Conventional breast conserving surgery versus Oncoplastic volume displacement breast Surgery in moderate to Large-breasted Patients

Abstract

Conventional breast-conserving surgery (CBCS) and oncoplastic volume displacement breast surgery (OPBS) in patients with moderate to large breasts are frequent. CBCS involves tumor excision with preservation of breast shape, but cosmetic deformities occur in 25–30% of cases, especially when more than 20% of breast volume is removed. It is generally suitable for tumors smaller than 2–3 cm or involving less than 20% of the breast. In contrast, OPBS allows safe resection of 20–50% of breast tissue using volume displacement techniques such as parenchymal advancement (Level I) and complex rearrangement with reduction mastopexy and pedicle-based reconstruction (Level II). OPBS is indicated in women with macromastia or ptosis, tumors in the medial, central, or inferior quadrants, extensive ductal carcinoma in situ, invasive lobular carcinoma, salvage after failed BCS, and incomplete response to neoadjuvant therapy. It preserves aesthetics, improves symmetry, and permits wider excision without increasing recurrence. Complication rates include fat necrosis (5%), seroma (8–10%), and rare nipple necrosis (0.5%). OPBS achieves high rates of oncologic safety, with 95% overall survival and 90% disease-free survival, while also enhancing cosmetic outcomes and quality of life.