Balancing risks of surgical complications and positive margins for patients with invasive lobular carcinoma of the breast and elevated BMI: An institutional cohort study

Israel Falade; Kayla Switalla; Astrid Quirarte; Molly Baxter; Daniel Soroudi; Harriet Rothschild; Shoko Emily Abe; Karen Goodwin; Merisa Piper; Michael Alvarado; Bao-Quynh Julian; Cheryl Ewing; Jasmine Wong; John Rose; Laura Esserman; Robert Foster; Rita A Mukhtar

doi:10.1016/j.amjsurg.2024.116073

Balancing risks of surgical complications and positive margins for patients with invasive lobular carcinoma of the breast and elevated BMI: An institutional cohort study

Am J Surg. 2024 Nov 6:241:116073. doi: 10.1016/j.amjsurg.2024.116073. Online ahead of print.

Authors

Israel Falade¹, Kayla Switalla², Astrid Quirarte², Molly Baxter², Daniel Soroudi³, Harriet Rothschild³, Shoko Emily Abe², Karen Goodwin², Merisa Piper², Michael Alvarado², Bao-Quynh Julian², Cheryl Ewing², Jasmine Wong², John Rose², Laura Esserman², Robert Foster², Rita A Mukhtar²

Affiliations

¹ University of California San Francisco, School of Medicine, San Francisco, CA, USA. Electronic address: israel.falade@ucsf.edu.
² University of California San Francisco, Department of Surgery, San Francisco, CA, USA.
³ University of California San Francisco, School of Medicine, San Francisco, CA, USA.

PMID: 39571369
DOI: 10.1016/j.amjsurg.2024.116073

Abstract

Background: The risks of postoperative complications in breast cancer patients vary by patient and tumor characteristics. Elevated BMI and invasive lobular carcinoma (ILC) increase risks of surgical complications and positive margins, respectively.

Methods: We retrospectively analyzed patients with BMI ≥30 kg/m² from an institutional ILC database. The primary outcome was surgical complication rate by procedure type. The secondary outcome was positive margin rates by surgical approach, stratified by T stage.

Results: Of 154 analyzed patients, standard BCS, lumpectomy with oncoplastic closure, and simple mastectomy had the lowest complication rates (18.2 %, 17.0 %, 11.8 %). Oncoplastic reduction mammoplasty and mastectomy with aesthetic closure had the highest rates (35.5 %, 33.3 %). The overall positive margin rate was 28.5 %, significantly higher in BCS vs. mastectomy (37.4 % vs. 15.0 %, p = 0.003). Oncoplastic surgery significantly reduced positive margin rates in BCS.

Conclusion: In this study, 23.4 % of patients experienced surgical complications, with higher rates in oncoplastic/reconstructive approaches. However, oncoplastic surgery reduced positive margins, highlighting the importance of balancing risks for optimal surgical planning.