Comparing Clinical, Patient-Reported, and Aesthetic Outcomes of Oncoplastic Reconstruction Versus Reduction Mammoplasty in Macromastia

BACKGROUND: Oncoplastic breast reconstruction (OP), combining tumor resection with volume reduction and soft tissue rearrangement, benefits women undergoing breast conservation surgery by both alleviating macromastia symptoms and enhancing symmetry, shape, and cosmesis. This study compared oncoplastic breast reconstruction with standard bilateral breast reduction (BBR) across three domains: (1) clinical safety profile, (2) patient-reported outcomes, and (3) aesthetic results. METHODS: A single-surgeon, single-institution retrospective review was conducted on patients who underwent OP or BBR from April 2022 to May 2025. Demographics, clinical data, BREAST-Q surveys, and aesthetic outcomes were collected via electronic medical record. Statistical analyses included univariate testing and minimal ANCOVA. RESULTS: Among 180 patients, 116 (64.4%) received BBR and 64 (35.6%) OP. BBR patients were younger and had greater resection weights (p<0.05). OP patients had higher BMI and ASA class (p<0.05). Wise pattern incision was utilized in all BBR and 97% of OP cases. While minor wound breakdown was statistically more frequent in the oncoplastic cohort, major complication rates were comparable between the two cohorts. Both cohorts showed significantly higher post-op BREAST-Q scores in psychosocial, sexual, and physical well-being, in addition to satisfaction with breasts, controlling for age and BMI. Comparing aesthetic scores between 10 patients of each group, BBR was slightly favored, though by less than 0.5 Likert scale in all six domains. CONCLUSIONS: OP provides significant QoL improvement with comparable major safety profile and aesthetic outcomes to BBR, further supporting its role as a favorable reconstructive option when lumpectomy is indicated.