Surgical Approaches for Breast Cancer in Inner Quadrants (No Man’s Land): A Single-Center Analysis

Abstract Background: Tumors in the upper-inner and lower-inner quadrants of the breast are highly challenging anatomically for the planning of oncoplastic breast-conserving surgery. They are therefore frequently referred to as “no man’s land.” This study retrospectively evaluated the efficacy, safety, and selection criteria of various oncoplastic surgical techniques applied to tumors in these regions. We aimed to determine the optimal oncoplastic breast-conserving surgical technique for tumors located in the upper inner quadrant of the breast. Methods: The demographic, clinical, and surgical data of 102 patients who underwent level 1 or 2 oncoplastic surgery for breast cancer localized in the upper or lower inner quadrants between December 2022 and July 2024 were retrospectively reviewed. The surgical techniques used (n = 10) were analyzed in terms of tumor–areola distance, tumor size, specimen volume and weight, surgical margin positivity, complication rates, and the need for reexcision. Results: The mean patient age was 54.44 ± 10.88 years. The most commonly performed surgical technique was conventional mastoplasty (35.3%; n = 36), followed by donut or round block mastoplasty (21.6%; n = 22). Multivariate analysis revealed that the tumor–areola distance was the most significant independent factor influencing surgical technique selection (p < 0.001). Although specimen volume and weight varied significantly among the surgical techniques (p < 0.001), no significant differences were observed in tumor size (p = 0.993), closest surgical margin (p = 0.198), or rate of positive surgical margins (p = 0.83). Reoperation was performed on eight patients (7.8%) because of positive surgical margins. Conclusion: The results demonstrated that tumor location and tumor–areola distance appear to play a more decisive role in surgical planning than tumor size does. Thus, a patient-tailored oncoplastic breast surgery strategy is both safe and effective for tumors located in this region.