{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T03:50:51Z","timestamp":1773373851306,"version":"3.50.1"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T00:00:00Z","timestamp":1752969600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T00:00:00Z","timestamp":1752969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006752","name":"Universidade do Porto","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006752","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Surg Oncol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>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\u2019 quality of life.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1245\/s10434-025-17838-0","type":"journal-article","created":{"date-parts":[[2025,7,20]],"date-time":"2025-07-20T16:29:12Z","timestamp":1753028952000},"page":"8769-8779","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Breast-Conserving Oncoplastic Surgery Stratification: Morbidity Retrospective Analysis and its Association with Procedure Complexity Level"],"prefix":"10.1245","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9858-6522","authenticated-orcid":false,"given":"In\u00eas","family":"de Cardoso Dias","sequence":"first","affiliation":[]},{"given":"Henrique Ferreira","family":"Mora","sequence":"additional","affiliation":[]},{"given":"B\u00e1rbara","family":"Peleteiro","sequence":"additional","affiliation":[]},{"given":"Jos\u00e9 Lu\u00eds","family":"Fougo","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,7,20]]},"reference":[{"key":"17838_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.breast.2022.08.010","volume":"66","author":"M Arnold","year":"2022","unstructured":"Arnold M, Morgan E, Rumgay H, et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast. 2022;66:15\u201323.","journal-title":"Breast"},{"issue":"4","key":"17838_CR2","doi-asserted-by":"publisher","first-page":"5748","DOI":"10.18632\/aging.202502","volume":"13","author":"J Huang","year":"2021","unstructured":"Huang J, Chan PS, Lok V, et al. Global incidence and mortality of breast cancer: a trend analysis. Aging (Albany NY). 2021;13(4):5748\u2013803.","journal-title":"Aging (Albany NY)"},{"key":"17838_CR3","doi-asserted-by":"publisher","first-page":"9605439","DOI":"10.1155\/2022\/9605439","volume":"2022","author":"D Kashyap","year":"2022","unstructured":"Kashyap D, Pal D, Sharma R, et al. Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures. Biomed Res Int. 2022;2022:9605439.","journal-title":"Biomed Res Int"},{"key":"17838_CR4","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.622621","volume":"11","author":"S Keelan","year":"2021","unstructured":"Keelan S, Flanagan M, Hill ADK. Evolving Trends in Surgical Management of Breast Cancer: An Analysis of 30 Years of Practice Changing Papers. Front Oncol. 2021;11:622621.","journal-title":"Front Oncol"},{"issue":"1","key":"17838_CR5","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1080\/028418601750070984","volume":"40","author":"GH Sakorafas","year":"2001","unstructured":"Sakorafas GH. Breast cancer surgery\u2013historical evolution, current status and future perspectives. Acta Oncol. 2001;40(1):5\u201318.","journal-title":"Acta Oncol"},{"issue":"2","key":"17838_CR6","doi-asserted-by":"publisher","first-page":"65","DOI":"10.3121\/cmr.2014.1245","volume":"13","author":"AA Onitilo","year":"2015","unstructured":"Onitilo AA, Engel JM, Stankowski RV, et al. Survival Comparisons for Breast Conserving Surgery and Mastectomy Revisited: Community Experience and the Role of Radiation Therapy. Clin Med Res. 2015;13(2):65\u201373.","journal-title":"Clin Med Res"},{"issue":"24","key":"17838_CR7","doi-asserted-by":"publisher","first-page":"4970","DOI":"10.3390\/ijerph16244970","volume":"16","author":"ET Ng","year":"2019","unstructured":"Ng ET, Ang RZ, Tran BX, et al. Comparing Quality of Life in Breast Cancer Patients Who Underwent Mastectomy Versus Breast-Conserving Surgery: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(24):4970.","journal-title":"Int J Environ Res Public Health"},{"key":"17838_CR8","doi-asserted-by":"crossref","unstructured":"Thompson PW, Chatterjee A, Losken A. Standards in oncoplastic breast-conserving surgery. 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