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

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.