Early outcomes of volume replacement using paste-type micronized acellular dermal matrix in oncoplastic...

Surgical approaches in breast cancer have evolved to balance oncologic safety with cosmetic outcomes. Oncoplastic breast-conserving surgery (BCS) was developed to overcome the cosmetic limitations of conventional BCS and has been widely adopted in breast cancer treatment. Although the concept of oncoplastic BCS has been established for decades, breast and plastic surgeons continue to refine surgical techniques to achieve oncologic outcomes that are not inferior while improving aesthetic results. Therefore, this study aimed to evaluate the early postoperative outcomes and safety of oncoplastic BCS using paste-type micronized acellular dermal matrix (ADM) for volume replacement.

This retrospective chart review included 167 female patients who underwent BCS at a single institution between February 2021 and May 2023. Patients were divided into two groups: BCS only (n=94) and BCS with volume replacement using paste-type micronized ADM (n=73). The decision to use ADM was made intraoperatively based on anticipated contour deformity after tumor excision, considering tumor location, defect size, and tissue characteristics, as well as patient preference. To adjust for baseline differences between groups, inverse probability of treatment weighting (IPTW) analysis was performed. Clinicopathologic characteristics, operative variables, and postoperative outcomes were analyzed.

Baseline clinicopathologic characteristics were initially imbalanced between the groups; however, after IPTW adjustment, variables including age and tumor characteristics were well balanced between the two groups. The mean operative time did not differ significantly between the BCS-only group and the ADM group (83.0 vs. 83.6 minutes). Minor postoperative complications were infrequent and included seroma and hematoma, all of which were managed conservatively or with minimal intervention. One patient in the ADM group developed wound dehiscence with associated postoperative infection and subsequently required ADM removal. No cases of red breast syndrome were observed. Cosmetic outcomes were generally acceptable in both groups during early follow-up. Postoperative imaging demonstrated no suspicious findings suggestive of recurrence during early follow-up.

Oncoplastic BCS with volume replacement using paste-type micronized ADM appears to be a safe and technically feasible option with comparable early postoperative outcomes. Given the retrospective design and limited follow-up, further prospective studies with standardized cosmetic assessment and longer follow-up are required to clarify long-term outcomes.