Annals of Surgical Oncology

, Volume 22, Issue 13, pp 4247–4253 | Cite as

Positive Margins After Oncoplastic Surgery for Breast Cancer

  • Krishna B. CloughEmail author
  • Pedro F. Gouveia
  • Djazia Benyahi
  • Eleanore J. D. Massey
  • Elisabeth Russ
  • Isabelle Sarfati
  • Claude Nos
Breast Oncology



Oncoplastic techniques applied to breast-conserving surgery (BCS) allow large-volume resections without compromising cosmetic results. Level II oncoplastic techniques are based on mammoplasties. When required, they allow resection of more than 20 % of the breast volume; however, a subgroup of these patients will still have positive margins. The clinical management of positive margins after level II oncoplastic surgery (OPS) is a challenge.


All patients who had undergone level II oncoplastic techniques at The Paris Breast Center between 2004 and 2013 were reviewed. The choice of the optimal mammoplasty technique was based on the tumor location and the ‘quadrant per quadrant atlas’.


A total of 277 level II oncoplastic techniques were performed on 272 patients. The mean tumor size was 26 mm (range 2–160 mm), with a mean resected weight of 175 g (range 50–1540 g). The rate of positive margins was 11.9 %. Risk factors for positive margins identified in univariate analysis were histologic subgroup, tumor size, T stage and grade. In multivariate analysis, only patients with invasive lobular carcinoma had a significantly higher risk of positive margins. A second operation was required in 33 cases, and a third operation was required in three cases because of positive margins. Final breast conservation rate was 91 %.


Level II OPS results in a low positive margin rate despite large tumor size. Patients with involved margins can be offered a second BCS if the remaining volume allows this.


Invasive Ductal Carcinoma Positive Margin Invasive Lobular Carcinoma Breast Volume Mastectomy Rate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Conflict of interest

Krishna Clough, Pedro F. Goueia, Eleanore J.D. Massey, Elisabeth Russ, Isabelle Sarfati, and Claude Nos have no conflicts of interest to declare that are directly relevant to the content of this study.

Ethical Approval

The ethical requirements of the Paris Breast Center have been met.

Funding Sources

No sources of funding were used to assist in the preparation of this study.


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Krishna B. Clough
    • 1
    Email author
  • Pedro F. Gouveia
    • 1
  • Djazia Benyahi
    • 1
  • Eleanore J. D. Massey
    • 1
  • Elisabeth Russ
    • 1
  • Isabelle Sarfati
    • 1
  • Claude Nos
    • 1
  1. 1.L’Institut du Sein – Paris Breast CenterParisFrance

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