Comparative Analysis of Volume Displacement versus Volume Replacement Oncoplastic Breast-Conserving Surgery with Pedicled Chest Wall Perforator Flaps: A Retrospective Cohort Study

Comparative Analysis of Volume Displacement versus Volume Replacement Oncoplastic Breast-Conserving Surgery with Pedicled Chest Wall Perforator Flaps: A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Analysis of Volume Displacement versus Volume Replacement Oncoplastic Breast-Conserving Surgery with Pedicled Chest Wall Perforator Flaps: A Retrospective Cohort Study Bin Lian, Huihui Yang, Qinghong Qin, Zhen Huang, Wei Wei, Huotang Qin, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6195577/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To evaluate the clinical efficacy, aesthetic outcomes, and safety profiles of volume displacement oncoplastic breast-conserving surgery (VD-OBCS) versus volume replacement oncoplastic breast-conserving surgery (VR-OBCS) utilizing pedicled chest wall perforator flaps in breast cancer patients. Methods This retrospective cohort study enrolled 75 patients undergoing breast-conserving surgery between February 2021 and August 2022. Patients were stratified into two groups: VR-OBCS (n = 38) and VD-OBCS (n = 37). Comparative analyses included tumor characteristics, operative parameters, complication rates, margin positivity, and disease-free survival (DFS). Aesthetic outcomes were assessed via standardized photographic evaluation and patient-reported satisfaction. Results The VR-OBCS cohort exhibited significantly larger tumor diameters (26.21 ± 11.17 mm vs. 19.57 ± 11.08 mm, P = 0.012) and longer operative durations (178.63 ± 43.71 vs. 116.51 ± 30.33 minutes, P = 0.006) compared to VD-OBCS. Conversely, VR-OBCS demonstrated shorter drainage tube retention (10.79 ± 3.28 vs. 13.97 ± 6.80 days, P = 0.011) and comparable complication rates (10.5% vs. 8.1%, P = 0.719). Margin positivity rates were 0% in VR-OBCS versus 8.1% in VD-OBCS (P = 0.073). No significant differences in DFS were observed (log-rank P > 0.05). Conclusion VR-OBCS with pedicled perforator flaps offers superior defect repair capacity, concealed scarring, and shorter recovery in patients with larger tumors or limited breast volume. Both techniques achieve equivalent oncologic safety when negative margins are secured. breast cancer Oncoplastic perforator flap breast conserving surgery Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1 Introduction Breast-conserving surgery is based on the completeresection of the tumor with limited excision of surrounding breast tissue. The difference between oncoplastic technique and traditional breast-conserving surgery is that plastic surgery can be applied to partial mastectomy so that the patient can avoid total mastectomy and obtain a better breast shape. Large-scale clinical data have confirmed that breast-conserving surgery plus radiotherapy has the same tumor safety and survival rate as total mastectomy while preserving the integrity of the female body and achieving a higher quality of life [ 1 ] . In addition, breast-conserving patients have high satisfaction, good cosmetic outcomes and fewer complications [ 2 ] . At present, the conventional method of breast conserving surgery is to use VD-OBCS, which include standard or modified breast reduction surgery or displacement and rearrangement of adjacent glandular flaps within the breast. The VD-OBCS usually adopts a local flap, which refers to the flap that exists around the recipient area, and rearranges the local flap position under certain conditions by taking advantage of the elasticity and looseness of the surrounding skin and soft tissue. The surgery mainly involves obtaining corresponding regional arterial perforations through preoperative color Doppler ultrasound localization and the application of plastic surgery techniques [ 3 – 5 ] .In patients with small breasts or large tumors, the glands remaining after tumor resection may not be able to fill the residual cavity or shape it to achieve a satisfactory appearance, so it is necessary to repair the residual cavity with tissues other than the breast glands for cosmetic purposes. The volume replacement of the tumor plastic cover during breast surgery was measured via the VR-OBCS. In this study, we aim to apply the volumetric displacement technique and the volumetric replacement technique for pedicled perforator flaps of the chest wall in breast-conserving plastic surgery and analyze the aesthetic effect, long-term curative effect and complications, especially through the analysis of the percentage of positive incision margins, to explore the advantages, disadvantages and applicability of both methods and to provide additional tissue repair options for breast-conserving plastic surgery. 2 Method 2.1 Clinical data: The data of 75 patients who underwent breast conserving surgery for primary breast cancer in the Breast Surgery Department of Guangxi Medical University Cancer Hospital from February 2021 to August 2022 were enrolled.The inclusion and exclusion criteria were detailed in Table 1 . Table 1 Inclusion criteria and exclusion criteria serial number inclusion criteria exclusion criteria (1) had a willingness to undergo BCS incomplete clinical data (2) had T1 or T2 tumors, for which the tumor-to-breast volume ratio was appropriate during pregnancy (3) had multiple lesions in the same quadrant, for which a single incision could ensure negative margins extensive or multicentric tumor lesions, diffuse malignant calcification, and difficulty achieving a negative margin or ideal shape (4) had stage III breast cancer except for inflammatory breast cancer after neoadjuvant chemotherapy or endocrine therapy extensive resection of the tumor with a positive margin but still cannot guarantee a negative margin (5) The volume of the breast defect after tumor resection was expected to be in the range of 20–50% inflammatory breast cancer (6) no desire to do BCS (7) BMI < 18 kg/m2 (8) clinical stage IV (9) Patients with a history of smoking 2.2 Ethics Approval: This study was approved by the Ethics Review Committee of Guangxi Medical University Cancer Hospital (Approval Number: KYB2023097). 2.3 Grouping and intervention: Subjects were randomly divided into a VD-OBCS group and a VR-OBCS group according to a randomized number table. In the VD-OBCS group, routine preoperative examination was performed, and the remaining breast glands were displaced to fill the residual lumen after extensive resection of the breast tumor to achieve shaping and cosmetic effects, including glandular remodeling and breast-conserving plastic surgery based on breast reduction and breast lift. In the VR-OBCS group, the perforating vessels of the chest wall were located by color Doppler ultrasound before the operation and were marked on the body surface. In general, the lateral intercostal artery perforator was found in the fifth to seventh intercostal space between the lateral thoracic margin and the leading edge of the latissimus dorsi. The anatomical position of the perforators of the thoracodorsal artery was relatively constant.The thoracodorsal artery generally emitted perforator at the junction 8 ~ 10 cm below the axillary fold and 3 cm outside the horizontal line of the subscapular angle. Most of the two main perforators were descending and transverse branches, and each main perforators emitted 1 ~ 3 perforators to supply superficial fascia and skin tissue [ 6 , 7 ] . After breast-conserving surgery, the perforators of the intercostal artery was found, and the fat flap around the perforator was dissociated from the deep layer of the superficial fascia. During the operation, according to the location, number and diameter of the perforator, the perforator with the smallest diameter and greatest distance from the pedicle was ligated, and the blood flow through the tissue flap was observed and evaluated. Finally, 1–3 main perforating vessels were retained. If necessary, multiple perforators can also be combined. Finally, the free pedicled flap was transferred to the breast defect, or the defect was transferred to the external or lower quadrant of the breast where the perforator flap was easily accessible by the "flap relay" method. The separated flap was sutured to the surrounding tissue, and titanium clips were placed for postoperative radiotherapy positioning. 2.4 Recordings: The tumor size, pathology, operation time, margin positive rate, flap blood flow, and complication rate were obtained for the two groups. After assessing good blood flow through the tissue flap during the operation, the flap was trimmed to an appropriate filling size, and the length of the vessel pedicle, the method of flap placement, and the thickness, length and width of the flap were recorded. 2.5 Postoperative follow-up: The patients were followed up by outpatient review and network questionnaire after discharge. Long-term effects were evaluated 3 months after surgery and at follow-up after radiotherapy. Follow-up was conducted every 3 months for 2 years, ranging from 16 to 36 months. Routine follow-up included breast ultrasound and adenocarcinoma tumor markers in the blood.Complications were recorded. 2.6 Data sorting and statistical analysis: Clinical and follow-up data from the two groups were sorted. Photos of the breasts, incisions, flaps and perforating vessels were taken before, during and after the operation. All the data were analyzed with SPSS 22.0 software. The measurement data were compared by means of ANOVA, a T test or the Wilcoxon paired rank sum test. The rates were compared between the two groups using the chi-square test or Fisher’s exact probability method. Survival curves were plotted by the Kaplan‒Meier method and analyzed by the log-rank test.All statistical data were statistically signifcant at P < 0.05. 3 Results 3.1 Clinical and pathological conditions Clinical Data: There were no significant differences in age or BMI between the two groups. In terms of tumor size, the tumor length and diameter in the volumetric replacement breast-preserving group were greater than those in the VD-OBCS group (26.21 ± 11.17mm vs. 19.51 ± 11.08mm, P < 0.05). The operation time of the VR-OBCS group was longer than that of the VD-OBCS group (116.51 ± 30.33 vs. 178.63 ± 43.71, P < 0.05), and the postoperative extubation time of the VR-OBCS group was shorter than that of the VD-OBCS group (10.79 ± 3.28days vs. 13.97 ± 6.80days, P < 0.05). (Table 2 ). In terms of pathological indices and staging, the proportion of patients with stage II or III disease in the VR-OBCS group was greater than that in the VD-OBCS group (P 0.05) (Table 2 and Table 3 ).In this study, 15 cases involving a single perforator and 23 cases involving a combined perforator were used(LICAP 4 cases,LTAP 4cases,AICAP 3cases,SEAP 2cases,TDAP 2cases,LICAP + LTAP + TDAP 4cases,LICAP + LTAP 14cases and AICAP + SEAP 5cases) 3.2 Complications: In the volume replacement breast-preserving surgery group, there were no perforator vessel injuries during or after surgery, and all the flaps survived; 4 patients had postoperative complications (4/38, 10.53%), 1 had local redness and swelling, 1 had an infection, 2 had a local hematoma caused by postoperative hemorrhage, and no complications, such as wound healing breakdown or poor healing. There was no necrosis or collapse of the flaps after radiotherapy. There was no secondary incisal margin or positive incisal margin during or after the operation. The incidence of complications was 3/37,8.11% in the volume shift lactation-preserving group. One patient with Staphylosa castillo infection complicated by poor incision healing was cured well after anti-infection, and drainage tubes were placed and other treatments. One patient with LTAP experienced flap edge ischemia 2 days post-surgery. After subcutaneous injection of 1ml papaverine into the center of the flap once daily for a week, the flap survived smoothly. After radiotherapy, one patient with TDAP experienced fat atrophy and local hardening, while one patient with SEAP experienced collapse and hardening at the junction between the flap and the glandular edge. Fluid accumulation and poor healing occurred in the operative area in 1 patient with fatty glands, Three patients experienced positive intraoperative frozen pathological margins, requiring re-examination of the margins during surgery (3/37, 8.11%). There were no significant differences in the incidence of complications or in the incidence of secondary resection margins between the two groups (P > 0.05) (Table 3 ). 3.3 Postoperative follow-up:All patients were followed up and no deaths occurred. The median follow-up time for the two groups of patients was 27 months. Among them, there was 1 case of local breast recurrence and 1 case of bone metastasis in the VD-OBCS group, and 1 case of chest wall recurrence in the VR-OBCS group. All flaps survived. Use Kaplan Meier method to calculate the difference between two sets of DFS(disease-free survival) and draw K-M curves. The log rank test showed no significant difference in DFS between the two groups (χ 2 = 0.211, P > 0.05) (Fig. 6 ). Table 2 Comparison of clinical indicator values Index VR-OBCS VD-OBCS T value P value Age (year) 48.14 ± 9.72 50.03 ± 10.05 0.823 0.413 Tumor diameter (mm) 26.21 ± 11.17 19.51 ± 11.08 2.585 0.012 KI-67(%) 27.24 ± 22.09 30.00 ± 22.76 0.533 0.595 Operation time(min) 178.63 ± 43.71 116.51 ± 30.33 5.790 0.006 drainage time(day) 10.79 ± 3.28 13.97 ± 6.80 2.594 0.011 BMI 23.75 ± 3.03 23.60 ± 2.86 0.216 0.829 Table 3 Comparison of the clinical indicators Indicators State VR-OBCS VD-OBCS Chi-square P value Lymph node positive 17 9 3.795 0.087 negative 20 28 HR(hormone receptor) positive 33 30 0.463 0.496 negative 5 7 HER-2 positive 6 13 3.709 0.054 negative 32 24 Complications Yes 4 3 0.130 0.719 No 34 34 Secondary margin Yes 0 3 3.209 0.073 No 38 34 Pathological type DCIS(intraductal carcinoma) 2 5 1.515 0.469 nonspecific invasive carcinoma 35 31 Mucinous carcinoma 1 1 Stage I 16 27 10.803 0.005 II 15 10 III 7 0 Molecular typing Luminal A 8 6 0.472 0.925 Luminal B 24 24 HER-2 overexpression 2 3 triple negative 4 4 4 Discussion Autologous tissue flaps are among the most important repair materials used in the field of breast reconstruction.Surgical techniques are being constantly innovated and developed, and the general trend is toward less trauma, safer surgery, and faster recovery. Until the last 10 years, especially for propeller perforator flaps, a variety of local perforator flap techniques (mainly in the outer and lower two parts of the breast) have been used. The field of breast reconstruction is bound to be affected. Some are modified versions of classic musculocutaneous flaps (such as the thoracodorsal perforator flap), which have been widely recognized in clinical practice. Some of these flaps are theoretically promising, have few clinical applications, and must be further developed and studied (such as intercostal artery perforator flaps based on pedicled chest wall perforator flaps and superior abdominal artery perforator flaps). Breast reconstruction surgery is a highly personalized surgery, and one or two mainstream techniques cannot solve all breast reconstruction problems. Therefore, the application of the pedicled perforator flap in chest wall volume replacement technique can expand the idea of breast preservation more flexibly, which is the direction of minimally invasive breast cancer surgery and can better serve patients. Volumetric replacement for plastic breast-conserving surgery involves the use of island or pedicled chest wall fascia skin perforator flaps to fill the volume removed during lumpectomy. This technique is suitable for patients with a large tumor/breast volume ratio and small or sagging breasts that cannot be reconstructed to remove defects via the volumetric transfer technique. In this study, the average length and diameter of tumors in the breast preservation group determined via the volumetric displacement technique were 19.51 ± 11.08 mm and 26.21 ± 11.17 mm, respectively (P = 0.012) (Table 2 ). In terms of tumor stage, the proportions of patients with stage II and III disease in the volume replacement group were larger (P = 0.005) (Table 3 ), indicating that the extent of repair via the volume replacement method was greater. In addition to removing the tumor, it is also necessary to remove at least 1 cm of the area around the tumor, so the defect will be larger and expected to exceed 20% of the breast volume. If only oncoplastic surgery technique is used, the entire breast volume will be reduced, and fullness and aesthetics will also be reduced. The perforator flap was first proposed by Kroll et al. [ 8 ] [9] and Koshima et al. [ 9 ] [10] in 1988 and 1989, respectively. An axial vascular flap containing skin or subcutaneous tissue with blood supplied by perforator vessels with a small diameter (0.5 ~ 0.8 mm) was used. The vascular pedicle of the perforator flap with the pedicle should have at least one perforator vessel with a diameter greater than 0.5 mm, the flap should not be restricted by a strict aspect ratio, the pedicle of the flap should not be swollen, and the flap can be covered by 180° rotation. The disadvantage of this approach is that the separation technique is delicate and complex, and the technical requirements for the surgeon are high. In this study, the operation time was bound to increase if the perforator flap was free, but the time was gradually shortened with the improvement of the learning curve, especially for breast preservation surgery, which required nearly 1 hour the intraoperative histology, which was just enough time to separate the anatomic perforator vessels. In this study, the average operation duration in the volume replacement group was 62 minutes longer than that in the volume displacement group (178.63 ± 43.71vs.116.51 ± 30.33(P = 0.006)). It is believed that after improving patient proficiency, the operation time can be further shortened. In terms of postoperative recovery, the drainage time was shorter in the volume replacement group (10.79 ± 3.28 vs. 13.97 ± 6.80), indicating that the breast defect was effectively filled and that wound healing was better promoted. Moreover, there was no significant difference in the complication rate between the two groups (10.53% vs. 8.11%, P = 0.719).The survival curve showed no difference in DFS between the two groups (Fig. 6 ), while the VR-OBCS group had larger tumors and later stages (Table 2 , 3 ), indicating that as long as negative margins were ensured, VR-OBCS was comparable to VD-OBCS in terms of tumor safety. In this study, there was no statistically significant difference in BMI between the two groups (23.75 ± 3.03 vs. 23.60 ± 2.86, P = 0.829), and both groups of patients were successfully breast-preserved. In terms of intraoperative secondary incisional margins, there were no positive intraoperative incisal margins in the volume replacement group, while positive intraoperative incisal margins occurred in 3 patients in the volume displacement group (P = 0.073). Moreover, there was no significant difference between the two groups, so the safety of these procedures was comparable (Table 2 ). Hamdi et al. [ 10 ] showed that among patients receiving immediate breast reconstruction, the utilization rate of volume replacement technique in the high body mass index group reached 22%. In addition, other studies have shown that volume replacement technique is used mainly for people with a low body mass index [ 3 , 5 ] . SchaverienMV et al. [ 11 ] reported that standard volumetric displacement methods (such as local tissue rearrangement or breast fixation/reduction) were not suitable for small breasts, but the pedicled perforator flap of the chest wall could achieve considerable breast volume and improve the success rate of breast preservation in patients with small breasts. In this study, BMI can be used only as a reference for the choice of volume replacement, which mainly depends on the size of the breast and the subcutaneous fat thickness of the surrounding tissue. For women in southern China, the breast volume is generally smaller, so volume replacement technique has greater applicability. Tips for choosing perforator : Local pedicled perforator flaps of the chest wall can be divided into three types according to the donor site: (1) Anterior intercostal artery perforator flaps (AICAP). A central breast defect is reconstructed by using soft tissue from anterior intercostal blood vessels distributed in an island shape under the inferior breast fold [ 3 ] . Khouri and Angrigiani described the use of a lateral basal anterior intercostal artery perforator flap for volume recovery after prosthetic breast reconstruction [14] (Figure. 2). (2) Medial intercostal artery perforator (MICAP)/superior epigastric artery perforator flap (SEAP). The middle intercostal artery is a perforator flap based on the internal branch of the mammary gland or the anterior intercostal vessel, while the perforator flap of the superior epigastric artery is an internal thoracic artery that passes through the diaphragm into the sheath of the rectus abdominis in the anterior abdominal wall and transits into the superior epigastric artery, which is in line with the inferior epigastric artery, and its perforator branch emerges from the intercostal or from the rectus abdominis muscle to the anterior sheath of the surface (Fig. 1 ). The above two types of flaps can be used alone or in combination to reconstruct medial and inferior breast defects [ 12 ] . (3) A perforator flap taken from the lateral chest wall, including the lateral intercostal artery perforator (LICAP) [ 5 , 10 ] (Fig. 4 ) and the perforator branch of the lateral thoracic artery [ 13 , 14 ] flap (LTAP) (Fig. 3 ), was used for volumetric replacement repair of the tumor resection defect in the lateral third of the breast. In this study, it was found that these perforator flaps are close to the breast and can be used alone or that two adjacent perforator flaps can be used together in one flap. For example, the anterior intercostal artery combined with the superior epigastric artery repaired defects in the lower and lower quadrants of the breast, the anterior intercostal artery combined with the lateral intercostal artery repaired external inferior and inferior quadrant defects, the lateral thoracic artery combined with the lateral intercostal perforator flap repaired external quadrant defects, and the lateral intercostal artery combined with the dorsal thoracic artery perforator flap repaired lateral and outer upper quadrant defects (Fig. 5 ). The use of a thoracodorsal artery perforator flap not only prevents the possibility of partial or total latissimus dorsi muscle repair but also prevents the complication of intramuscular perforator branch detachment. In this study, 15 cases involving a single perforator and 23 cases involving a combined perforator were used. The application of combined perforators greatly improved the survival rate of the flaps. Surgical technique:(1)Try to use a magnifying glass and bipolar to dissect the perforating vessels.(2)Choose flap or fascial flap according to the relationship between tumor and skin.(3)In axillary surgery, LTA (lateral thoracic artery) and LTV (lateral thoracic vein) were found first and routinely preserved. If the axillary node is positive, LTA and TDA (perforator of thoracodorsal artery) should be carefully protected during axillary dissection.LTAP can be used for LICA injury. If neither of them is available, the latissimus dorsi descending branch myocutaneous flap can be used(no need to change position during surgery).(4)The vascular pedicle should be as long as possible to avoid vasospasm caused by traction, and the muscle should be cut if necessary. Compared to the volumetric displacement method, scar selection is more diverse and concealed: the lateral and anterior areas of the chest wall have a rich blood supply, so the flap design can be extended laterally to form an aesthetically pleasing scar within the natural boundary of the chest wall, which can be well hidden within the inner band area. For the anterior intercostal artery perforator flap and the epigastric artery perforator flap, an incision can be made in the lower fold,for patients with breast sagging, the scar is not visible from the front, thus increasing patient’s appearance and confidence. In addition, the volume replacement method does not require nipple areolar repositioning, so the nipple-areolar complex can be preserved, but some of the volume replacement methods can extend the surgical scar to the outer breast area while maintaining the integrity of the breast skin. This study revealed that most patients in the experimental group were still in the edema stage of the skin flap in the first month and that the local breast tissue was hard; however, by the third month after surgery, the feel of the defect was obviously soft, which was close to the normal breast tissue.In two cases, local hardening and skin collapse occurred at the edge of the skin flap after radiotherapy,which was considered to be due to the inhibitory effect of radiotherapy on angiogenesis.. Therefore, the aesthetic effect and patient satisfaction of the proposed method must be further studied. This study has several limitations, such as a short follow-up time (median follow-up time was 27 months) and long recurrence and survival of patients with breast cancer; thus, long-term observation and prognostic evaluation are needed. 5 Conclusions There is abundant blood supply in the lateral and anterior regions of the chest wall. Therefore, compared with deep inferior epigastric perforator flap (DIEP) flaps, pedicled perforator flaps of the chest wall need no vascular anastomoses. The dissection of blood vessels in the donor region of these local fascial flaps is relatively easy. Technically, it is only necessary to locate the perforator with preoperative color Doppler and separate blood vessels with surgical magnifying glass, which greatly reduces the operation time and difficulty. Compared with VD-OBCS, VR-OBCS has significant application prospects and can ensure the fullness of breast shape and prevent a large reduction in breast volume after breast conservation to further improve the possibility and confidence of patients with breast conservation, provide a basis for the clinical formulation of breast cancer surgery plans and strategies and improve the aesthetic effect of patients' breasts as well as their quality of life. Declarations Ethical Approval This study was reviewed and approved by the Ethics Committee of Guangxi Medical University Cancer Hospital (Approval No. KYB2023097). Written informed consent was obtained from all participants prior to study enrollment.All methods were carried out in accordance with the Declaration of Helsinki. Competing interests The authors declare no competing interests. Authors' contributions Bin Lian: conceptualization, methodology, follow-up, survey questionnaire Huihui Yang: writing - original draft, perforator localization Qinghong Qin: operation, formal analysis Zhen Huang: operation Wei Wei: Funding acquisition Huotang Qin: Data collection Yanlin Huang: data collection #Qinguo Mo: Writing - Review & Editing #Changyuan Wei: Supervision *Bin Lian and Huihui Yang contributed equally to this work. # Changyuan Wei and Qinguo Mo contributed equally to this work. Funding This article was supported by the Guangxi Health Commission self-funded project (No.Z20210117)，Basic ability improvement project for young and middle-aged teachers in Guangxi universities(2025KY0124).Guangxi Medical University College Student Innovation and Entrepreneurship Project (No.X202410598380),(No.X202410598383),Key Laboratory of Breast Cancer Diagnosis and Treatment Research of Guangxi Department of Education. Availability of data and materials Data Accessibility:Under privacy protection protocols, de-identified datasets are available from the corresponding author upon approval by the ethics committee (Contact: [email protected] ). References Carter SA, Lyons GR, Kuerer HM, et al. Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction[J]. Ann Surg Oncol. 2016;23(10):3190–8. Kouwenberg Ca, De E KM, Kranenburg LW, et al. Long-Term Health-Related Quality of Life after Four Common Surgical Treatment Options for Breast Cancer and the Effect of Complications: A Retrospective Patient-Reported Survey among 1871 Patients[J]. Plast Reconstr Surg. 2020;146(1):1–13. Carrasco-López C, Julian Ibañez JF, Vilà J, et al. Anterior intercostal artery perforator flap in immediate breast reconstruction: Anatomical study and clinical application[J]. Microsurgery. 2017;37(6):603–10. Hamdi M, Van Landuyt K, De Frene B, et al. The versatility of the inter-costal artery perforator (ICAP) flaps[J]. J Plast Reconstr Aesthet Surg. 2006;59(6):644–52. Hamdi M, Van Landuyt K, Monstrey S, et al. Pedicled perforator flaps in breast reconstruction: a new concept[J]. Br J Plast Surg. 2004;57(6):531–9. Chartier C, Safran T, Alhalabi B, et al. Locoregional perforator flaps in breast reconstruction: An anatomic review & quadrant algorithm[J]. J Plast Reconstr Aesthet Surg. 2022;75(4):1328–41. Hwang KT, Kim SW, Kim YH. Anatomical variation of the accessory thoracodorsal artery as a direct cutaneous perforator[J]. Clin Anat. 2013;26(8):1024–7. Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects[J]. Plast Reconstr Surg. 1988;81(4):561–6. Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle[J]. Br J Plast Surg. 1989;42(6):645–8. Hamdi M, Van Landuyt K, Blondeel P, et al. Autologous breast augmentation with the lateral intercostal artery perforator flap in massive weight loss patients[J]. J Plast Reconstr Aesthet Surg. 2009;62(1):65–70. Schaverien MV, Kuerer HM, Caudle AS, et al. Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: Comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction[J]. Plast Reconstr Surg. 2020;146(1):14–27. Macmillan RD, Mcculley SJ. Oncoplastic Breast Surgery: What, When and for Whom?[J]. Curr Breast Cancer Rep. 2016;8:112–7. Mangialardi ML, Baldelli I, Salgarello M, et al. Breast Reconstruction Using the Lateral Thoracic, Thoracodorsal, and Intercostal Arteries Perforator Flaps[J]. Plast Reconstr Surg Glob Open. 2021;9(1):e3334. Mcculley SJ, Schaverien MV, Tan VK, et al. Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction[J]. J Plast Reconstr Aesthet Surg. 2015;68(5):686–91. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6195577","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440281011,"identity":"b0938762-410b-46cb-bef3-3517b559c744","order_by":0,"name":"Bin Lian","email":"","orcid":"","institution":"Tumor Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Bin","middleName":"","lastName":"Lian","suffix":""},{"id":440281012,"identity":"fbeeb364-e0ab-4a43-9a22-99c8ec14e2c8","order_by":1,"name":"Huihui Yang","email":"","orcid":"","institution":"The People's Hospital of Guangxi Zhuang Autonomous Region","correspondingAuthor":false,"prefix":"","firstName":"Huihui","middleName":"","lastName":"Yang","suffix":""},{"id":440281013,"identity":"befcc8fe-671d-498a-bee4-9e322e117756","order_by":2,"name":"Qinghong Qin","email":"","orcid":"","institution":"Tumor Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qinghong","middleName":"","lastName":"Qin","suffix":""},{"id":440281014,"identity":"158179a9-eba8-4baf-8f11-52746435b523","order_by":3,"name":"Zhen Huang","email":"","orcid":"","institution":"Tumor Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhen","middleName":"","lastName":"Huang","suffix":""},{"id":440281015,"identity":"6312afac-a0ed-4f1e-94fa-34442b4038f4","order_by":4,"name":"Wei Wei","email":"","orcid":"","institution":"Tumor Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wei","middleName":"","lastName":"Wei","suffix":""},{"id":440281016,"identity":"fbd63455-3813-45fd-8d3d-22f54e386c07","order_by":5,"name":"Huotang Qin","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huotang","middleName":"","lastName":"Qin","suffix":""},{"id":440281017,"identity":"4b73730b-401a-4638-98d5-4eb280019177","order_by":6,"name":"Yanlin Huang","email":"","orcid":"","institution":"Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yanlin","middleName":"","lastName":"Huang","suffix":""},{"id":440281018,"identity":"aab23c19-d50c-4bd9-a267-fea1892b675d","order_by":7,"name":"Qinguo Mo","email":"","orcid":"","institution":"Tumor Hospital of Guangxi Medical University","correspondingAuthor":false,"prefix":"","firstName":"Qinguo","middleName":"","lastName":"Mo","suffix":""},{"id":440281019,"identity":"ae6ad563-bf39-47e6-b787-f468c9434aaf","order_by":8,"name":"Changyuan Wei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/klEQVRIiWNgGAWjYDACCST2gQ9YBPFrOTiDZC3MPMRo4Z/d/Ozh17bD8uYSyQcP2/w6HG1wgPngbR4Guzycltw5Zm4s23bYcOeMtITDuX1puRsOsCVb8zAkF+PSYiCRYCYt2XaYccPtHIPDuT02QC08ZtI8DAcSG3BqSf8G0mK/4Xb+h8OWPRJALfzfCGjJMZP82HY4EWgLw2GGH2Bb2PBqkbiRUybNcC49ecP9ZwYHexvScmceZjO2nGOQjFML/4z0bZI/yqxtN5w5/PjDjz/AEDje/PDGmwo7nFpAgJmXDcpibANxwQ7Gox6k8McfGPMPPnWjYBSMglEwUgEAtslf1Y9y1RoAAAAASUVORK5CYII=","orcid":"","institution":"Tumor Hospital of Guangxi Medical University","correspondingAuthor":true,"prefix":"","firstName":"Changyuan","middleName":"","lastName":"Wei","suffix":""}],"badges":[],"createdAt":"2025-03-10 12:38:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6195577/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6195577/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80660067,"identity":"2e3b68a4-b6e0-441a-9924-3a5f84509eaa","added_by":"auto","created_at":"2025-04-15 16:21:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":483278,"visible":true,"origin":"","legend":"\u003cp\u003eSEAP: 1A: Preoperative color doppler image of the tumor surface location and the location of the perforator. 1B: CT scan showing the perforator of the superior abdominal wall. 1C: Preoperative breast MRI image indicated multiple masses in the lower left internal breast quadrant. 1D: The perforator flap of the superior abdominal artery was cut during the operation, showing an inverted \"L\" shape, and the blood supply was good. 1E: The yellow arrow pointed the location of the intercostal artery perforator, and the green arrow pointed the location of the superior epigastric artery perforato.1F: Six months after surgery (3 months after radiotherapy).\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6195577/v1/0c1dacd98bd2a1f635926c29.png"},{"id":80660070,"identity":"976046d8-56eb-44ad-b0e4-3870621820de","added_by":"auto","created_at":"2025-04-15 16:21:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":667248,"visible":true,"origin":"","legend":"\u003cp\u003eAICAP:2A Preoperative photos (supine position); 2B: The tumor was located at 7:00 on the right side of the breast. Preoperative color ultrasound was used to locate the tumor and the surface of the perforator. 2C: Perforator location; 2D: A long strip tissue flap 11x4.5 cm in length was cut along the design line, and the flap was turned over and folded to fill the defect. 2E: Three months after the operation (positive view). 2F: The scar was hidden in the inframammary fold.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6195577/v1/39217d5276123db6e2293ac3.png"},{"id":80661409,"identity":"5f1fe051-b46f-4f39-ab62-c6a911c3a05f","added_by":"auto","created_at":"2025-04-15 16:37:10","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":649396,"visible":true,"origin":"","legend":"\u003cp\u003eLTAP: 3A: Preoperative frontal photography.3B:Preoperative color doppler \u0026nbsp;was performed to locate the mass and perforator,and marked them on the body surface. 3C: Lateral thoracic blood vessels, approximately 5 cm in length, so that the tissue flap could fill the lateral defect without tension. 3D: The motion and blood flow of the tissue flap were good, and the blue arrow pointed to the lateral thoracic artery pedicle. 3E:2 weeks after surgery(positive view)3F: 2 weeks after surgery(45° from the side).\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6195577/v1/eab18fd8b35f99b0a6237afc.png"},{"id":80660842,"identity":"5191bfcc-bc57-4bbf-9867-34575c2e33ea","added_by":"auto","created_at":"2025-04-15 16:29:10","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":565926,"visible":true,"origin":"","legend":"\u003cp\u003eLICAP: 4A: Multiple masses in the upper quadrant of the right outer breast and the surface location of the masses were located by preoperative color ultrasound; 4B: CT scan showed the lateral intercostal perforator vessels; 4C: Perforating vessels were found and dissected during the operation; 4D: Freed tissue flap to fill the external defect without tension; 4E: Six months after surgery (positive view); 4F: Six months after surgery (45° from the side).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6195577/v1/fbab1c926846d1669efc9495.png"},{"id":80660075,"identity":"4feb1bd4-1379-4418-9d22-0c59a8e14127","added_by":"auto","created_at":"2025-04-15 16:21:10","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":609360,"visible":true,"origin":"","legend":"\u003cp\u003eLTAP+TDAP+LICAP: 5A: Preoperative frontal photography; 5B: Preoperative lateral view, in which color ultrasonography was performed to locate the tumor and perforator; 5C: The lateral chest wall tissue flap could be free to fill the outer lower quadrant defect without tension; 5D: To ensure tissue valve blood flow, three perforating vessels were preserved during the operation; 5E: 3 months after surgery (positive view); 5F: 3 months after surgery (45° from the side).\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6195577/v1/4458a75bd58c1b266380960e.png"},{"id":80660069,"identity":"6601d2dd-09dd-499b-992a-dcb55d2c711e","added_by":"auto","created_at":"2025-04-15 16:21:10","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":30555,"visible":true,"origin":"","legend":"\u003cp\u003eSurvival Curve\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6195577/v1/951f64cac9803bdbd333d520.png"},{"id":92273643,"identity":"f2715be3-13bb-4db9-a21b-8f49f92a10b3","added_by":"auto","created_at":"2025-09-26 15:10:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4378081,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6195577/v1/845790dc-a745-4972-891c-a52003689063.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Analysis of Volume Displacement versus Volume Replacement Oncoplastic Breast-Conserving Surgery with Pedicled Chest Wall Perforator Flaps: A Retrospective Cohort Study","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eBreast-conserving surgery is based on the completeresection of the tumor with limited excision of surrounding breast tissue. The difference between oncoplastic technique and traditional breast-conserving surgery is that plastic surgery can be applied to partial mastectomy so that the patient can avoid total mastectomy and obtain a better breast shape. Large-scale clinical data have confirmed that breast-conserving surgery plus radiotherapy has the same tumor safety and survival rate as total mastectomy while preserving the integrity of the female body and achieving a higher quality of life\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In addition, breast-conserving patients have high satisfaction, good cosmetic outcomes and fewer complications\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. At present, the conventional method of breast conserving surgery is to use VD-OBCS, which include standard or modified breast reduction surgery or displacement and rearrangement of adjacent glandular flaps within the breast. The VD-OBCS usually adopts a local flap, which refers to the flap that exists around the recipient area, and rearranges the local flap position under certain conditions by taking advantage of the elasticity and looseness of the surrounding skin and soft tissue. The surgery mainly involves obtaining corresponding regional arterial perforations through preoperative color Doppler ultrasound localization and the application of plastic surgery techniques\u003csup\u003e[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.In patients with small breasts or large tumors, the glands remaining after tumor resection may not be able to fill the residual cavity or shape it to achieve a satisfactory appearance, so it is necessary to repair the residual cavity with tissues other than the breast glands for cosmetic purposes. The volume replacement of the tumor plastic cover during breast surgery was measured via the VR-OBCS. In this study, we aim to apply the volumetric displacement technique and the volumetric replacement technique for pedicled perforator flaps of the chest wall in breast-conserving plastic surgery and analyze the aesthetic effect, long-term curative effect and complications, especially through the analysis of the percentage of positive incision margins, to explore the advantages, disadvantages and applicability of both methods and to provide additional tissue repair options for breast-conserving plastic surgery.\u003c/p\u003e"},{"header":"2 Method","content":"\u003cp\u003e2.1 Clinical data: The data of 75 patients who underwent breast conserving surgery for primary breast cancer in the Breast Surgery Department of Guangxi Medical University Cancer Hospital from February 2021 to August 2022 were enrolled.The inclusion and exclusion criteria were detailed in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eInclusion criteria and exclusion criteria\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eserial number\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003einclusion criteria\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eexclusion criteria\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehad a willingness to undergo BCS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eincomplete clinical data\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehad T1 or T2 tumors, for which the tumor-to-breast volume ratio was appropriate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eduring pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehad multiple lesions in the same quadrant, for which a single incision could ensure negative margins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eextensive or multicentric tumor lesions, diffuse malignant calcification, and difficulty achieving a negative margin or ideal shape\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ehad stage III breast cancer except for inflammatory breast cancer after neoadjuvant chemotherapy or endocrine therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eextensive resection of the tumor with a positive margin but still cannot guarantee a negative margin\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThe volume of the breast defect after tumor resection was expected to be in the range of 20\u0026ndash;50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003einflammatory breast cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno desire to do BCS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;18 kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eclinical stage IV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e(9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePatients with a history of smoking\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Ethics Approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Review Committee of Guangxi Medical University Cancer Hospital (Approval Number: KYB2023097).\u003c/p\u003e\n\u003cp\u003e2.3 Grouping and intervention: Subjects were randomly divided into a VD-OBCS group and a VR-OBCS group according to a randomized number table. In the VD-OBCS group, routine preoperative examination was performed, and the remaining breast glands were displaced to fill the residual lumen after extensive resection of the breast tumor to achieve shaping and cosmetic effects, including glandular remodeling and breast-conserving plastic surgery based on breast reduction and breast lift. In the VR-OBCS group, the perforating vessels of the chest wall were located by color Doppler ultrasound before the operation and were marked on the body surface. In general, the lateral intercostal artery perforator was found in the fifth to seventh intercostal space between the lateral thoracic margin and the leading edge of the latissimus dorsi. The anatomical position of the perforators of the thoracodorsal artery was relatively constant.The thoracodorsal artery generally emitted perforator at the junction 8\u0026thinsp;~\u0026thinsp;10 cm below the axillary fold and 3 cm outside the horizontal line of the subscapular angle. Most of the two main perforators were descending and transverse branches, and each main perforators emitted 1\u0026thinsp;~\u0026thinsp;3 perforators to supply superficial fascia and skin tissue\u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. After breast-conserving surgery, the perforators of the intercostal artery was found, and the fat flap around the perforator was dissociated from the deep layer of the superficial fascia. During the operation, according to the location, number and diameter of the perforator, the perforator with the smallest diameter and greatest distance from the pedicle was ligated, and the blood flow through the tissue flap was observed and evaluated. Finally, 1\u0026ndash;3 main perforating vessels were retained. If necessary, multiple perforators can also be combined. Finally, the free pedicled flap was transferred to the breast defect, or the defect was transferred to the external or lower quadrant of the breast where the perforator flap was easily accessible by the \u0026quot;flap relay\u0026quot; method. The separated flap was sutured to the surrounding tissue, and titanium clips were placed for postoperative radiotherapy positioning.\u003c/p\u003e\n\u003cp\u003e2.4 Recordings: The tumor size, pathology, operation time, margin positive rate, flap blood flow, and complication rate were obtained for the two groups. After assessing good blood flow through the tissue flap during the operation, the flap was trimmed to an appropriate filling size, and the length of the vessel pedicle, the method of flap placement, and the thickness, length and width of the flap were recorded.\u003c/p\u003e\n\u003cp\u003e2.5 Postoperative follow-up: The patients were followed up by outpatient review and network questionnaire after discharge. Long-term effects were evaluated 3 months after surgery and at follow-up after radiotherapy. Follow-up was conducted every 3 months for 2 years, ranging from 16 to 36 months. Routine follow-up included breast ultrasound and adenocarcinoma tumor markers in the blood.Complications were recorded.\u003c/p\u003e\n\u003cp\u003e2.6 Data sorting and statistical analysis: Clinical and follow-up data from the two groups were sorted. Photos of the breasts, incisions, flaps and perforating vessels were taken before, during and after the operation. All the data were analyzed with SPSS 22.0 software. The measurement data were compared by means of ANOVA, a T test or the Wilcoxon paired rank sum test. The rates were compared between the two groups using the chi-square test or Fisher\u0026rsquo;s exact probability method. Survival curves were plotted by the Kaplan‒Meier method and analyzed by the log-rank test.All statistical data were statistically signifcant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e3.1 Clinical and pathological conditions Clinical Data: There were no significant differences in age or BMI between the two groups. In terms of tumor size, the tumor length and diameter in the volumetric replacement breast-preserving group were greater than those in the VD-OBCS group (26.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17mm vs. 19.51\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08mm, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The operation time of the VR-OBCS group was longer than that of the VD-OBCS group (116.51\u0026thinsp;\u0026plusmn;\u0026thinsp;30.33 vs. 178.63\u0026thinsp;\u0026plusmn;\u0026thinsp;43.71, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the postoperative extubation time of the VR-OBCS group was shorter than that of the VD-OBCS group (10.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28days vs. 13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80days, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). In terms of pathological indices and staging, the proportion of patients with stage II or III disease in the VR-OBCS group was greater than that in the VD-OBCS group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There were no significant differences in hormone receptor expression, HER-2 expression, molecular typing, Ki-67 expression or lymph node metastasis between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e and Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).In this study, 15 cases involving a single perforator and 23 cases involving a combined perforator were used(LICAP 4 cases,LTAP 4cases,AICAP 3cases,SEAP 2cases,TDAP 2cases,LICAP\u0026thinsp;+\u0026thinsp;LTAP\u0026thinsp;+\u0026thinsp;TDAP 4cases,LICAP\u0026thinsp;+\u0026thinsp;LTAP 14cases and AICAP\u0026thinsp;+\u0026thinsp;SEAP 5cases)\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e3.2 Complications: In the volume replacement breast-preserving surgery group, there were no perforator vessel injuries during or after surgery, and all the flaps survived; 4 patients had postoperative complications (4/38, 10.53%), 1 had local redness and swelling, 1 had an infection, 2 had a local hematoma caused by postoperative hemorrhage, and no complications, such as wound healing breakdown or poor healing. There was no necrosis or collapse of the flaps after radiotherapy. There was no secondary incisal margin or positive incisal margin during or after the operation. The incidence of complications was 3/37,8.11% in the volume shift lactation-preserving group. One patient with Staphylosa castillo infection complicated by poor incision healing was cured well after anti-infection, and drainage tubes were placed and other treatments. One patient with LTAP experienced flap edge ischemia 2 days post-surgery. After subcutaneous injection of 1ml papaverine into the center of the flap once daily for a week, the flap survived smoothly. After radiotherapy, one patient with TDAP experienced fat atrophy and local hardening, while one patient with SEAP experienced collapse and hardening at the junction between the flap and the glandular edge. Fluid accumulation and poor healing occurred in the operative area in 1 patient with fatty glands, Three patients experienced positive intraoperative frozen pathological margins, requiring re-examination of the margins during surgery (3/37, 8.11%). There were no significant differences in the incidence of complications or in the incidence of secondary resection margins between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3.3 Postoperative follow-up:All patients were followed up and no deaths occurred. The median follow-up time for the two groups of patients was 27 months. Among them, there was 1 case of local breast recurrence and 1 case of bone metastasis in the VD-OBCS group, and 1 case of chest wall recurrence in the VR-OBCS group. All flaps survived. Use Kaplan Meier method to calculate the difference between two sets of DFS(disease-free survival) and draw K-M curves. The log rank test showed no significant difference in DFS between the two groups (\u0026chi;\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.211, P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of clinical indicator values\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndex\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVR-OBCS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVD-OBCS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eT value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48.14\u0026thinsp;\u0026plusmn;\u0026thinsp;9.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50.03\u0026thinsp;\u0026plusmn;\u0026thinsp;10.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.413\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTumor diameter (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19.51\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKI-67(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27.24\u0026thinsp;\u0026plusmn;\u0026thinsp;22.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.00\u0026thinsp;\u0026plusmn;\u0026thinsp;22.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.595\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOperation time(min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e178.63\u0026thinsp;\u0026plusmn;\u0026thinsp;43.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e116.51\u0026thinsp;\u0026plusmn;\u0026thinsp;30.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5.790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edrainage time(day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.594\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of the clinical indicators\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIndicators\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eState\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVR-OBCS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVD-OBCS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eChi-square\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eLymph node\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e3.795\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHR(hormone receptor)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHER-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e3.709\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSecondary margin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e3.209\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003ePathological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDCIS(intraductal carcinoma)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e1.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003enonspecific invasive carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMucinous carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e10.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eMolecular typing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLuminal A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.925\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLuminal B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHER-2 overexpression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etriple negative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eAutologous tissue flaps are among the most important repair materials used in the field of breast reconstruction.Surgical techniques are being constantly innovated and developed, and the general trend is toward less trauma, safer surgery, and faster recovery. Until the last 10 years, especially for propeller perforator flaps, a variety of local perforator flap techniques (mainly in the outer and lower two parts of the breast) have been used. The field of breast reconstruction is bound to be affected. Some are modified versions of classic musculocutaneous flaps (such as the thoracodorsal perforator flap), which have been widely recognized in clinical practice. Some of these flaps are theoretically promising, have few clinical applications, and must be further developed and studied (such as intercostal artery perforator flaps based on pedicled chest wall perforator flaps and superior abdominal artery perforator flaps). Breast reconstruction surgery is a highly personalized surgery, and one or two mainstream techniques cannot solve all breast reconstruction problems. Therefore, the application of the pedicled perforator flap in chest wall volume replacement technique can expand the idea of breast preservation more flexibly, which is the direction of minimally invasive breast cancer surgery and can better serve patients.\u003c/p\u003e \u003cp\u003eVolumetric replacement for plastic breast-conserving surgery involves the use of island or pedicled chest wall fascia skin perforator flaps to fill the volume removed during lumpectomy. This technique is suitable for patients with a large tumor/breast volume ratio and small or sagging breasts that cannot be reconstructed to remove defects via the volumetric transfer technique. In this study, the average length and diameter of tumors in the breast preservation group determined via the volumetric displacement technique were 19.51\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08 mm and 26.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17 mm, respectively (P\u0026thinsp;=\u0026thinsp;0.012) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In terms of tumor stage, the proportions of patients with stage II and III disease in the volume replacement group were larger (P\u0026thinsp;=\u0026thinsp;0.005) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), indicating that the extent of repair via the volume replacement method was greater. In addition to removing the tumor, it is also necessary to remove at least 1 cm of the area around the tumor, so the defect will be larger and expected to exceed 20% of the breast volume. If only oncoplastic surgery technique is used, the entire breast volume will be reduced, and fullness and aesthetics will also be reduced.\u003c/p\u003e \u003cp\u003eThe perforator flap was first proposed by Kroll et al.\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e [9] and Koshima et al.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e [10] in 1988 and 1989, respectively. An axial vascular flap containing skin or subcutaneous tissue with blood supplied by perforator vessels with a small diameter (0.5\u0026thinsp;~\u0026thinsp;0.8 mm) was used. The vascular pedicle of the perforator flap with the pedicle should have at least one perforator vessel with a diameter greater than 0.5 mm, the flap should not be restricted by a strict aspect ratio, the pedicle of the flap should not be swollen, and the flap can be covered by 180\u0026deg; rotation. The disadvantage of this approach is that the separation technique is delicate and complex, and the technical requirements for the surgeon are high. In this study, the operation time was bound to increase if the perforator flap was free, but the time was gradually shortened with the improvement of the learning curve, especially for breast preservation surgery, which required nearly 1 hour the intraoperative histology, which was just enough time to separate the anatomic perforator vessels. In this study, the average operation duration in the volume replacement group was 62 minutes longer than that in the volume displacement group (178.63\u0026thinsp;\u0026plusmn;\u0026thinsp;43.71vs.116.51\u0026thinsp;\u0026plusmn;\u0026thinsp;30.33(P\u0026thinsp;=\u0026thinsp;0.006)). It is believed that after improving patient proficiency, the operation time can be further shortened. In terms of postoperative recovery, the drainage time was shorter in the volume replacement group (10.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28 vs. 13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80), indicating that the breast defect was effectively filled and that wound healing was better promoted. Moreover, there was no significant difference in the complication rate between the two groups (10.53% vs. 8.11%, P\u0026thinsp;=\u0026thinsp;0.719).The survival curve showed no difference in DFS between the two groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e6\u003c/span\u003e), while the VR-OBCS group had larger tumors and later stages (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), indicating that as long as negative margins were ensured, VR-OBCS was comparable to VD-OBCS in terms of tumor safety.\u003c/p\u003e \u003cp\u003eIn this study, there was no statistically significant difference in BMI between the two groups (23.75\u0026thinsp;\u0026plusmn;\u0026thinsp;3.03 vs. 23.60\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86, P\u0026thinsp;=\u0026thinsp;0.829), and both groups of patients were successfully breast-preserved. In terms of intraoperative secondary incisional margins, there were no positive intraoperative incisal margins in the volume replacement group, while positive intraoperative incisal margins occurred in 3 patients in the volume displacement group (P\u0026thinsp;=\u0026thinsp;0.073). Moreover, there was no significant difference between the two groups, so the safety of these procedures was comparable (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Hamdi et al.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003eshowed that among patients receiving immediate breast reconstruction, the utilization rate of volume replacement technique in the high body mass index group reached 22%. In addition, other studies have shown that volume replacement technique is used mainly for people with a low body mass index\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. SchaverienMV et al. \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e reported that standard volumetric displacement methods (such as local tissue rearrangement or breast fixation/reduction) were not suitable for small breasts, but the pedicled perforator flap of the chest wall could achieve considerable breast volume and improve the success rate of breast preservation in patients with small breasts. In this study, BMI can be used only as a reference for the choice of volume replacement, which mainly depends on the size of the breast and the subcutaneous fat thickness of the surrounding tissue. For women in southern China, the breast volume is generally smaller, so volume replacement technique has greater applicability.\u003c/p\u003e \u003cp\u003eTips for choosing perforator : Local pedicled perforator flaps of the chest wall can be divided into three types according to the donor site: (1) Anterior intercostal artery perforator flaps (AICAP). A central breast defect is reconstructed by using soft tissue from anterior intercostal blood vessels distributed in an island shape under the inferior breast fold \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Khouri and Angrigiani described the use of a lateral basal anterior intercostal artery perforator flap for volume recovery after prosthetic breast reconstruction [14] (Figure. 2). (2) Medial intercostal artery perforator (MICAP)/superior epigastric artery perforator flap (SEAP). The middle intercostal artery is a perforator flap based on the internal branch of the mammary gland or the anterior intercostal vessel, while the perforator flap of the superior epigastric artery is an internal thoracic artery that passes through the diaphragm into the sheath of the rectus abdominis in the anterior abdominal wall and transits into the superior epigastric artery, which is in line with the inferior epigastric artery, and its perforator branch emerges from the intercostal or from the rectus abdominis muscle to the anterior sheath of the surface (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The above two types of flaps can be used alone or in combination to reconstruct medial and inferior breast defects\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. (3) A perforator flap taken from the lateral chest wall, including the lateral intercostal artery perforator (LICAP)\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e) and the perforator branch of the lateral thoracic artery\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e flap (LTAP) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e), was used for volumetric replacement repair of the tumor resection defect in the lateral third of the breast. In this study, it was found that these perforator flaps are close to the breast and can be used alone or that two adjacent perforator flaps can be used together in one flap. For example, the anterior intercostal artery combined with the superior epigastric artery repaired defects in the lower and lower quadrants of the breast, the anterior intercostal artery combined with the lateral intercostal artery repaired external inferior and inferior quadrant defects, the lateral thoracic artery combined with the lateral intercostal perforator flap repaired external quadrant defects, and the lateral intercostal artery combined with the dorsal thoracic artery perforator flap repaired lateral and outer upper quadrant defects (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The use of a thoracodorsal artery perforator flap not only prevents the possibility of partial or total latissimus dorsi muscle repair but also prevents the complication of intramuscular perforator branch detachment. In this study, 15 cases involving a single perforator and 23 cases involving a combined perforator were used. The application of combined perforators greatly improved the survival rate of the flaps.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSurgical technique:(1)Try to use a magnifying glass and bipolar to dissect the perforating vessels.(2)Choose flap or fascial flap according to the relationship between tumor and skin.(3)In axillary surgery, LTA (lateral thoracic artery) and LTV (lateral thoracic vein) were found first and routinely preserved. If the axillary node is positive, LTA and TDA (perforator of thoracodorsal artery) should be carefully protected during axillary dissection.LTAP can be used for LICA injury. If neither of them is available, the latissimus dorsi descending branch myocutaneous flap can be used(no need to change position during surgery).(4)The vascular pedicle should be as long as possible to avoid vasospasm caused by traction, and the muscle should be cut if necessary.\u003c/p\u003e \u003cp\u003eCompared to the volumetric displacement method, scar selection is more diverse and concealed: the lateral and anterior areas of the chest wall have a rich blood supply, so the flap design can be extended laterally to form an aesthetically pleasing scar within the natural boundary of the chest wall, which can be well hidden within the inner band area. For the anterior intercostal artery perforator flap and the epigastric artery perforator flap, an incision can be made in the lower fold,for patients with breast sagging, the scar is not visible from the front, thus increasing patient\u0026rsquo;s appearance and confidence. In addition, the volume replacement method does not require nipple areolar repositioning, so the nipple-areolar complex can be preserved, but some of the volume replacement methods can extend the surgical scar to the outer breast area while maintaining the integrity of the breast skin. This study revealed that most patients in the experimental group were still in the edema stage of the skin flap in the first month and that the local breast tissue was hard; however, by the third month after surgery, the feel of the defect was obviously soft, which was close to the normal breast tissue.In two cases, local hardening and skin collapse occurred at the edge of the skin flap after radiotherapy,which was considered to be due to the inhibitory effect of radiotherapy on angiogenesis..\u003c/p\u003e \u003cp\u003eTherefore, the aesthetic effect and patient satisfaction of the proposed method must be further studied. This study has several limitations, such as a short follow-up time (median follow-up time was 27 months) and long recurrence and survival of patients with breast cancer; thus, long-term observation and prognostic evaluation are needed.\u003c/p\u003e"},{"header":"5 Conclusions","content":"\u003cp\u003eThere is abundant blood supply in the lateral and anterior regions of the chest wall. Therefore, compared with deep inferior epigastric perforator flap (DIEP) flaps, pedicled perforator flaps of the chest wall need no vascular anastomoses. The dissection of blood vessels in the donor region of these local fascial flaps is relatively easy. Technically, it is only necessary to locate the perforator with preoperative color Doppler and separate blood vessels with surgical magnifying glass, which greatly reduces the operation time and difficulty. Compared with VD-OBCS, VR-OBCS has significant application prospects and can ensure the fullness of breast shape and prevent a large reduction in breast volume after breast conservation to further improve the possibility and confidence of patients with breast conservation, provide a basis for the clinical formulation of breast cancer surgery plans and strategies and improve the aesthetic effect of patients' breasts as well as their quality of life.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical Approval\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by the Ethics Committee of Guangxi Medical University Cancer Hospital (Approval No. KYB2023097). Written informed consent was obtained from all participants prior to study enrollment.All methods were carried out in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBin Lian: conceptualization, methodology, follow-up, survey questionnaire\u003c/p\u003e\n\u003cp\u003eHuihui Yang: writing - original draft, perforator localization\u003c/p\u003e\n\u003cp\u003eQinghong Qin: operation, formal analysis\u003c/p\u003e\n\u003cp\u003eZhen Huang: operation\u003c/p\u003e\n\u003cp\u003eWei Wei: Funding acquisition\u003c/p\u003e\n\u003cp\u003eHuotang Qin: Data collection\u003c/p\u003e\n\u003cp\u003eYanlin Huang: data collection\u003c/p\u003e\n\u003cp\u003e#Qinguo Mo: Writing - Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e#Changyuan Wei: Supervision\u003c/p\u003e\n\u003cp\u003e*Bin Lian and Huihui Yang contributed equally to this work.\u003c/p\u003e\n\u003cp\u003e# Changyuan Wei and Qinguo Mo contributed equally to this work.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis article was supported by the Guangxi Health Commission self-funded project (No.Z20210117)，Basic ability improvement project for young and middle-aged teachers in Guangxi universities(2025KY0124).Guangxi Medical University College Student Innovation and Entrepreneurship Project (No.X202410598380),(No.X202410598383),Key Laboratory of Breast Cancer Diagnosis and Treatment Research of Guangxi Department of Education.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eData Accessibility:Under privacy protection protocols, de-identified datasets are available from the corresponding author upon approval by the ethics committee (Contact:[email protected]).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCarter SA, Lyons GR, Kuerer HM, et al. Operative and Oncologic Outcomes in 9861 Patients with Operable Breast Cancer: Single-Institution Analysis of Breast Conservation with Oncoplastic Reconstruction[J]. Ann Surg Oncol. 2016;23(10):3190\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKouwenberg Ca, De E KM, Kranenburg LW, et al. Long-Term Health-Related Quality of Life after Four Common Surgical Treatment Options for Breast Cancer and the Effect of Complications: A Retrospective Patient-Reported Survey among 1871 Patients[J]. Plast Reconstr Surg. 2020;146(1):1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarrasco-L\u0026oacute;pez C, Julian Iba\u0026ntilde;ez JF, Vil\u0026agrave; J, et al. Anterior intercostal artery perforator flap in immediate breast reconstruction: Anatomical study and clinical application[J]. Microsurgery. 2017;37(6):603\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamdi M, Van Landuyt K, De Frene B, et al. The versatility of the inter-costal artery perforator (ICAP) flaps[J]. J Plast Reconstr Aesthet Surg. 2006;59(6):644\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamdi M, Van Landuyt K, Monstrey S, et al. Pedicled perforator flaps in breast reconstruction: a new concept[J]. Br J Plast Surg. 2004;57(6):531\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChartier C, Safran T, Alhalabi B, et al. Locoregional perforator flaps in breast reconstruction: An anatomic review \u0026amp; quadrant algorithm[J]. J Plast Reconstr Aesthet Surg. 2022;75(4):1328\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHwang KT, Kim SW, Kim YH. Anatomical variation of the accessory thoracodorsal artery as a direct cutaneous perforator[J]. Clin Anat. 2013;26(8):1024\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects[J]. Plast Reconstr Surg. 1988;81(4):561\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle[J]. Br J Plast Surg. 1989;42(6):645\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamdi M, Van Landuyt K, Blondeel P, et al. Autologous breast augmentation with the lateral intercostal artery perforator flap in massive weight loss patients[J]. J Plast Reconstr Aesthet Surg. 2009;62(1):65\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchaverien MV, Kuerer HM, Caudle AS, et al. Outcomes of Volume Replacement Oncoplastic Breast-Conserving Surgery Using Chest Wall Perforator Flaps: Comparison with Volume Displacement Oncoplastic Surgery and Total Breast Reconstruction[J]. Plast Reconstr Surg. 2020;146(1):14\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacmillan RD, Mcculley SJ. Oncoplastic Breast Surgery: What, When and for Whom?[J]. Curr Breast Cancer Rep. 2016;8:112\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMangialardi ML, Baldelli I, Salgarello M, et al. Breast Reconstruction Using the Lateral Thoracic, Thoracodorsal, and Intercostal Arteries Perforator Flaps[J]. Plast Reconstr Surg Glob Open. 2021;9(1):e3334.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcculley SJ, Schaverien MV, Tan VK, et al. Lateral thoracic artery perforator (LTAP) flap in partial breast reconstruction[J]. J Plast Reconstr Aesthet Surg. 2015;68(5):686\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, Oncoplastic, perforator flap, breast conserving surgery","lastPublishedDoi":"10.21203/rs.3.rs-6195577/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6195577/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo evaluate the clinical efficacy, aesthetic outcomes, and safety profiles of volume displacement oncoplastic breast-conserving surgery (VD-OBCS) versus volume replacement oncoplastic breast-conserving surgery (VR-OBCS) utilizing pedicled chest wall perforator flaps in breast cancer patients.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis retrospective cohort study enrolled 75 patients undergoing breast-conserving surgery between February 2021 and August 2022. Patients were stratified into two groups: VR-OBCS (n\u0026thinsp;=\u0026thinsp;38) and VD-OBCS (n\u0026thinsp;=\u0026thinsp;37). Comparative analyses included tumor characteristics, operative parameters, complication rates, margin positivity, and disease-free survival (DFS). Aesthetic outcomes were assessed via standardized photographic evaluation and patient-reported satisfaction.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe VR-OBCS cohort exhibited significantly larger tumor diameters (26.21\u0026thinsp;\u0026plusmn;\u0026thinsp;11.17 mm vs. 19.57\u0026thinsp;\u0026plusmn;\u0026thinsp;11.08 mm, P\u0026thinsp;=\u0026thinsp;0.012) and longer operative durations (178.63\u0026thinsp;\u0026plusmn;\u0026thinsp;43.71 vs. 116.51\u0026thinsp;\u0026plusmn;\u0026thinsp;30.33 minutes, P\u0026thinsp;=\u0026thinsp;0.006) compared to VD-OBCS. Conversely, VR-OBCS demonstrated shorter drainage tube retention (10.79\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28 vs. 13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;6.80 days, P\u0026thinsp;=\u0026thinsp;0.011) and comparable complication rates (10.5% vs. 8.1%, P\u0026thinsp;=\u0026thinsp;0.719). Margin positivity rates were 0% in VR-OBCS versus 8.1% in VD-OBCS (P\u0026thinsp;=\u0026thinsp;0.073). No significant differences in DFS were observed (log-rank P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eVR-OBCS with pedicled perforator flaps offers superior defect repair capacity, concealed scarring, and shorter recovery in patients with larger tumors or limited breast volume. Both techniques achieve equivalent oncologic safety when negative margins are secured.\u003c/p\u003e","manuscriptTitle":"Comparative Analysis of Volume Displacement versus Volume Replacement Oncoplastic Breast-Conserving Surgery with Pedicled Chest Wall Perforator Flaps: A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-15 16:21:05","doi":"10.21203/rs.3.rs-6195577/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd39ddb0-e404-48eb-a39a-df93532e6fee","owner":[],"postedDate":"April 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-26T05:24:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-15 16:21:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6195577","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6195577","identity":"rs-6195577","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}