Yi Hyung-Suk, Gwak Han, Park Jin-Hyung, Jung Sung-Ui, Choi Jin-Hyuk, Kim Ku-Sang, Kim Yoon-Soo
Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Republic of Korea.
Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan 49267, Republic of Korea.
Cancers (Basel). 2025 Apr 11;17(8):1293. doi: 10.3390/cancers17081293.
: Oncoplastic breast-conserving surgery (OBCS) with acellular dermal matrix (ADM) has gained prominence in contemporary breast cancer management, yet evidence-based guidelines for selecting optimal ADM techniques based on the tumor location remain undefined. This investigation evaluated the impact of the tumor quadrant location and ADM application methodology on aesthetic outcomes, patient satisfaction, and postoperative complications following OBCS. : This retrospective comparative analysis examined 229 patients who underwent OBCS with immediate ADM-based volume replacement (2020-2022) utilizing three distinct techniques: the diced ADM with sheet technique (n = 102), the diced ADM with paste-type micronized technique (n = 70), or the diced ADM-only technique (n = 57). The outcomes were stratified by tumor location (superomedial, superolateral, inferomedial, and inferolateral) and evaluated using validated physician-assessed aesthetic scores (four-point scale), patient satisfaction metrics, and comprehensive complication profiling with 24-month minimum follow-up. : The tumor quadrant location significantly influenced aesthetic outcomes across all techniques ( < 0.001), with superolateral quadrants demonstrating superior results (3.5 ± 0.4). In the superomedial quadrant, the diced ADM with paste-type micronized technique yielded significantly higher aesthetic scores than the diced ADM-only technique (3.2 ± 0.5 vs. 2.8 ± 0.6, = 0.032, Cohen's d = 0.71). In the superolateral quadrant, the diced ADM-only technique achieved superior outcomes compared with the diced ADM with sheet technique (3.6 ± 0.4 vs. 3.4 ± 0.5, = 0.020, d = 0.44). For inferomedial defects, the diced ADM with sheet technique demonstrated significant advantages over the diced ADM-only technique (2.9 ± 0.7 vs. 2.7 ± 0.7, = 0.005, d = 0.29). A consistent discrepancy between physician and patient assessments was observed, particularly in medial quadrant reconstructions (mean difference: 0.2 points, = 0.003). : The optimal ADM technique varied significantly by tumor location. The diced ADM with paste-type micronized technique demonstrated superior outcomes in superomedial defects, the diced ADM with sheet technique provided essential structural support for inferomedial reconstructions, and the diced ADM-only technique achieved excellent results with reduced material requirements in superolateral locations. These findings provide preliminary evidence that may guide quadrant-specific ADM technique selection in OBCS, potentially enhancing aesthetic outcomes, patient satisfaction, and resource utilization.
带脱细胞真皮基质（ADM）的肿瘤整形保乳手术（OBCS）在当代乳腺癌治疗中已备受关注，但基于肿瘤位置选择最佳ADM技术的循证指南仍未明确。本研究评估了肿瘤象限位置和ADM应用方法对OBCS术后美学效果、患者满意度及术后并发症的影响。 ：这项回顾性比较分析研究了229例行OBCS并即刻采用基于ADM的容量替代术（2020 - 2022年）的患者，采用了三种不同技术：带片技术的切碎ADM（n = 102）、带膏状微粉化技术的切碎ADM（n = 70）或仅切碎ADM技术（n = 57）。结果按肿瘤位置（上内侧、上外侧、下内侧和下外侧）分层，并使用经过验证的医生评估美学评分（四分制）、患者满意度指标以及至少随访24个月的全面并发症分析进行评估。 ：肿瘤象限位置在所有技术中均对美学效果有显著影响（<0.001），上外侧象限显示出更好的结果（3.5±0.4）。在上内侧象限，带膏状微粉化技术的切碎ADM产生的美学评分显著高于仅切碎ADM技术（3.2±0.5对2.8±0.6， = 0.032，科恩d = 0.71）。在上外侧象限，仅切碎ADM技术比带片技术的切碎ADM取得了更好的效果（3.6±0.4对3.4±0.5， = 0.020，d = 0.44）。对于下内侧缺损，带片技术的切碎ADM比仅切碎ADM技术显示出显著优势（2.9±0.7对2.7±0.7， = 0.005，d = 0.29）。观察到医生和患者评估之间存在持续差异，特别是在内侧象限重建中（平均差异：0.2分， = 0.003）。 ：最佳ADM技术因肿瘤位置而异。带膏状微粉化技术的切碎ADM在上内侧缺损中显示出更好的效果，带片技术的切碎ADM为下内侧重建提供了重要的结构支撑，仅切碎ADM技术在上外侧位置以减少材料需求取得了优异结果。这些发现提供了初步证据，可能指导OBCS中特定象限的ADM技术选择，潜在地提高美学效果、患者满意度和资源利用。
