A new study has reported that breast reduction surgery may be successfully combined with lumpectomy to treat ductal carcinoma in situ (DCIS). The application of oncoplastic techniques (in which plastic surgery techniques are combined with oncological breast surgery) to breast conservation surgery may improve cosmetic results and have some oncologic advantages in certain patients. The study examined all women with DCIS in the Emory Healthcare system who underwent lumpectomies combined with simultaneous surgery for breast reduction or to correct sagging breasts between January 1991 and June 2006. A total of 28 women with an average age of 47 were included.
Breast reduction was the only procedure required for 18 (64%) of the women. Ten patients (36%) required reoperations: nine because of positive margins and one for microcalcifications indicative of DCIS. Overall, seven patients (25%) required mastectomy with reconstruction, while three patients (11%) underwent re-excisions with confirmation of negative margins. All ten women who required completion mastectomy or re-excisions had either intermediate or high-grade, comedo DCIS. The final positive margin rate for women diagnosed with intermediate-grade, comedo necrosis was 43% (3/7). Generally speaking, women in the group that required reoperations were younger (median age 43 years) than those in which oncoplastic surgery was the one and only procedure (media 57 years). On the other hand, there were no significant differences between the two groups in terms of biopsy weight, type of excision (e.g., wire-localized), location of tumor, reduction type, or postoperative complications. One case of locoregional recurrence of DCIS was diagnosed seven months after the initial operation. All 28 patients had no evidence of disease after an average follow-up period of 2.7 years. The authors conclude that while oncoplastic reduction techniques are a reasonable approach for women with DCIS, strict patient selection and improved confirmation of negative margins are required to minimize the need for either re-excision or completion mastectomy and reconstruction.