The application of oncoplastic techniques to
breast conservation therapy (BCT) is thought to improve cosmetic results with some documented oncologic advantages in certain patients. Although present data highlight the oncologic safety of this approach, the role of oncoplastic surgery specific to
ductal carcinoma in situ (
DCIS) has not been elucidated. In this study, all women in the Emory Healthcare system between January 1991 and June 2006 with biopsy-proven
DCIS who underwent
lumpectomies combined with simultaneous reduction
mammaplasties or mastopexies were identified. Medical records, including office notes, operative and pathology reports were analyzed. Parameters included age, BMI, histologic grade (low, intermediate, high) and type (comedo versus non-comedo) of
DCIS, margin status, locoregional recurrence, specimen weight, postoperative complications, and overall outcomes. Pedicle design and contralateral breast pathology were also analyzed. Twenty-eight women were included in the study with an average age of 47. Therapeutic
mammaplasty was the definitive procedure for 18 (64%) of these patients. Ten patients (36%) required reoperations: nine for positive margins and one for residual
microcalcifications (stereo biopsy
DCIS). Overall, seven patients (25%) required completion
mastectomy with reconstruction (transverse rectus abdominus
myocutaneous flap: n = 3, latissimus flap: n = 4), whereas three patients (11%) underwent re-excisions with confirmation of negative margins. All ten women who required completion
mastectomy or re-excisions exhibited either intermediate or high-grade, comedo
DCIS. Overall, 50% (6/12) of women diagnosed with high-grade comedo
DCIS required completion
mastectomy with reconstruction after initial therapeutic
mammaplasty. The final positive-margin rate for women diagnosed with intermediate-grade, comedo
necrosis was 43% (3/7). The women in this failed group that required reoperations were overall younger (mean: 45.6; median: 43) than those in which oncoplastic surgery was the definitive procedure (mean: 57.8; median: 57). There were no significant differences between the failed and successful groups in terms of biopsy weight (failed: 253 g, successful: 237 g), type of excision (e.g., wire-localized), location of
tumor, reduction type (e.g., superior medial), or postoperative complications. There was one case of locoregional recurrence of
DCIS 7 months after the initial operation. All 28 patients had no evidence of disease at an average follow-up of 2.7 years. This study suggests that although oncoplastic reduction techniques are a reasonable approach for women with
DCIS, stricter patient selection and improved confirmation of negative margins will minimize the need for either re-excisions or completion
mastectomy and reconstruction.