Outcomes of Breast-Conserving Surgery in Triple-Negative Breast Cancer Patients: Insights from Institutional Practice

Abstract

Background: Triple-negative breast cancer (TNBC) accounts for 10–15% of breast cancers worldwide but is associated with disproportionately high mortality due to its aggressive biology and limited targeted therapies. In Bangladesh, TNBC represents a higher proportion of cases, often affecting younger women who present with advanced-stage disease, highlighting a significant clinical burden and scarcity of regional outcome data. While breast-conserving surgery (BCS) with radiotherapy is established as equivalent to mastectomy in early breast cancer, its safety in TNBC has been debated. The study aim was to evaluate the oncological outcomes of breast-conserving surgery in patients with TNBC at the National Institute of Cancer Research and Hospital (NICRH) in Bangladesh. Methods: This prospective observational study was conducted at the Department of Surgery, Naogaon Medical College, Naogaon, Bangladesh, from May 2024 to December 2024, including 80 post-neoadjuvant chemotherapy (NACT) triple-negative breast cancer (TNBC) patients undergoing breast-conserving surgery (BCS). Eligible patients were selected through purposive sampling. Clinical, perioperative, and pathological data were prospectively recorded, and outcomes assessed included tumor response, surgical safety, cosmetic results, recurrence, disease-free survival, and patient satisfaction. Statistical analysis was performed using SPSS v26.0, with significance set at p<0.05. Results: Eighty post-NACT TNBC patients (mean age 44.4 years) were analyzed, with most presenting with Stage II, cT2 tumors, and nodal involvement. Following NACT, 21.3% achieved complete clinical response and 23.8% pathological complete response. Oncoplastic BCS (66.3%) showed superior cosmetic outcomes (87.5% vs. 51.9%, p=0.007) and no local recurrence compared to SBCS (14.8%, p=0.041), while complication rates, distant recurrence, and disease-free survival were comparable. Patient satisfaction favored OPBS, and overall, OPBS provided oncological safety with improved aesthetic outcomes. Conclusion: Oncoplastic breast-conserving surgery in TNBC patients post-NACT demonstrated excellent oncologic safety, superior cosmetic outcomes, and higher patient satisfaction compared to standard techniques. With no local recurrences and comparable survival outcomes, OPBS is a preferred surgical option for appropriately selected patients, supporting its integration into routine clinical practice.