < 0.05. RESULTS: Mean follow-up was 44 months for EO and 57 months for ER (p = 0.03). Clinical tumor size before chemotherapy was 60 mm in both groups; after neoadjuvant chemotherapy, tumors were smaller in EO (37 mm vs. 44.5 mm, p = 0.02). EO required fewer procedures, with 74% completed in a single surgery, while ER more often required multiple operations (p < 0.01). No significant differences were found between groups regarding margin status or re-excision rates. In the ER group, 51.40% of patients developed complications, with 18.60% requiring reoperation due to severe events (p < 0.01). Five-year overall survival was similar (94.40% EO vs. 97.50% ER, p = 0.53), as was locoregional recurrence-free survival (97%). Patient-reported outcomes and physician assessments demonstrated superior satisfaction and aesthetic results in EO. CONCLUSIONS: EO provides equivalent oncologic safety to ER, with fewer surgeries, lower complication rates, and improved aesthetic and psychosocial outcomes. These findings support EO as a valid alternative to mastectomy with reconstruction in selected patients with large or multicentric breast cancer.