Tielens, Quirine (2025) A Two-Stage Approach to Oncoplastic Breast Surgery: Expanding Indications for Breast-Conserving Surgery. thesis, Medicine.
Full text available on request.Abstract
Background: Breast cancer is the most common malignancy in women in the Netherlands. Unfavorable tumor characteristics, such as large tumor-to-breast ratio, ductal carcinoma in situ (DCIS), multifocal breast cancer, or invasive lobular carcinoma (ILC), often result in positive margins post-breast conserving surgery (BCS), requiring mastectomy. The two-stage procedure allows for delayed reconstruction and re-excision of positive margins, improving breast conservation in high-risk patients. Methods: This retrospective cohort study included 22 patients who underwent two-stage breast-conserving surgery at Isala Hospital Zwolle between 2015 and 2024. Clinical data were collected from medical records, including demographic, tumor, and treatment characteristics. Primary outcomes included breast conservation rates, re-excision rates, and surgical complications. Secondary outcomes assessed time to adjuvant therapy initiation and treatment delays. Results: The cohort consisted of 22 patients, with a mean age of 56.0 years and a mean body mass index (BMI) of 27.6 kg/m². Tumors were unifocal in 72.7% and multifocal in 27.3%. Negative margins were achieved in 64%, and 36% had positive margins. Of the 22 patients, 77.2% retained breast conservation, and 22.7% required mastectomy. Seven patients underwent re-excision, and four of them preserved their breast. Only one reconstruction was dismantled. Complications occurred in 13.6%. The median interval between surgeries was 14 days. No local recurrences were noted. Conclusion: The two-stage surgical approach successfully preserved the breast in 77.2% of patients, who would likely have undergone a mastectomy without the procedure, with minimal complications and a low mastectomy rate, demonstrating a promising oncological safe procedure.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Beek, dr. M.A. and Francken, dr. A.B. and Lam-Boer, dr. J.T. ‘t |
| Faculty: | Medical Sciences |
| Date Deposited: | 12 May 2026 12:34 |
| Last Modified: | 12 May 2026 12:34 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3950 |
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