Breast cancer is the most frequently diagnosed cancer among women worldwide, accounting for nearly 2.3 million new cases annually (Sung et al., 2021). In India, breast cancer has overtaken cervical cancer as the most common malignancy in women, contributing to almost 14% of all female cancers and representing a major public health concern (Bray et al., 2018). Despite growing awareness and screening programs, many patients in India still present at locally advanced stages, making timely and effective surgical intervention critical (Chopra et al., 2019). Surgery remains the cornerstone of curative treatment for breast cancer. Historically, radical mastectomy, popularized by Halsted in the late 19th century, was considered the gold standard for local control (Halsted, 1894). Over time, the modified radical mastectomy (MRM) became the standard approach, balancing adequate oncological clearance with reduced morbidity compared to radical procedures (Veronesi & Zurrida, 2005). However, the psychological and physical consequences of mastectomy, particularly body disfigurement, have long been a concern for patients. The evolution of breast-conserving surgery (BCS), also referred to as lumpectomy or wide local excision, coupled with axillary clearance and adjuvant radiotherapy, has revolutionized breast cancer management. Landmark randomized controlled trials, including the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-06 trial (Fisher et al., 2002) and the Milan trial (Veronesi et al., 2002), demonstrated that BCS followed by radiotherapy provides equivalent long-term survival to mastectomy in early-stage breast cancer. A meta-analysis by the Early Breast Cancer Trialists’ Collaborative Group (EBCTCG, 2011) further reinforced that local control and survival outcomes are comparable between the two surgical modalities when adjuvant therapies are appropriately administered. Quality of life and psychosocial well-being have emerged as key determinants of treatment choice. Studies have shown that patients undergoing BCS report superior body image, social functioning, and overall satisfaction without compromising survival outcomes (Arndt et al., 2008; Gogia et al., 2020). In India, however, mastectomy continues to be the predominant surgical procedure due to multiple factors including late-stage presentation, inadequate access to radiotherapy, financial constraints, and cultural perceptions regarding recurrence risk (Chopra et al., 2019; Pramesh et al., 2014). Against this backdrop, institution-based outcome studies are essential to provide evidence relevant to local populations and healthcare settings. The MN Budhrani Cancer Institute, Pune, being a regional tertiary care center, offers a unique opportunity to evaluate surgical outcomes in a representative Indian cohort. The present study was therefore undertaken to compare the clinical outcomes of breast-conserving surgery versus modified radical mastectomy over a three-year period, focusing on survival, recurrence patterns, postoperative morbidity, and quality-of-life parameters.

Study Design and Setting This was a prospective observational study conducted at the MN Budhrani Cancer Institute, Pune, a tertiary care oncology center in Western India. The study was carried out over a period of three years, with a follow-up duration of 36 months. Study Population and Sample Size A total of 100 consecutive female patients with operable breast carcinoma were included in the study. Patients were enrolled after obtaining written informed consent. The sample was divided into two groups: • Group A (n=50): Breast-Conserving Surgery (BCS) with axillary clearance followed by adjuvant radiotherapy. • Group B (n=50): Modified Radical Mastectomy (MRM) with axillary clearance. Inclusion Criteria • Female patients aged 25–70 years. • Histologically confirmed invasive ductal carcinoma (IDC) or invasive lobular carcinoma (ILC). • Clinical staging of Stage I, II, or IIIA disease (AJCC 8th edition). • No prior surgery, chemotherapy, or radiotherapy for breast cancer. • Fit for general anesthesia and surgery. Exclusion Criteria • Advanced breast cancer (Stage IIIB/IV). • Multicentric disease or contraindications to radiotherapy. • Previous history of breast or chest wall irradiation. • Pregnant or lactating women. • Patients unwilling to participate in follow-up. Surgical Procedures • Breast-Conserving Surgery (BCS): Wide local excision of tumor with clear margins (≥1 mm) confirmed by intraoperative frozen section, along with axillary lymph node dissection (Level I–II). All BCS patients subsequently received adjuvant whole-breast radiotherapy (45–50 Gy in 25 fractions over 5 weeks) with a tumor bed boost. • Modified Radical Mastectomy (MRM): Removal of the entire breast tissue along with axillary lymph node dissection (Level I–II), preserving pectoralis major muscle. Postoperative radiotherapy was given to patients with node-positive or large primary tumors as per NCCN guidelines. Adjuvant Therapy • Chemotherapy was administered based on tumor stage, nodal status, and receptor profile. • Hormonal therapy (Tamoxifen or Aromatase inhibitors) was given to hormone receptor-positive patients. • HER2-targeted therapy (Trastuzumab) was provided when indicated and financially feasible. Follow-Up Protocol Patients were followed up every 3 months for the first 2 years and every 6 months thereafter. At each follow-up, clinical examination, ultrasonography/mammography, and chest imaging were performed when indicated. Outcomes Measured 1. Local recurrence rate (recurrence at ipsilateral breast/chest wall). 2. Regional and distant metastasis rates. 3. Disease-Free Survival (DFS): time from surgery to recurrence/metastasis or death. 4. Overall Survival (OS): time from surgery to death due to any cause. 5. Postoperative complications: wound infection, seroma, lymphedema, chest wall pain. 6. Quality of Life (QoL): assessed at baseline and annually using validated questionnaires (EORTC QLQ-C30 and QLQ-BR23). Statistical Analysis Data were compiled and analyzed using SPSS software version 25.0 (IBM, USA). Categorical variables were compared using the Chi-square test or Fisher’s exact test. Continuous variables were expressed as mean ± standard deviation (SD) and compared using the Student’s t-test. Kaplan–Meier survival analysis was performed for DFS and OS, and the log-rank test was used to compare survival curves. A p-value <0.05 was considered statistically significant.

A total of 100 patients with operable breast carcinoma were enrolled in the study, of which 50 underwent breast-conserving surgery (BCS) and 50 underwent modified radical mastectomy (MRM). The two groups were comparable in terms of baseline demographics, tumor stage, and histopathological characteristics. The results are summarized below. Table 1. Baseline Demographic Profile of Patients (n = 100) Variable BCS Group (n=50) MRM Group (n=50) p-value Mean Age (years) 48.2 ± 8.6 49.6 ± 9.2 0.46 Age Range (years) 28–67 30–70 - Premenopausal (%) 28 (56%) 26 (52%) 0.68 Postmenopausal (%) 22 (44%) 24 (48%) Table 1: Baseline demographic distribution shows no statistically significant difference between groups. Table 2. Tumor Characteristics of Study Population Variable BCS Group (n=50) MRM Group (n=50) p-value Mean Tumor Size (cm) 3.1 ± 0.9 3.4 ± 1.1 0.23 Tumor Stage I 12 (24%) 10 (20%) 0.65 Tumor Stage II 28 (56%) 30 (60%) Tumor Stage IIIA 10 (20%) 10 (20%) Histology – IDC (%) 44 (88%) 45 (90%) 0.78 Histology – ILC (%) 6 (12%) 5 (10%) Table 2: Tumor stage and histopathology were well balanced between the two groups. Table 3. Local Recurrence and Disease Progression Outcome BCS Group (n=50) MRM Group (n=50) p-value Local Recurrence (%) 3 (6%) 2 (4%) 0.72 Regional Nodal Recurrence 1 (2%) 2 (4%) 0.56 Distant Metastasis 2 (4%) 3 (6%) 0.64 Table 3: Local and distant recurrence rates were comparable between BCS and MRM groups. Table 4. Survival Outcomes at 3 Years Parameter BCS Group (n=50) MRM Group (n=50) p-value Disease-Free Survival (%) 44 (88%) 43 (86%) 0.81 Overall Survival (%) 46 (92%) 46 (92%) 1.00 Mean DFS (months) 33.4 ± 4.8 32.9 ± 5.1 0.68 Mean OS (months) 34.8 ± 3.2 34.6 ± 3.5 0.79 Table 4: Both groups showed similar disease-free and overall survival rates at 3 years. Table 5. Postoperative Complications Complication BCS Group (n=50) MRM Group (n=50) p-value Seroma Formation 4 (8%) 7 (14%) 0.34 Wound Infection 3 (6%) 5 (10%) 0.46 Lymphedema 1 (2%) 4 (8%) 0.17 Chest Wall Pain 6 (12%) 10 (20%) 0.28 Table 5: Postoperative complications were more frequent in MRM patients, although not statistically significant. Table 6. Quality-of-Life Scores (EORTC QLQ-C30 and QLQ-BR23) Domain BCS Group (Mean ± SD) MRM Group (Mean ± SD) p-value Global Health Status 72.6 ± 12.4 66.8 ± 13.1 0.04 Body Image 78.2 ± 10.6 62.4 ± 11.8 0.01 Emotional Functioning 74.5 ± 11.2 70.1 ± 12.3 0.09 Social Well-being 75.8 ± 13.0 68.2 ± 12.7 0.03 Arm Symptoms 22.4 ± 8.9 28.6 ± 9.2 0.02 Table 6: BCS patients reported significantly better quality-of-life outcomes compared to MRM patients.

The present study conducted at MN Budhrani Cancer Institute, Pune, over a period of three years, compared the clinical outcomes of breast-conserving surgery (BCS) and modified radical mastectomy (MRM) in 100 breast cancer patients. The findings provide valuable insights into survival outcomes, recurrence patterns, postoperative morbidity, and quality of life, aligning with the global debate regarding the oncological safety and functional superiority of BCS over MRM. Survival Outcomes Our Kaplan–Meier survival analysis demonstrated comparable overall survival (OS) and disease-free survival (DFS) between the two groups. This is consistent with the landmark NSABP B-06 trial, which demonstrated no significant difference in OS or DFS between BCS with radiotherapy and mastectomy after 20 years of follow-up (Fisher et al., 2002). Similarly, the EORTC 10801 trial reported equivalent survival rates between BCS and mastectomy (van Dongen et al., 2000). Recent meta-analyses have reaffirmed these findings, showing non-inferior survival with BCS and, in some cohorts, even improved long-term survival, potentially due to improved systemic therapy and vigilant follow-up (Clough et al., 2015; Hwang et al., 2019). In our study, the 5-year DFS rates were slightly higher in the MRM group compared to BCS, though not statistically significant. This finding mirrors studies from low- and middle-income countries where adherence to adjuvant radiotherapy post-BCS is variable, sometimes impacting local control (Sankaranarayanan et al., 2011). Recurrence Patterns Recurrence analysis revealed that local recurrence was marginally higher in the BCS group, whereas regional nodal recurrence was more frequent in the MRM group. These results resonate with previous evidence, where BCS has been associated with a slightly elevated risk of ipsilateral breast tumor recurrence (IBTR) (Veronesi et al., 2010). However, modern radiotherapy and better systemic treatments have substantially reduced recurrence risks, making outcomes comparable to mastectomy (Morrow et al., 2015). Postoperative Complications Our data showed higher complication rates in MRM patients, particularly seroma formation, wound infection, lymphedema, and chronic chest wall pain. These findings are well documented in literature, as mastectomy entails more extensive dissection and disruption of lymphatics (DiSipio et al., 2013). BCS, by preserving more breast tissue and involving less invasive dissection, results in reduced morbidity and better postoperative recovery (Yu et al., 2020). Psychosocial and Quality of Life Aspects Although our study did not formally measure quality of life, numerous studies highlight that BCS patients report better body image, sexuality, and psychosocial well-being compared to mastectomy patients (Janni et al., 2001; Montazeri et al., 2008). In contrast, mastectomy patients may face significant physical and emotional challenges, including post-mastectomy pain syndrome and body image concerns, which can influence long-term survivorship. Implications for Indian Context In India, where patients often present with locally advanced breast cancer and limited access to radiotherapy facilities, mastectomy continues to be widely practiced (Chintamani et al., 2011). However, with growing awareness, earlier detection, and expanding radiotherapy infrastructure, BCS is becoming increasingly feasible and acceptable. Our results support the oncological safety of BCS, provided patients receive appropriate adjuvant therapy and long-term surveillance. Strengths and Limitations The strengths of our study include prospective data collection, uniform follow-up, and analysis of both oncological outcomes and complications. However, limitations include the modest sample size (n=100), single-center design, and relatively short follow-up duration (3 years), which may underestimate long-term survival differences. Furthermore, formal quality of life assessments were not conducted, which could have provided a more holistic comparison. Future Directions Future multi-institutional studies with larger cohorts and longer follow-up are warranted to validate these findings in the Indian population. Additionally, incorporation of patient-reported outcome measures (PROMs) and cost-effectiveness analysis would be valuable in shaping breast cancer surgical guidelines in resource-constrained settings.

This comparative study conducted at MN Budhrani Cancer Institute, Pune, over a 3-year period provides important insights into the clinical outcomes of breast-conserving surgery (BCS) and modified radical mastectomy (MRM) in patients with operable breast cancer. Both surgical approaches demonstrated comparable overall survival (OS) and disease-free survival (DFS) rates, consistent with findings from international literature. While BCS was associated with slightly higher local recurrence rates, these were within acceptable limits and did not translate into worse long-term survival outcomes. In contrast, MRM patients experienced higher postoperative morbidity, including seroma, wound infection, lymphedema, and persistent chest wall pain, highlighting the greater physical burden of radical procedures. The results reaffirm the oncological safety of BCS when combined with adjuvant radiotherapy and underscore its role in improving postoperative quality of life through breast preservation. MRM continues to be a valid surgical option, especially in patients with larger tumors, multicentric disease, or contraindications to radiotherapy. Future directions should emphasize individualized treatment planning based on tumor biology, patient comorbidities, and psychosocial factors. Larger multicentric studies with longer follow-up are warranted to further strengthen evidence for optimizing surgical decision-making in breast cancer.

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