17 Modified Oncoplastic Technique for Multifocal Breast Cancer: A Single-Center Experience

Background

Multifocal breast cancer often requires wide excision of multiple segments, leading to substantial loss of breast volume and distortion of breast contour. This challenge is particularly relevant in patients with small to moderate breast volume, where achieving oncologic safety while preserving bilateral aesthetic symmetry is difficult. Central pedicle techniques are widely used in oncoplastic breast-conserving surgery; however, their application for large-volume resections in multifocal disease of the upper inner quadrant remains limited. The aim of this study is to evaluate a technical modification of the Würinger central pedicle technique designed to enable large-volume resections in multifocal upper inner quadrant tumors while preserving nipple-areolar complex (NAC) viability and optimizing bilateral aesthetic outcomes.

Materials and Methods

A retrospective single-center analysis was conducted of 52 patients with multifocal breast cancer involving the upper inner quadrant treated between 2022 and 2024 by a single surgical team. All patients underwent oncoplastic breast-conserving surgery with large-volume lumpectomy, intraoperative margin assessment, and immediate reconstruction using a modified Würinger central pedicle mastopexy. Complete parenchymal mobilization from the skin envelope was performed, followed by local tissue redistribution with parenchymal sutures. Contralateral breast symmetrization was achieved using a Wise pattern mastopexy. All patients received adjuvant radiotherapy. Median follow-up was 12 months. Postoperative complications and patient-related risk factors were recorded. Patient-reported outcomes and quality of life were assessed using the BREAST-Q questionnaire with multivariate statistical analysis. The technique was indicated in patients without NAC involvement and with sufficient breast volume. Exclusion criteria included nipple invasion, multicentric disease, inadequate breast volume, and prior breast irradiation.

Results

Postoperative fat necrosis occurred in 7 patients (13.5%). Delayed wound healing was observed in 3 patients (5.8%), including 2 active smokers and 1 patient with diabetes mellitus. Hematoma developed in 1 patient (1.9%), and seroma in 4 patients (7.7%). No major infectious complications were reported. Overall, 42 patients (80.8%) reported satisfaction with the surgical outcome. BREAST-Q analysis demonstrated a statistically significant improvement in postoperative quality-of-life and satisfaction scores compared with baseline (P =.001).

Conclusions

The modified Würinger central pedicle technique is feasible, reproducible, and oncologically safe for large-volume resections in multifocal upper inner quadrant breast cancer. Despite the use of different mastopexy techniques on each breast, reliable NAC preservation and satisfactory bilateral symmetry can be achieved. This approach expands oncoplastic options for breast-conserving surgery and is associated with high patient satisfaction in appropriately selected patients.