Long-term oncological and cosmetic outcomes of oncoplastic breast surgery: a single-center LMIC experience

Surgical management of breast cancer has evolved significantly, with oncoplastic breast surgery (OBS) emerging as a safe option offering superior cosmetic outcomes compared to standard breast conservation. However, it remains a relatively novel concept in developing countries with a limited number of professionals with the expertise to perform these procedures. This study aims to determine the long-term oncological and cosmetic outcomes of patients with early-stage breast cancer who underwent OBS at our institution. A single-center retrospective study was conducted on adult female patients with biopsy proven Stage I to III breast cancer who underwent OBS from January 2017 to June, 2022 (ERC 2025-11482-34955). A total of 194 women were eligible for the study and the long-term oncologic outcomes: ipsilateral breast tumor recurrence (IBTR), estimated 5-year disease-free survival (DFS), and overall survival (OS) were determined. Cosmetic outcomes were evaluated via patient-reported satisfaction using the Harvard breast cosmesis scale. The mean age of women at diagnosis was 48.3 ± 13.2 years. Majority of the women had hormone receptor positive breast cancer, while 25.8% had triple negative disease. Almost half of the patients received neoadjuvant chemotherapy before OBS. Six (3.1%) women had a positive margin requiring re-excision. Level 1 OBS was performed among 76.8% of the patients with the remaining undergoing a variety of local perforator and rotation flaps. Self-reported cosmetic outcomes were reported by 68.1% of the women, among whom 50.8% reported a ‘Good’ and 39.5% reported an ‘Excellent’ cosmetic outcome. The 5-year IBTR was noted in 9 (4.6%) patients. The Kaplan Meier analysis showed that the estimated mean OS of the study participants was 96 months (95% CI = 92.2–99.7) since diagnosis, with death as the outcome event. The mean DFS was 93 months (95% CI = 89.5–97.6) since diagnosis until recurrence as the outcome event. Oncoplastic breast surgery is a safe and effective option for early-stage breast cancer, with low margin positivity and favorable long-term outcomes. Our study demonstrates excellent survival and high patient-reported cosmetic satisfaction, especially with Level 1 OBS. These findings support its broader use, even in resource-limited settings, as a balanced approach to oncologic safety and aesthetic outcomes.