Volume replacement versus displacement of anterior intercostal artery perforator flap as a reconstructive mode in oncoplastic breast-conserving surgery: A retrospective study

Background: This study aimed to investigate the potential advantages of anterior intercostal artery perforator (AICAP) flap compared to volume displacement (VD) in breast-conserving surgery for cancers located in the lower quadrant of medium to small-sized breasts. Methods: This retrospective comparative study analyzed 68 patients who underwent VD breast-conserving surgery and 27 patients who underwent AICAP flap breast-conserving surgery at the Affiliated Hospital of Southwest Medical University from 2022 to 2024. The patients were categorized into two cohorts: AICAP and VD cohorts. Statistical analysis was performed on baseline characteristics, Breast-Q scale scores and aesthetic scores. Results: The incidences of fibrosis in the surgical area (p < 0.001) and seroma (p = 0.02) were higher in the VD cohort. Moreover, the AICAP cohort indicated greater satisfaction with breasts (p = 0.03), physical well-being chest (p = 0.001) and aesthetic outcomes (p < 0.001) compared to the VD cohort. After balancing inter-cohort confounding via propensity score matching, the AICAP cohort indicated greater satisfaction with breasts (p = 0.01), sex well being (p = 0.04) and aesthetic outcomes (p = 0.01) compared to the VD cohort. The AICAP cohort had longer durations of surgery (p = 0.03) and more blood loss (p = 0.02) than the VD cohort. Conclusion: In the breast-conserving surgery for lower quadrant cancers, AICAP flap demonstrated higher scores in patient-reported outcomes and aesthetic outcomes compared to VD.