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

[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/m 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.