18 Advanced Oncoplastic Breast Surgery Using Multiple Pedicles Following Breast-Conserving Surgery: Oncologic and Surgical Outcomes

Background

Oncoplastic breast surgery (OPS) is a form of breast conservation surgery (BCS) that has been shown to be a safe and effective treatment for breast cancer. OPS includes both volume displacement and volume replacement techniques, which allow for oncologic resection while preserving aesthetic outcomes. This study aims to evaluate advanced oncoplastic approaches that combine oncoplastic approaches using multiple pedicles and techniques to address complex reconstructive needs following BCS.

Materials and Methods

Patients undergoing OPS using at least dual pedicles were retrospectively reviewed from January 2023 to December 2025. Primary outcomes included oncologic safety and postoperative complication rates. Secondary outcomes included surgical complications, delay in adjuvant therapy, recurrence, mortality, and utilization of reconstructive techniques and adjunctive technologies.

Results

A total of 135 patients (139 breasts) underwent BCS with advanced oncoplastic reconstruction using at least a dual-pedicle technique. Median age was 59.0 years (IQR, 51.5-66.0), and median body mass index was 30.1 kg/m² (IQR, 26.0-35.0; Table). Common comorbidities included hypertension (36.0%) and diabetes (8.6%). Median postoperative follow-up was 13.3 months (IQR, 3.3-22.8). The most common primary cancer type was invasive ductal carcinoma (54.7%), followed by ductal carcinoma in situ (18.7%). Median tumor size was 1.5 cm (IQR, 0.8-2.2). Positive margins occurred in 7.9% of cases, and 5.8% experienced a delay in adjuvant therapy. There were no cases of local recurrence or breast cancer–specific mortality during follow-up. One patient (0.7%) had evidence of metastatic disease, and all-cause mortality was 1.4%. Indications for advanced oncoplastic reconstruction included patient preference (51.1%), large area of disease or defect (28.8%), multicentric disease (10.1%), and tumor involvement of the nipple-areolar complex (NAC; 10.1%). Of the combined reconstructive approaches, the most frequently involved pedicle was the inferior pedicle in combination with another pedicle (66.2%). Sentinel lymph node biopsy was performed in 79.9% of patients. Adjunctive technologies included intraoperative indocyanine green angiography in 65.5% and closed-incision negative-pressure wound therapy in 96.4%. Overall, postoperative complications occurred in 17.3% of patients, most commonly wound dehiscence (6.5%) and infection (5.8%). No cases of flap failure or nipple loss were observed.

Conclusion

Advanced OPS that combines multiple pedicles and techniques for reconstruction of complex defects is feasible and oncologically safe in selected patients undergoing BCS. These approaches address a range of indications, including large areas of disease, multicentric tumors, tumor involvement of the NAC, and patient preference, without compromising margin status or short-term oncologic outcomes. Complication rates were comparable to published outcomes, supporting the role of combined oncoplastic strategies in complex breast reconstruction.