Abstract
INTRODUCTION: Breast-conserving oncoplastic surgery (BCOS), in association with radiotherapy, is the state of the art in the surgical treatment of breast cancer. In this study, we aimed to systematize and validate a novel, four-level complexity classification system for BCOS and associate it with surgical morbidity. METHODS: We conducted a retrospective, observational study of consecutive female patients who underwent breast-conserving surgery between August 2022 and January 2024 at our breast center. Descriptive statistics were used to summarize the main sample characteristics. The primary outcome was surgical morbidity associated with the novel four-level complexity classification category of surgery performed, computed through a logistic regression model. RESULTS: Overall, 304 patients underwent the procedures of interest in this study. Surgery complexity levels 1, 2, 3, and 4 were performed in 28, 121, 114, and 41 patients, respectively. A total of 95 patients had complications, including infection, seroma, hematoma, dehiscence, or other complications. A total of 28 patients required re-interventions after definitive diagnosis. The odds of complications increased according to the surgery complexity level, independently of risk factors for complications and factors linked to the surgery type selection, even when considering only clinically relevant complications. CONCLUSIONS: We concluded that there is an association between morbidity and the complexity level of the surgery performed, with the most complex techniques being associated with higher rates of overall complications and the need for re-intervention, validating the need for a new stratification system for surgeries to improve patients' quality of life.