Does oncological necessity compromise patient-reported outcomes? A comparative study of reduction mammoplasty pedicles versus elective procedures.

Abstract

Oncoplastic reduction mammoplasty (ORM) aims to integrate oncologic safety with aesthetic restoration. However, it is unclear whether oncological constraints and pedicle selection compromise patient-reported outcomes compared to elective aesthetic procedures. We evaluated whether ORM can achieve satisfaction levels comparable to elective cohorts and identified the primary determinants of patient-reported success across different pedicle techniques. We included patients who underwent bilateral oncoplastic reduction mammoplasty with superomedial (Group 1) or inferior (Group 2) pedicles, and bilateral benign superomedial reduction mammoplasty (Control). Patients with missing data, unilateral reductions, or those operated using free nipple or other pedicle techniques were excluded from the study. Demographics, clinical features, oncologic variables, and BREAST-Q® scores were documented. Among the 187 patients (Oncoplastic: n=59, Control: n=74) included, oncoplastic groups had higher age and BMI (p<0.05). Tumor location significantly dictated pedicle selection (p<0.001). Although control and Group 1 (superomedial) scores improved across all BREAST-Q domains postoperatively (p<0.005), Group 2 (inferior) showed no significant gains in breast satisfaction (p=0.119) or psychosocial well-being (p=0.113). Breast satisfaction was significantly higher in the controls than in Group 2 (p=0.005). Sexual well-being was the highest in controls, followed by Group 1, and the lowest in Group 2 (p<0.001). ORM achieves aesthetic standards comparable to elective procedures, particularly when the superomedial technique is used. Although tumor localization remains the primary determinant of pedicle selection, an individualized four-quadrant reconstruction ensures oncologic safety without compromising patient-reported satisfaction. Therapeutic, III.