# A Single-Center Prospective Evaluation of Oncoplastic Crescent Incision in the Surgical Management of Large and Multiple Benign Breast Lesions

## TL;DR

This study shows that the oncoplastic crescent incision improves cosmetic results and access for removing large or multiple benign breast lesions compared to traditional methods.

## Contribution

The study introduces the oncoplastic crescent incision as a novel surgical technique for better cosmetic and functional outcomes in benign breast surgery.

## Key findings

- The crescent incision provided better access to peripheral lesions and was more frequently used for lesions >5 cm.
- Cosmetic outcomes were superior in the crescent group based on scar quality and symmetry measurements.
- Nipple sensation was preserved in all patients using the crescent incision with comparable patient-reported quality of life.

## Abstract

Background

Benign breast diseases constitute a significant proportion of breast pathologies, often requiring surgical excision. Excision of large or multiple lesions by conventional approaches may compromise cosmetic outcomes, especially for peripheral lesions. Oncoplastic techniques offer a way to achieve complete excision while preserving breast aesthetics. This study aimed to evaluate the efficacy, safety, cosmetic outcomes, and patient satisfaction associated with the oncoplastic crescent incision technique for the excision of large and/or multiple benign breast lesions compared to the conventional periareolar approach.

Methodology

A prospective, comparative cohort study was conducted in a single tertiary care center, from April 2022 to August 2023, on 74 histologically confirmed large (>3 cm) and/or multiple benign breast lesions. Breast lesions were excised by crescent oncoplasty incision (Group A) or periareolar incision (Group B). Surgical outcomes, postoperative complications, scar quality, breast symmetry, patient satisfaction, and patient-reported outcomes were assessed using objective measurements such as the Vancouver Scar Scale, sonographic scar thickness, and the BREAST-Q questionnaire with a follow-up of three months.

Results

The crescent incision provided better access for peripheral lesions (mean lesion-to-nipple-areolar complex (NAC) distance: 3.20 ± 0.71 cm vs. 2.37 ± 0.82 cm, p < 0.001) and was more frequently used for lesions >5 cm (33% vs. 9%, p = 0.0051). Postoperative breast symmetry was significantly better in the crescent group based on sternal notch-to-nipple and midline-to-nipple measurements (p < 0.01). Cosmetic outcomes were superior in the crescent group based on the Vancouver Scar Scale (4.24 ± 1.93 vs. 6.62 ± 1.72, p < 0.001) and sonographic scar thickness (p = 0.02). Nipple sensation was preserved in all Group A patients. BREAST-Q scores for satisfaction, psychosocial, sexual, and physical well-being were comparable between groups throughout follow-up.

Conclusions

The oncoplastic crescent incision is a safe and effective alternative to the conventional periareolar approach for excising large or multiple benign breast lesions. It provides superior cosmetic outcomes, better lesion access, and comparable patient-reported quality of life, supporting its broader adoption in benign breast surgery.