极端肿瘤成形术是一种使用肿瘤整形技术对不符合传统保乳标准的患者进行的保乳手术，大多数医生会建议患者进行乳房切除术。这些肿瘤通常是多中心和/或多灶性的，跨度超过 50 毫米，或者可能是先前接受过照射的乳房中的大复发。从 2008 年到 2023 年中期，对一个前瞻性单一机构数据库进行了查询，以查找符合极端肿瘤成形术标准的患者并接受切除加全乳放疗 (WBRT) 或乳房切除术但不进行 WBRT 治疗。复发性乳腺癌患者被排除在外。终点包括局部、区域和远处复发以及总体生存率和乳腺癌特异性生存率。272 名患者接受了肿瘤整形乳房成形术，采用标准或劈裂切除术，然后进行术后全脑放疗 (WBRT)。另外 101 名患者选择接受乳房切除术而不进行术后放射治疗。中位随访时间为 7 年，局部、区域或远处复发，以及乳腺癌特异性生存或总体生存没有显着差异。我们强烈支持极端肿瘤成形术加 WBRT 作为默认手术选择患有大的多病灶/多中心病变的患者适合通过体积移位乳房成形术进行重建。© 2024。作者。

Extreme oncoplasty is a breast-conserving operation using oncoplastic techniques in a patient who does not meet the traditional criteria for breast conservation and in whom most physicians would suggest a mastectomy. These tumors are generally multicentric and/or multifocal, they span more than 50 mm, or they can be large recurrences in a previously irradiated breast.A prospective single institution database was queried from 2008 through mid 2023 for patients who met the criteria for extreme oncoplasty and were treated with excision plus whole-breast radiation therapy (WBRT) or mastectomy without WBRT. Patients with recurrent breast cancer were excluded. Endpoints were local, regional, and distant recurrence as well as overall and breast-cancer-specific survival.272 patients were treated with oncoplastic mammaplasty, using a standard or split reduction excision followed by postoperative WBRT. An additional 101 patients elected to be treated with mastectomy without postoperative radiation therapy. With a median follow-up of 7 years, there were no significant differences in local, regional, or distant recurrence, nor in breast-cancer-specific survival or overall survival.We strongly support extreme oncoplasty plus WBRT as the default procedure of choice for patients with large multifocal/multicentric lesions amenable to reconstruction with volume displacement mammaplasty.© 2024. The Author(s).