{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T09:23:02Z","timestamp":1787304182034,"version":"build-2736575974"},"reference-count":42,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Multicentric breast cancer\u2014two or more biopsy-proven tumor foci in anatomically distinct regions of the same breast\u2014has historically been treated as a near-automatic indication for mastectomy, reflecting concerns about occult residual disease, achievability of negative margins at every focus, and unacceptable cosmetic outcome. This narrative review synthesizes the evidence underlying that historical position and the more recent data that have begun to qualify it. The single-arm ACOSOG Z11102 (Alliance) trial reported a 5-year local recurrence rate of 3.1% after breast-conserving therapy for two to three ipsilateral foci and recent retrospective cohorts report comparable to local control. These findings sit alongside a persistent and unresolved tension around preoperative MRI, which improves detection of additional foci but has not demonstrated improvement in local control or survival outcomes in randomized trials, despite increasing mastectomy conversion. We review the definitions and biology of multifocal and multicentric disease, the maturing role of oncoplastic technique, margin and radiotherapy planning considerations specific to multicentric resection, the evolving use of neoadjuvant systemic therapy, hereditary cancer considerations, and the current guideline landscape (ASBrS, NCCN, ESMO, AGO). We propose a practical, multidisciplinary framework for patient selection and identify the principal gaps\u2014absence of randomized comparison with mastectomy, unresolved necessity of routine MRI, and limited data on breast conservation after neoadjuvant therapy specifically in multicentric disease\u2014that should guide both clinical decision-making and future research.<\/jats:p>","DOI":"10.3390\/cancers18162705","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:14:01Z","timestamp":1787300041000},"page":"2705","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Breast-Conserving Surgery in Multicentric Breast Cancer: Evolving Evidence and Patient Selection"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9708-6482","authenticated-orcid":false,"given":"Mariam","family":"Rizk","sequence":"first","affiliation":[{"name":"The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kefah","family":"Mokbel","sequence":"additional","affiliation":[{"name":"The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK"},{"name":"Burjeel Cancer Institute, Burjeel Medical City, Abu Dhabi P.O. Box 92510, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Witzel, I. (2026). Breast-conserving surgery in multicentric breast cancer: Progress, pitfalls, and risks. Breast Care.","DOI":"10.1159\/000552608"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3184","DOI":"10.1200\/JCO.22.02553","article-title":"Local recurrence after breast-conserving therapy in patients with multiple ipsilateral breast cancer: Results from ACOSOG Z11102 (Alliance)","volume":"41","author":"Boughey","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41073-019-0064-8","article-title":"SANRA\u2014A scale for the quality assessment of narrative review articles","volume":"4","author":"Baethge","year":"2019","journal-title":"Res. Integr. 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