Improving quality of breast conservative surgery for lower quadrants cancer in small and medium sized breasts: Crescent technique versus J mammoplasty.

Background: For medium/small size breast, breast conserving surgery (BCS) is usually associated to poor cosmetic results. The objective of the study is to evaluate oncological safety and cosmetic results comparing the "Crescent" and the "J" mammoplasty technique and to develop an algorithm for the treatment of breast cancer located in lower quadrants in medium/small breast. Methods: We retrospectively analysed all consecutive patients who underwent a "J" mammoplasty or a "Crescent" technique at AUSL IRCCS Reggio Emilia between 2016 and 2021. Fifty-eight patients were enrolled, the first group including 29 "Crescent" technique procedures and the second one including 29 patients who underwent the "J" mammoplasty technique. Oncological safety and surgical minor and major complications were evaluated. Aesthetic results were evaluated by two senior breast surgeons, independently, at least 6 months after radiotherapy (RT). Results: At follow-up of 36 months, no recurrences and no major complications were observed in both groups. Minor complications were observed in two (6.9%) "J" group cases and in six (20.7%) "Crescent" ones (P<0.05). The 96.6% of "Crescent" and the 73.5% of "J" cases were judged excellent/good. One (3.4%) "Crescent" was judged fair versus six (20.7%) "J" mammoplasty. Two (6.9%) "J" cases were judged poor, requiring ipsilateral re-operation. Conclusions: When a favourable ratio between tumor size and breast volume is present, BCS can be performed for tumors located in the lower quadrants. Evaluating patients' anthropometric characteristics, skin involvement and tumor features is the key to select the right technique and to obtain both great cosmetic result and low rate of complications.