BackgroundNeoadjuvant chemotherapy (NAC) increases breast‐conserving surgery (BCS) rates with comparable locoregional control and survival outcomes to adjuvant therapy. More women are receiving NAC and achieving pathologic complete responses (pCR). This study sought to evaluate the effect of NAC on surgical outcomes after the adoption of a “no‐ink‐on‐tumor” margin policy in patients undergoing primary BCS (PBSC).MethodsAn IRB approved database was queried for women undergoing BCS for invasive breast cancer after March 2014. We compared patients who underwent NAC followed by BCS versus PBCS. Demographic, tumor, treatment, and outcome variables were compared using both univariate and multivariable analysis.ResultsA total of 162 patients were evaluated. NAC patients had significantly lower re‐excision rates (0% NAC vs. 9% PBCS, p = .03), margin positivity (0% NAC vs. 5% PBCS, p = .01), and greater patient satisfaction with breast cosmesis (97 NAC vs. 77 PBCS, p = .01). On multivariable analysis, NAC was not an independent predictor of lower final resection volume, total complications, or greater satisfaction with breasts when controlling for age and T category at diagnosis.ConclusionNAC followed by BCS may offer less margin positivity, lower re‐excision rates, and greater patient satisfaction when compared to a contemporary PBCS cohort in the “no‐ink‐on‐tumor” era.

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The 2016 consensus guideline on margins for breastconserving surgery with whole-breast irradiation for ductal carcinoma in situ sought to decrease breast tumor recurrence. However, its implementation resulted in an increase in reexcisions and mastectomy conversions at two institutions (