Aesthetic Outcomes and Patient-Reported Outcomes of Volume Replacement (Chest Wall Perforator Flaps) versus Volume Displacement: An Observational Study.

[BACKGROUND] Previous studies on oncoplastic breast-conserving surgery (OBCS) have focused primarily on European-descent populations. However, Chinese women have distinct breast morphological characteristics, such as smaller volume and denser glandular tissue. These anatomical differences may influence the choice of procedure and postoperative outcomes. This study aimed to compare differences in aesthetic outcomes and patient-reported outcomes between volume replacement (VR) and volume displacement (VD) techniques in Chinese patients with breast cancer to clarify the applicability of different surgical approaches.

[METHODS] This study analyzed patients who underwent OBCS with chest wall perforator flaps (CWPFs) or VD at the Affiliated Hospital of Southwest Medical University (Luzhou City, China) from 2022 to 2024. Demographic, surgical, oncological, and complication data were collected. Patients completed the BREAST-Q questionnaire preoperatively and at 12 months postoperatively, and aesthetic outcomes were evaluated using the criteria proposed by Ueda et al. Statistical analysis was performed on baseline characteristics, questionnaire scores, and aesthetic scores.

[RESULTS] A total of 159 patients were included in the analysis. Of these, five underwent mastectomy due to positive margins. The two cohorts showed no significant difference in preoperative BREAST-Q scores. Patients who underwent OBCS with CWPFs reported significant improvements in satisfaction with breasts, physical well-being: chest, and aesthetic outcomes.

[CONCLUSION] Chest wall perforator flaps demonstrated significant advantages in aesthetic and patient-reported outcomes compared with volume displacement. Therefore, they should be offered as an alternative to volume displacement for women with small-to-medium breasts.

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