Is oncoplastic breast-conserving surgery better than mastectomy with reconstruction?
Foley et al. presented a retrospective cohort study which aimed to compare patient-reported outcomes (PROs), oncologic safety, and stratify outcomes based on race, ethnicity, and body mass index (BMI) in patients who underwent oncoplastic breast-conserving surgery (OBCS) or mastectomy with reconstruction (1). A retrospective chart review was conducted for 57 OBCS patients and 204 mastectomy patients treated from 2015 to 2021. The authors found that OBCS offered better PROs in terms of satisfaction with the breast and the overall surgical outcome when compared to mastectomy, while maintaining oncologic safety. Additionally, OBCS patients experienced significantly lower rates of infection and required fewer additional surgeries. Importantly, the rates of positive margins and recurrences were similar between OBCS and mastectomy patients. Furthermore, the analysis did not reveal any statistically significant differences in PROs when stratifying by race or ethnicity. In conclusion, OBCS appears to be a viable and advantageous surgical option for patients, particularly in underserved populations. While the study provides valuable insights, there are a few limitations that could be addressed to strengthen the conclusions.
Firstly, the sample size of the study is relatively small, especially the number of patients who completed the BREAST-Q questionnaires. To solve this issue, a larger multicenter study with a higher patient response rate should be conducted. This would significantly increase the statistical power of the results and provide a more representative response of the population.
Secondly, the follow-up duration of the study is limited, making it difficult to draw conclusions about long-term outcomes. To overcome this limitation, the follow-up period should be extended, and data should be collected over a longer period. This would enable a more comprehensive assessment of recurrence rates and other important long-term outcomes.
Thirdly, there are significant differences in baseline characteristics, such as age, BMI, and clinical stage of disease, between the OBCS and mastectomy groups. To mitigate the potential impact of these differences, statistical analyses should control for these variables, or propensity score matching methods could be used.
Fourthly, the retrospective nature of the study introduces the possibility of selection bias. To minimize this bias, a prospective randomized controlled trial should be conducted. This would provide stronger evidence for the comparative effectiveness of OBCS versus mastectomy.
Lastly, the analysis of PROs stratified by race and ethnicity is constrained by the small sample sizes within the subgroups. To address this limitation, the number of patients in the subgroups should be increased, or data could be pooled from multiple studies to enable more robust subgroup analyses.
In summary, while the study provides valuable preliminary data, addressing the above-mentioned limitations through larger studies, longer follow-up periods, prospective designs, and more detailed subgroup analyses would greatly enhance the conclusions regarding the relative benefits of OBCS versus mastectomy with reconstruction in the underserved populations.
Acknowledgments
Funding: None.
Footnote
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Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-144/coif). The authors have no conflicts of interest to declare.
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References
- Foley A, Choppa A, Bhimani F, et al. Oncoplastic breast-conserving surgery (OBCS) vs. mastectomy with reconstruction: a comparison of outcomes in an underserved population. Gland Surg 2024;13:358-73. [Crossref] [PubMed]
