Oncologic and Functional Outcomes of Breast-Conserving Surgery Versus Modified Radical
Mastectomy: A Comparative Study in Locally Advanced Breast Cancer
Submission: 21 August 2025 | Acceptance: 26 September 2025 | Publication: 24 November 2025
1Dr Javaid Iqbal, 2Waqar Manzoor, 3Dr Kaleem Akhtar, 4Khawar Qayyum, 5Sobia Wajid,
6Abbas Ali
1
Prof of Surgery, Continental Medical college Lahore.
2
Mayo Hospital Lahore
3
Karachi Institute of Medical Sciences Karachi
4
PIMS Islamabad
5
PIMS
6
RIC Rawalpindi
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
middleincome 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 fewercomplications, 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.