Comparison of quality of life and complications after oncoplastic breast-conserving surgery and implant-based reconstruction for central breast cancer—a retrospective cohort study

Background: Breast-conserving surgery (BCS) has traditionally been avoided for centrally located breast cancer due to concerns over oncologic safety and cosmetic outcomes, though advances in oncoplastic techniques have expanded its applicability. The aim of this study is to compare postoperative complications and quality of life between patients with centrally located breast cancer (CLBC) undergoing oncoplastic BCS and those undergoing nipple-sparing mastectomy (NSM) with implant-based reconstruction. Methods: CLBC usually refers to tumors located in the area within 2 cm of the nipple-areolar complex (NAC) including malignancies directly behind the nipple-areola area. A retrospective analysis was conducted on 130 patients treated for CLBC between March 2020 and September 2023. Among them, 98 underwent oncoplastic BCS, while 32 underwent NSMs with implant reconstruction. Inclusion criteria for the BCS group: absence of extensive calcifications or multiple lesions; tumor diameter ≤3 cm, allowing for the preservation of a favorable breast shape postoperatively; preoperative breast MRI demonstrating a tumor margin of at least 2 mm from the nipple. Inclusion criteria for the reconstruction group: unsuitability for or unwillingness to undergo BCS; medium or small breast size; mild or absent breast ptosis; presence of multiple or multicentric lesions precluding the achievement of satisfactory breast aesthetics with BCS. Postoperative quality of life was assessed six months after surgery using the Breast-Q questionnaire. Results: Compared to the BCS group, the reconstruction group had a higher proportion of non-ptotic, normal-shaped breasts (84.38% vs. 51.02%, P=0.002), more tumors >3 cm (62.50% vs. 40.82%, P=0.03), and more multifocal or multicentric lesions (56.25% vs. 6.12%, P