Oncoplastic Level II Volume Displacement Surgery for Breast Cancer: Aesthetic and Oncological Results
Overview
This retrospective cohort study of 109 breast cancer patients undergoing Level II oncoplastic breast conserving surgery (OBCS) demonstrated excellent oncological safety with low margin involvement (2.7%) and high 5-year overall (97%) and disease-free survival (94%). Patient satisfaction assessed by the BREAST-Q questionnaire showed a high average satisfaction index, indicating favorable aesthetic outcomes.
Background
Breast conserving surgery (BCS) has evolved to improve oncological safety and cosmetic outcomes, yet up to 30% of patients report unsatisfactory aesthetic results requiring further surgery. Oncoplastic breast conserving surgery (OBCS) integrates plastic surgery techniques to allow larger excisions with immediate breast reshaping, aiming to reduce positive margins and improve aesthetics. Despite widespread adoption, robust data validating oncological safety and patient satisfaction remain limited. This study assesses these outcomes in patients undergoing Level II volume displacement OBCS with contralateral symmetrisation.
Data Highlights
Parameter
Value
Number of patients
109
Mean age (years)
57.8 (SD 10.59)
Smokers
24%
Mean operative time (minutes)
212 (SD 56)
Sentinel lymph-node biopsy
72.5%
Axillary lymph node dissection
27.5%
Mean resected volume (g)
324
Nipple-areolar complex grafted
33%
Mean hospitalization (days)
3.7 (range 1-9)
Margin involvement
2.7%
Post-operative complications
17%
Neo-adjuvant therapy
32%
Adjuvant chemotherapy
60%
Radiation therapy
90%
Local recurrence
6.4%
5-year overall survival
97% (95% CI 92-100)
5-year disease-free survival
94% (95% CI 90-99)
Mean follow-up (months)
36 (SD 17.7)
Key Findings
Margin involvement was low at 2.7%, with only 1.8% requiring mastectomy due to residual breast volume.
Post-operative complications occurred in 17% of patients but were managed conservatively without reoperation.
Five-year overall survival was 97% and disease-free survival was 94%, demonstrating excellent oncological safety.
Patient satisfaction measured by BREAST-Q showed a high average satisfaction index, reflecting favorable aesthetic outcomes.
Level II volume displacement OBCS allowed excision of 20–50% of breast volume with immediate reconstruction and contralateral symmetrisation.
Multimodal treatment including neo-adjuvant therapy (32%), adjuvant chemotherapy (60%), and radiation therapy (90%) was integrated according to guidelines.
Clinical Implications
Level II volume displacement oncoplastic surgery is a safe and effective breast conserving technique that achieves excellent local control and survival outcomes while providing high patient satisfaction with breast aesthetics. The approach allows larger resections with immediate reshaping, reducing positive margins and the need for mastectomy. Surgeons should consider this technique for suitable patients to optimize both oncological and cosmetic results.
Conclusion
Level II volume displacement oncoplastic breast conserving surgery offers a reliable oncological outcome with low recurrence and high survival rates, alongside favorable patient-reported aesthetic satisfaction. This supports its role as a valuable surgical option in breast cancer management.
References
Clough et al. -- Oncoplastic Breast Surgery Classification
Italian Association of Medical Oncology (AIOM) Guidelines -- Breast Cancer Management
BREAST-Q Development -- Patient Reported Outcome Tool
