Matrix rotation flap for upper inner quadrant breast tumors: an oncoplastic solution for a persistent surgical challenge

Abstract

AimBreast-conserving surgery (BCS) is the standard treatment for breast cancer; however, tumors located in the upper inner quadrant (UIQ) remain a persistent oncoplastic challenge. Limited glandular volume and the distance from the nipple–areola complex (NAC) increase the risk of contour deformity and unsatisfactory cosmetic outcomes. The matrix rotation flap, although widely used in reconstructive surgery, has rarely been applied for UIQ breast tumors.MethodsThis retrospective study included 15 female patients who underwent BCS with a matrix rotation dermoglandular flap for UIQ breast tumors between January and December 2025. Patient demographics, perioperative findings, surgical margin status, postoperative complications, and cosmetic results were analyzed. Cosmetic outcomes were evaluated at 3 months postoperatively using a patient-reported questionnaire.ResultsThe mean age of the patients was 53.2 years. All tumors were classified as T1 or T2. Negative surgical margins were achieved in all patients, and no intraoperative or postoperative re-excision was required. No secondary reconstructive procedures were needed, and no delays in adjuvant therapy occurred. Postoperative seroma developed in two patients (13.3%) and was managed conservatively. Cosmetic outcomes were rated as excellent in 53.3% of patients, good in 40%, fair in 6.6%, and poor in none.ConclusionThe matrix rotation flap appears to be a feasible oncoplastic option for selected patients with UIQ breast tumors, allowing wide excision with favorable short-term surgical and cosmetic outcomes without the need for NAC repositioning.

Keywords

Introduction

Breast cancer is the most diagnosed malignancy among women worldwide.¹ Survival rates in early-stage disease are high, and as life expectancy increases, aesthetic and quality-of-life outcomes have become increasingly important components of treatment planning.²
Since the endorsement of breast-conserving surgery (BCS) as a standard treatment option for early-stage breast cancer, it has been widely accepted as an alternative to radical mastectomy. Large, randomized trials have demonstrated that BCS provides overall survival rates comparable to those of mastectomy.^3-5 In addition to equivalent oncologic safety, breast-conserving approaches offer superior psychosocial outcomes by minimizing the negative effects of mastectomy on body image, self-esteem, and sexual well-being.⁶ The oncologic success of BCS relies on complete tumor excision with clear surgical margins followed by adjuvant radiotherapy.^7,8
The primary objective of breast-conserving surgery is to achieve complete tumor removal with adequate margins while preserving the natural shape and appearance of the breast. When the tumor is large relative to breast volume, adequate excision may result in significant contour deformity. Even in medium- to large-sized breasts, improper surgical planning can lead to noticeable asymmetry, volume loss, and distortion, sometimes prompting surgeons to recommend mastectomy instead.⁹ Furthermore, conventional BCS is associated with positive surgical margins in approximately 5–18% of cases, leading to high re-excision rates.^10,11 These additional surgeries increase morbidity, complication rates, and the risk of poor cosmetic outcomes.
Despite optimal oncologic resection, aesthetic results are not always satisfactory. Approximately 30–40% of patients undergoing BCS followed by adjuvant radiotherapy develop breast deformities related to surgical cavity collapse and radiation-induced tissue changes.¹² These problems are more pronounced in tumors located in the upper inner quadrant (UIQ) of the breast.¹³ In this region, the limited amount of glandular tissue available for local flap reconstruction increases the risk of volume deficiency and contour depression. Moreover, as the tumor is located farther from the areola, redistribution of tissue becomes more difficult, further worsening cosmetic outcomes.
The concept of “oncoplastic surgery” was introduced in the late 1990s to expand the indications for breast-conserving surgery and to improve aesthetic outcomes without compromising oncologic safety. By combining principles of oncologic resection with plastic and reconstructive techniques, oncoplastic surgery allows wider excisions while maintaining breast shape and symmetry.^14-18
Numerous oncoplastic techniques have been described to address tumors of the upper inner quadrant.^19-22 However, each technique has inherent limitations, and no single method has been universally accepted as ideal for this challenging location. Therefore, there remains a need for innovative and adaptable techniques that can overcome the shortcomings of existing approaches.
The matrix rotation technique, widely used in various fields of plastic and reconstructive surgery, was subsequently adapted to oncoplastic breast surgery for tumors of the upper and upper inner quadrants by Lin et al..^13,23,24 However, clinical experience with this technique in breast-conserving surgery remains limited. In this study, we aimed to present our experience with the matrix rotation dermoglandular flap technique in patients with upper inner quadrant tumors, particularly in small- to medium-sized breasts, in cases requiring wide excision and located far from the areola. We sought to evaluate its feasibility, short-term surgical outcomes, and cosmetic outcomes as an alternative oncoplastic solution for this technically challenging region.

Materials and Methods

Study DesignThis study was designed as a retrospective analysis. Patients who underwent surgery between January 2025 and December 2025 were included.Patient SelectionPatients aged 18 years and older with a diagnosis of breast cancer were included. All patients were evaluated by a multidisciplinary tumor board, and those considered suitable for breast-conserving surgery were enrolled. The diagnosis of breast cancer was established by tru-cut biopsy. Patients who received neoadjuvant therapy as well as those who did not were included.
Eligible tumors were located in the upper inner quadrant of the breast, at least 2 cm away from the areola, and classified as T1 or T2. Patients generally had small- to medium-sized breasts; however, patients with large and ptotic breasts who declined Wise-pattern oncoplastic surgery were also included.
Patients with metastatic disease, prior breast radiotherapy, recurrent breast cancer, connective tissue disorders, or multicentric tumors were excluded.Axillary ManagementPatients with clinical or radiological suspicion of axillary lymph node metastasis underwent preoperative ultrasound-guided fine-needle aspiration biopsy. Patients without evidence of axillary metastasis underwent sentinel lymph node biopsy (SLNB). Axillary lymph node dissection was performed in patients with proven metastatic lymph nodes.
In patients with axillary lymph node metastasis before neoadjuvant therapy, the metastatic node was clipped, and targeted axillary dissection was performed. The primary breast lesion was also clipped prior to neoadjuvant treatment.Preoperative Assessment and ConsentAll patients underwent preoperative physical examination, medical history assessment, mammography, and ultrasonography. The oncoplastic technique to be applied was determined by the breast surgeon and approved by the multidisciplinary tumor board.
The planned oncoplastic procedure was explained to all patients in the outpatient setting, and written informed consent was obtained. All patients underwent preoperative anesthesia consultation. Standardized preoperative photographs were taken.Surgical TechniqueAll operations were performed by one experienced breast surgeon. On the morning of surgery, preoperative markings were made in the standing position. Anatomical landmarks—including the inframammary fold, sternum, jugulum, and a meridian line drawn between the midclavicular line and the areola—were identified.
Using a ruler, an equilateral triangle with its apex pointing downward was drawn around the tumor to obtain safe surgical margins of approximately 1 cm. A second equilateral triangle, smaller than the first and with its base oriented inferiorly, was drawn so that its lateral border was aligned with the planned axillary incision. The bases of the two triangles were connected.
Surgery was performed in the supine position with the ipsilateral arm abducted at 90 degrees under general anesthesia. In patients scheduled for SLNB, isosulfan blue dye was injected, and after 15 minutes the operation was started through the axillary incision.
The lesion was excised down to the pectoral fascia. Surgical margins were marked with silk sutures, and the specimen was sent for frozen-section analysis. The base of the cavity was marked with metallic clips.
The glandular flap was sutured to the contralateral gland using 2/0 Vicryl sutures, after which the subcutaneous tissue and skin were closed, completing the procedure (Figure 1-5).
No drains were placed in patients who did not undergo axillary dissection. Patients with drains were discharged with the drain in situ, and drains were removed in the outpatient clinic when the daily output fell below 30 cc.OutcomesThe primary study endpoints included:
• Surgical margin outcomes: re-excision rate and surgical margin status
• Surgical outcomes: postoperative complications and length of hospital stay
• Cosmetic outcomes: patient satisfaction and need for revision or reconstructive surgery
For each patient, operative time, margin status, and postoperative complications—including wound infection, wound dehiscence, hematoma, seroma, nipple–areola complex (NAC) changes, skin slough or necrosis, and alterations in NAC sensation—were recorded.
Cosmetic outcomes were evaluated at 3 months postoperatively using the questionnaire described by Chan et al., and results were documented.²⁵Ethical ApprovalThis study was approved by the Ethics Committee of University of Health Sciences Van Training and Research Hospital (Date: 06.02.2026, Decision No: GOKAEK/2026-02/12).Statistical AnalysisStatistical analyses were performed using SPSS statistical software version 19 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize the study data. Continuous variables were presented as mean ± standard deviation (SD), whereas categorical variables were presented as frequencies and percentages [n (%)]. Given the descriptive nature of the study and the small sample size, no inferential statistical analyses were performed.Reporting GuidelinesThis study was reported in accordance with the STROBE guideline.

Results

A total of 15 female patients were included in the study. The mean age of the patients was 53.2 years. All tumors were classified as T1 or T2 lesions. Comorbid conditions were present in 10 patients (66.6%). The general demographic and tumor characteristics of the study population are summarized in Table 1. The median postoperative follow-up duration was 10 months.
In all cases, negative surgical margins were achieved and confirmed by intraoperative frozen section analysis; therefore, no intraoperative or postoperative re-excision was required. None of the patients required secondary reconstructive procedures due to cosmetic concerns. No delays in the initiation of adjuvant therapy were observed because of postoperative complications.
Postoperative seroma developed in two patients; both were managed successfully with outpatient aspiration alone, without the need for additional interventions. Operative findings are detailed in Table 2.
Cosmetic outcomes were assessed using a patient-reported questionnaire at the third postoperative month. None of the patients rated their cosmetic outcome as poor. A summary of the cosmetic assessment results is presented in Table 3.

Discussion

The upper inner quadrant (UIQ) of the breast has been described by Grisotti as a “no man’s land” due to the high risk of deformity and patient dissatisfaction following wide excisions in this region.²⁶ Achieving both oncologic safety and satisfactory cosmetic outcomes remains particularly challenging in the UIQ, primarily because of the limited volume of glandular tissue available for reconstruction.
When wide excision is required—especially in larger tumors—volume replacement in the UIQ becomes difficult, and a variety of oncoplastic techniques have been described to address this problem.^19-22 In cases where the tumor is located close to the areola, techniques such as vertical mammoplasty, batwing mammoplasty, or the Grisotti flap may be appropriate. However, in tumors located far from the nipple–areola complex (NAC), particularly in small- to medium-sized breasts, the applicability of these techniques is limited.
The particular advantage of the matrix rotation flap in the UIQ derives from its ability to recruit dermoglandular tissue from the lateral breast and rotate it medially into a region where local glandular volume is inherently limited. This is especially relevant for tumors located far from the NAC, where conventional mammoplasty-based techniques relying on periareolar tissue redistribution may be less suitable. By combining wide tumor excision with medial advancement of well-vascularized dermoglandular tissue, the technique allows restoration of the UIQ contour without requiring NAC repositioning or additional periareolar incisions.
Myofascial advancement flaps have also been described for filling UIQ defects; however, compared with tumors located in the outer quadrants, their feasibility in the UIQ is lower.²⁷ In addition, dermoglandular flaps are generally less invasive and associated with shorter operative times, making them an attractive option in appropriate patients.
In situations requiring very wide resections, skin-sparing or nipple-sparing mastectomy followed by implant-based reconstruction may be considered. However, given the long life expectancy of breast cancer patients, implant exchange may be required in the future. Moreover, postoperative radiotherapy increases the risk of capsular contracture, and implant-related complications may delay the initiation of adjuvant therapy.^28,29
The matrix rotation technique has long-standing roots in plastic and reconstructive surgery and was subsequently adapted to oncoplastic breast surgery for upper and upper inner quadrant tumors by Lin et al..^13,23,24 Nevertheless, clinical data regarding its use in breast-conserving surgery remain limited. In the present study, our findings support the feasibility of this technique as an oncoplastic option for selected patients with UIQ breast tumors.
One of the major advantages of the matrix rotation flap compared with many previously described oncoplastic techniques is that it does not require repositioning of the NAC. As a result, additional periareolar de-epithelialization is unnecessary, reducing surgical complexity and preserving NAC anatomy.^30,31
In our series, negative surgical margins were achieved in all patients and confirmed by intraoperative frozen-section analysis, with no need for intraoperative or postoperative re-excision. In addition, no delays in adjuvant therapy were observed due to postoperative complications. These findings demonstrate favorable short-term surgical and margin outcomes; however, the limited follow-up duration precludes conclusions regarding long-term oncologic outcomes.
The technique was also feasible in patients who had received neoadjuvant therapy. Because the technique allows for wide excision, additional wire localization is not required in non-palpable tumors after neoadjuvant therapy.
Current guidelines suggest that axillary staging may be omitted in selected patient groups.^32,33We believe that the matrix rotation flap is particularly suitable for patients in whom sentinel lymph node biopsy (SLNB) or axillary dissection is not initially planned, as well as for ductal carcinoma in situ (DCIS) cases requiring wide excision. The absence of a periareolar incision preserves the option for future SLNB if required, and any subsequent axillary intervention can be performed through the existing axillary incision.
Furthermore, in patients undergoing SLNB in whom a decision for axillary dissection is made intraoperatively, this technique offers an additional advantage. Unlike other techniques that require enlargement of the separate axillary incision, the matrix rotation flap provides sufficient axillary exposure, eliminating the need for additional incision extension.
In our series, axillary drains were used only in patients undergoing axillary dissection, while no drains were placed in patients without axillary surgery.
Although the incision length in this technique is longer compared with some other oncoplastic methods, previous studies by Al-Ghazal and Blamey have demonstrated no significant association between scar length and patient satisfaction³⁴
Our cosmetic outcomes are consistent with these findings. At three months postoperatively, none of the patients rated their cosmetic outcome as poor, and more than 90% reported excellent or good results, indicating favorable early patient-reported cosmetic outcomes in this series.
In patients with large and ptotic breasts, wise-pattern mammoplasty remains an appropriate option for UIQ tumors.²² However, in patients who declined wise-pattern surgery, we offered the matrix rotation flap as an alternative. In this subgroup, postoperative breast symmetry was also satisfactory, further supporting the versatility of this technique.

Limitations

This study has several limitations. Its retrospective, single-center, single-surgeon design and small sample size limit the generalizability of the findings and preclude robust comparative analyses. The absence of a control group undergoing alternative oncoplastic techniques further prevents direct comparison of surgical and cosmetic outcomes. In addition, the relatively short postoperative follow-up, with a median duration of 10 months, does not allow assessment of long-term oncologic outcomes. Cosmetic outcomes were assessed only three months after surgery and were based solely on patient-reported evaluation, without independent clinician assessment or objective photographic analysis. Therefore, these findings should be interpreted as preliminary evidence regarding the feasibility and short-term surgical and cosmetic outcomes of the technique. Larger comparative studies with longer oncologic and cosmetic follow-up are needed to further evaluate the role of the matrix rotation flap in UIQ breast tumors.

Conclusion

The upper inner quadrant represents a technically demanding area for breast-conserving surgery. In this series, the matrix rotation dermoglandular flap allowed wide excision with negative margins, a low rate of short-term complications, and favorable patient-reported cosmetic outcomes. Preservation of the NAC position and compatibility with axillary procedures may represent practical advantages of the technique. Although these findings support its feasibility as an oncoplastic option for selected patients with UIQ breast tumors, larger comparative studies with longer follow-up are required to evaluate long-term oncologic and cosmetic outcomes.

Declarations

References

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.3322/caac.21660
   Article · PubMed · Google Scholar
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7-34. doi:10.3322/caac.21551
   Article · PubMed · Google Scholar
3. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-1232. doi:10.1056/nejmoa020989
   Article · PubMed · Google Scholar
4. Veronesi U, Banfi A, Saccozzi R, et al. Conservative treatment of breast cancer: a trial in progress at the Cancer Institute of Milan. Cancer. 1977;39(suppl 6):2822-2826. doi:10.1002/1097-0142(197706)39:63.0.co;2-#
   Article · PubMed · Google Scholar
5. Veronesi U, Saccozzi R, Del Vecchio M, et al. Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast. N Engl J Med. 1981;305(1):6-11. doi:10.1056/nejm198107023050102
   Article · PubMed · Google Scholar
6. Schover LR, Yetman RJ, Tuason LJ, et al. Partial mastectomy and breast reconstruction: a comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer. 1995;75(1):54-64. doi:10.1002/1097-0142(19950101)75:13.0.co;2-i
   Article · PubMed · Google Scholar
7. Fisher B, Anderson S. Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials. National Surgical Adjuvant Breast and Bowel Project. World J Surg. 1994;18(1):63-69. doi:10.1007/bf00348193
   Article · PubMed · Google Scholar
8. Veronesi U, Zucali R, Luini A. Local control and survival in early breast cancer: the Milan trial. Int J Radiat Oncol Biol Phys. 1986;12(5):717-720. doi:10.1016/0360-3016(86)90027-1
   Article · PubMed · Google Scholar
9. Kaur N, Petit JY, Rietjens M, et al. Comparative study of surgical margins in oncoplastic surgery and quadrantectomy in breast cancer. Ann Surg Oncol. 2005;12(7):539-545. doi:10.1245/aso.2005.12.046
   Article · PubMed · Google Scholar
10. Clough KB, Lewis JS, Couturaud B, Fitoussi A, Nos C, Falcou MC. Oncoplastic techniques allow extensive resections for breast-conserving therapy of breast carcinomas. Ann Surg. 2003;237(1):26-34. doi:10.1097/00000658-200301000-00005
    Article · PubMed · Google Scholar
11. Clough KB, Cuminet J, Fitoussi A, Nos C, Mosseri V. Cosmetic sequelae after conservative treatment for breast cancer: classification and results of surgical correction. Ann Plast Surg. 1998;41(5):471-481. doi:10.1097/00000637-199811000-00004
    Article · PubMed · Google Scholar
12. Patterson MP, Pezner RD, Hill LR, Vora NL, Desai KR, Lipsett JA. Patient self-evaluation of cosmetic outcome of breast-preserving cancer treatment. Int J Radiat Oncol Biol Phys. 1985;11(10):1849-1852. doi:10.1016/0360-3016(85)90044-6
    Article · PubMed · Google Scholar
13. Lin J, Chen DR, Wang YF, Yuan Z, Chen Y, Chen Z. Oncoplastic surgery for upper/upper inner quadrant breast cancer. PLoS One. 2016;11(12):e0168434. doi:10.1371/journal.pone.0168434
    Article · PubMed · Google Scholar
14. Gabka CJ, Maiwald G, Baumeister RG. Erweiterung des Indikationsspektrums für die brusterhaltende Therapie des Mammakarzinoms durch onkoplastische Operationen [Expanding the indications spectrum for breast saving therapy of breast carcinoma by oncoplastic operations]. Langenbecks Arch Chir Suppl Kongressbd. 1997;114:1224-1227. doi:10.1007/978-3-642-60881-0_309
    Article · PubMed · Google Scholar
15. Kaviani A, Sodagari N, Sheikhbahaei S, et al. From radical mastectomy to breast-conserving therapy and oncoplastic breast surgery: a narrative review comparing oncological result, cosmetic outcome, quality of life, and health economy. ISRN Oncol. 2013;2013:742462. doi:10.1155/2013/742462
    Article · PubMed · Google Scholar
16. Fitoussi AD, Berry MG, Famà F, et al. Oncoplastic breast surgery for cancer: analysis of 540 consecutive cases. Plast Reconstr Surg. 2010;125(2):454-462. doi:10.1097/prs.0b013e3181c82d3e
    Article · PubMed · Google Scholar
17. Haloua MH, Krekel NM, Winters HA, et al. A systematic review of oncoplastic breast-conserving surgery: current weaknesses and future prospects. Ann Surg. 2013;257(4):609-620. doi:10.1097/sla.0b013e3182888782
    Article · PubMed · Google Scholar
18. van Paridon MW, Kamali P, Paul MA, et al. Oncoplastic breast surgery: achieving oncological and aesthetic outcomes. J Surg Oncol. 2017;116(2):195-202. doi:10.1002/jso.24634
    Article · PubMed · Google Scholar
19. Holmes DR, Schooler W, Smith R. Oncoplastic approaches to breast conservation. Int J Breast Cancer. 2011;2011:303879. doi:10.4061/2011/303879
    Article · PubMed · Google Scholar
20. Bordoni D, Cadenelli P, Rocco N, et al. Oncoplastic resection of breast cancers located in the upper-inner quadrants: a safe and effective surgical technique. Eur J Plast Surg. 2018;41(2):157-164.
    PubMed · Google Scholar
21. Zhu X, Egro FM, De La Cruz C. The “Wiser” oncoplastic reduction mammaplasty—an approach to challenging medial defects. Breast J. 2018;24(6):1051-1054. doi:10.1111/tbj.13124
    Article · PubMed · Google Scholar
22. Cutress R, Simoes T, Gill J, et al. Modification of the Wise pattern breast reduction for oncological mammaplasty of upper outer and upper inner quadrant breast tumours: a technical note and case series. J Plast Reconstr Aesthet Surg. 2013;66(1):e31-e36. doi:10.1016/j.bjps.2012.09.003
    Article · PubMed · Google Scholar
23. Bosniak SL, McDevitt TF. Cosmetic blepharoplasty. Curr Opin Ophthalmol. 1991;2(5):601-606. doi:10.1097/00055735-199110000-00013
    Article · PubMed · Google Scholar
24. Zitelli JA. Burow's grafts. J Am Acad Dermatol. 1987;17(2 pt 1):271-279.
    PubMed · Google Scholar
25. Chan SW, Cheung PS, Lam SH. Cosmetic outcome and percentage of breast volume excision in oncoplastic breast conserving surgery. World J Surg. 2010;34(7):1447-1452. doi:10.1007/s00268-009-0278-x
    Article · PubMed · Google Scholar
26. Grisotti A. Conservative treatment of breast cancer: reconstructive problems. In: Spear S, ed. Surgery of the Breast. Lippincott Williams & Wilkins; 2006:115-125.
    PubMed · Google Scholar
27. Hu JJ, Qin C, Liu S, et al. Oncoplastic breast-conserving surgery for upper inner quadrant breast cancer using pedicled pectoralis major myofascial flap. Cancer Manag Res. 2024;16:1747-1752. doi:10.2147/cmar.s472263
    Article · PubMed · Google Scholar
28. Ogita M, Sawayanagi S, Jinnouchi H, et al. Postmastectomy radiation therapy for implant-based breast reconstruction: a systematic review and meta-analysis for the 2022 Japanese Breast Cancer Society Clinical Practice Guideline. Breast Cancer. 2025;32(6):1169-1179. doi:10.1007/s12282-025-01788-2
    Article · PubMed · Google Scholar
29. Ren Y, Yu Y, Xu K, Li Z, Wang X. Meta-analysis of immediate implant-based breast reconstruction versus autologous breast reconstruction in the setting of PMRT. Aesthetic Plast Surg. 2024;48(10):1940-1948. doi:10.1007/s00266-023-03430-y
    Article · PubMed · Google Scholar
30. Staub G, Fitoussi A, Falcou MC, Salmon RJ. Résultats carcinologiques et esthétiques du traitement du cancer du sein par plastie mammaire. 298 cas [Breast cancer surgery: use of mammaplasty. Results. Series of 298 cases]. Ann Chir Plast Esthet. 2008;53(2):124-134. doi:10.1016/j.anplas.2007.05.012
    Article · PubMed · Google Scholar
31. Berrino P, Campora E, Santi P. Postquadrantectomy breast deformities: classification and techniques of surgical correction. Plast Reconstr Surg. 1987;79(4):567-572. doi:10.1097/00006534-198704000-00010
    Article · PubMed · Google Scholar
32. Gentilini OD, Botteri E, Sangalli C, et al. Sentinel lymph node biopsy vs no axillary surgery in patients with small breast cancer and negative results on ultrasonography of axillary lymph nodes: the SOUND randomized clinical trial. JAMA Oncol. 2023;9(11):1557-1564. doi:10.1001/jamaoncol.2023.3759
    Article · PubMed · Google Scholar
33. Reimer T, Stachs A, Veselinovic K, et al. Axillary surgery in breast cancer—primary results of the INSEMA trial. N Engl J Med. 2025;392(11):1051-1064. doi:10.1056/nejmoa2412063
    Article · PubMed · Google Scholar
34. Al-Ghazal SK, Blamey RW. Cosmetic assessment of breast-conserving surgery for primary breast cancer. Breast. 1999;8(4):162-168. doi:10.1054/brst.1999.0017
    Article · PubMed · Google Scholar

Additional Information

Publisher’s Note
Bayrakol MP remains neutral with regard to jurisdictional and institutional claims.

Rights and Permissions

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0). To view a copy of the license, visit https://creativecommons.org/licenses/by-nc/4.0/

View full license details →