Comparison Between Small and Large Breasts Following Oncoplastic Breast Reconstruction: Complications, Oncological Safety, and Patient Satisfaction

Background: This study compared oncoplastic breast reconstruction (OBR) outcomes in patients with small breasts (cup sizes A-C, SB-OR) undergoing large tumor resections versus those with large breasts (cup size D+, LB-OR). It evaluated safety, complications, and aesthetic results in these challenging cases. Methods: A retrospective review included 28 OBR patients (9 SB-OR, 19 LB-OR) treated between 2014 and 2018 at Kaplan Medical Center. Data collected included demographics, tumor characteristics, reoperation rates, complications, recurrence, and satisfaction (via BREAST-Q). Aesthetic outcomes were assessed by 12 medical professionals using a validated scale (0-10). Results: Relumpectomy rates for positive margins were 22.2% (SB-OR) versus 10.5% (LB-OR) (P = 0.4). SB-OR had no complications, whereas LB-OR had a 42.1% complication rate (P = 0.02). Patient satisfaction scores were similar (SB-OR: 74.4±11.6; LB-OR: 73.1±14.3; P = 0.68). Cosmetic outcomes were comparable (SB-OR: 8.09±0.88; LB-OR: 8.6±1.17; P = 0.33). One LB-OR patient had ipsilateral recurrence at 26 months (5.3% versus 0% in SB-OR; P = 0.4), with a mean follow-up of 19.4 months in the SB-OR group (range: 1-45 mo). Conclusions: OBR in patients with small breasts undergoing large resections demonstrated low complication rates (0%), oncological safety (no recurrences), and high patient satisfaction, comparable to the LB-OR group. Despite smaller sample sizes, SB-OR achieved similar aesthetic outcomes without the need for volume augmentation, suggesting it is a viable option for patients with small breasts.