Level II Oncoplastic Surgery as an Alternative Option to Mastectomy with Immediate Breast Reconstruction in the Neoadjuvant Setting: A Multidisciplinary Single Center Experience

SIMPLE SUMMARY: In patients with breast cancers larger than 2 cm undergoing neoadjuvant chemotherapy, there is a poor evaluation regarding the equivalence between oncoplastic surgery level II (OPSII) and mastectomy with immediate breast reconstruction (MIBR) regarding the aesthetic and oncological outcomes. The aim of our retrospective study was to assess whether OPSII is a safe alternative to MIBR. We confirmed the uniformity of the two techniques after neoadjuvant chemotherapy concerning loco-regional and systemic disease-free survival and overall survival in a population of 297 patients (87 undergoing OPSII, and 210 MIBR). In addition, we have highlighted how OPSII results in a lower loss of breast sensitivity after surgery and a better physical well-being of the chest. Therefore, in selected cases, OPSII should be preferred over MIBR, as it does not affect the oncological outcome, but improves physical well-being and allows the preservation of breast sensitivity in patients undergoing surgical treatment. ABSTRACT: Oncoplastic surgery level II techniques (OPSII) are used in patients with operable breast cancer. There is no evidence regarding their safety and efficacy after neoadjuvant chemotherapy (NAC). The aim of this study was to compare the oncological and aesthetic outcomes of this technique compared with those observed in mastectomy with immediate breast reconstruction (MIBR), in post-NAC patients undergoing surgery between January 2016 and March 2021. Local disease-free survival (L-DFS), regional disease-free survival (R-DFS), distant disease-free survival (D-DFS), and overall survival (OS) were compared; the aesthetic results and quality of life (QoL) were evaluated using BREAST-Q. A total of 297 patients were included, 87 of whom underwent OPSII and 210 of whom underwent MIBR. After a median follow-up of 39.5 months, local recurrence had occurred in 3 patients in the OPSII group (3.4%), and in 13 patients in the MIBR group (6.1%) (p = 0.408). The three-year L-DFS rates were 95.1% for OPSII and 96.2% for MIBR (p = 0.286). The three-year R-DFS rates were 100% and 96.4%, respectively (p = 0.559). The three-year D-DFS rate were 90.7% and 89.7% (p = 0.849). The three-year OS rates were 95.7% and 95% (p = 0.394). BREAST-Q highlighted significant advantages in physical well-being for OPSII. No difference was shown for satisfaction with breasts (p = 0.656) or psychosocial well-being (p = 0.444). OPSII is safe and effective after NAC. It allows oncological and aesthetic outcomes with a high QoL, and is a safe alternative for locally advanced tumors which are partial responders to NAC.