Sanchez AM, Franceschini G, D'Archi S, et al. - Given that despite the demonstrated superiority over traditional breast-conserving surgery, oncoplastic surgery (OPS) is struggling to consolidate its role in breast cancer therapeutic protocols because of contrasting scientific evidence and reduced follow-up results available. Researchers here sought to report the results obtained with 381 patients consecutively treated by means of level II OPS at their Multidisciplinary Breast Center between January 1998 and January 2018 for unilateral, primary breast cancer. Treatment for multifocal/multicentric disease was undertaken in nearly 29.1%, and receipt of previous neo-adjuvant chemotherapy (NACT) was reported in 29.1%. Regarding surgical techniques, “inverted T” and “J” mammoplasties were performed in 53.0% and 30.1% of patients, respectively, whereas “round block,” “Grisotti,” “batwing” techniques were undertaken in 13.6%, 2.3%, and 1% respectively. Regarding surgical outcomes, mean specimen weight of 215 g (50-2157) and volume of 345 mm³ (21-7,980) were reported. Diameter of main lesion was 23 mm; rates of positive margins, re-excision, conversion to mastectomy and complications were 7.6%, 3.6%, 1.6%, and 5.8%, respectively. Oncological outcomes, with a mean follow-up of 118 months, were: overall survival 93.7%, disease-free survival 82.3%, local recurrence rate 4.4%. Findings thereby strengthen level II OPS reliability even for longer follow-up timing and in difficult situations as multifocal disease or after NACT.