Comparative Analysis of Oncological and Functional Outcomes of Breast-Conserving Surgery Versus Modified Radical Mastectomy in Locally Advanced Breast Cancer
Submission: 21 August 2025 | Acceptance: 26 September 2025 | Publication: 24 November 2025
Aymen Shafiq1, Fatima Imran1, Zakria Siddiq1, Ahsan Iqbal2, Amara Younas3, Sharjeel Mahmood3, Fatima Naeem4, Hira Nargis1
1Gujranwala Medical College Teaching Hospital, Gujranwala.
2Tehsil Headquarters Hospital, Pasrur.
3Shalamar Hospital, Lahore.
4Mayo Hospital, Lahore.
Corresponding author: Dr Aymen Shafiq, Gujranwala Medical College Teaching Hospital, Gujranwala.
ABSTRACT
Background: Breast-conserving surgery (BCS) has become standard in early-stage breast cancer. Still, its role in locally advanced breast cancer (LABC) remains debated, particularly in low- and middle-income countries (LMICs). This study compares oncological and functional outcomes of BCS versus modified radical mastectomy (MRM) in LABC patients following neoadjuvant chemotherapy.
Methods: We conducted a retrospective observational study of 200 women with LABC treated at a tertiary care center. Patients underwent either BCS (n = 120) or MRM (n = 80) following neoadjuvant therapy. Data on tumor characteristics, recurrence, survival, postoperative morbidity, and quality of life were collected and analyzed.
Results: At a median follow-up of 60 months, the 5-year disease-free survival (DFS) was 78% in the BCS group and 65% in the MRM group (p = 0.04), while overall survival (OS) was 85% versus 70%, respectively (p = 0.02). Recurrence and distant metastasis were lower in the BCS group. Multivariate analysis identified triple-negative subtype, nodal positivity, and lack of pathologic complete response—not surgical type—as independent predictors of poorer outcomes. BCS patients reported fewer complications, shorter hospital stays, quicker recovery, and better body image and social functioning scores.
Conclusion: BCS is oncologically safe and functionally superior to MRM in selected LABC patients treated with neoadjuvant therapy, even in LMIC settings. Broader adoption of BCS in countries like Pakistan will require improved access to radiotherapy, oncoplastic training, and earlier detection strategies.
Keywords: breast cancer, locally advanced breast cancer, breast-conserving surgery, modified radical mastectomy, low- and middle-income countries, survival outcomes, quality of life, Pakistan.