In recent years, with improvements in early breast cancer screening and evolving treatment paradigms, breast-conserving surgery (BCS) has seen increasingly widespread use in clinical practice. However, the incidence of postoperative breast deformities remains high. These deformities—ranging from asymmetry and contour depressions to scarring—compromise the aesthetic integrity of the breast and may lead to psychological distress and social withdrawal (6), thereby significantly impairing patients’ quality of life. A systematic review by Berry et al. reported that the incidence of poor cosmetic outcomes following BCS ranges from 5% to 30% (7). Although the introduction of oncoplastic techniques has aimed to mitigate the disadvantages associated with conventional BCS (8), postoperative deformities still persist. Iwuchukwu and colleagues reviewed the literature and noted that 5% to 14% of patients continued to experience suboptimal cosmetic outcomes even after oncoplastic surgery (9). This suggests that while oncoplastic approaches may reduce the risk of aesthetic complications compared to traditional BCS, they do not eliminate them entirely (6). Moreover, adjuvant radiotherapy often induces tissue fibrosis and skin pigmentation, further contributing to the development of postoperative deformities (10). As survival rates improve, there is a growing clinical emphasis on both functional and aesthetic restoration. Accordingly, the prevention and correction of breast deformities after BCS have become key areas of focus in breast surgery.

Currently, a wide range of surgical techniques are available for correcting breast deformities following BCS. With advances in reconstructive surgery, local perforator flaps such as the anterior intercostal artery perforator (AICAP) flap, thoracodorsal artery perforator (TDAP) flap, and lateral intercostal artery perforator (LICAP) flap have proven effective in repairing post-BCS breast defects. Studies have shown that flap techniques can safely restore breast contour (11). Li Xie reported that among patients who underwent chest wall perforator flap reconstruction, only one case of tumor recurrence was observed during a median follow-up period of 14.5 months, with no reported deaths (12). Pujji reviewed 11 studies published between 1990 and 2020 involving a total of 432 cases using perforator flap techniques. After a mean follow-up period of 21 months (range 1 – 49 months), only one case of local recurrence was observed (13). Similarly, in a study by Roy, 105 patients underwent lateral chest wall perforator flap reconstruction, with a reported local recurrence rate of 2% and an overall survival rate of 94.8% during a median follow-up of 4.5 years (14).

Autologous fat grafting (AFG) is another well-established method for addressing localized volume deficits. Evidence suggests that AFG does not increase the risk of cancer recurrence (15). A comprehensive analysis of all oncoplastic breast reconstruction cases using AFG—identified through searches of PubMed, Embase.com, Wiley/Cochrane Library, and Web of Science from January 1996 to November 2014—found no evidence of cancer recurrence or significant complications, affirming the oncologic safety of fat grafting (16). Federico Lo Tort conducted a meta-analysis that included 40 studies, encompassing 7,619 patients who underwent autologous fat grafting (AFG), with a reported overall local recurrence rate (LRR) of 3.15%. In comparison, among 6,459 patients who did not receive AFG, the LRR was 5.3%. The analysis found no significant association between AFG and an increased risk of local recurrence, further confirming that autologous fat grafting is a safe and feasible adjunctive reconstructive technique (17).

For patients presenting with macromastia or breast asymmetry following BCS, reduction mammaplasty and mastopexy are often recommended. These procedures have not been shown to increase the risk of tumor recurrence, and their complications are generally controllable, supporting their safety (18). In a study investigating contralateral breast adjustment following breast-conserving surgery, 77 patients underwent immediate oncoplastic reconstruction along with contralateral symmetrization. During a 5-year follow-up period, the local recurrence rate was 4.1%. These findings suggest that contralateral symmetrization in the context of oncoplastic surgery is a safe and effective therapeutic strategy (19). In a study by Maurizio B. Nava and colleagues, patients were divided into three groups based on the type of contralateral breast reshaping technique: Group 1 underwent mastopexy or reduction mammaplasty with an inferior dermoglandular flap; Group 2 underwent mastopexy or reduction without the flap; and Group 3 did not receive any contralateral reshaping. The incidence of contralateral metachronous breast cancer was assessed, and no statistically significant difference was found among the groups (8.6% in Group 1, 8.6% in Group 2, and 5.7% in Group 3; p=0.87). These findings indicate that contralateral reshaping procedures such as mastopexy and reduction are highly safe following breast reconstruction. Additionally, parenchymal rearrangement during oncoplastic surgery does not impair the ability of imaging techniques to detect subsequent malignancies (20). Similarly, Muir’s study confirmed that breast changes following reduction mammaplasty do not significantly interfere with the detection of cancer on mammography (21). Collectively, these findings indicate that surgical correction of post-BCS deformities is both safe and clinically effective. Given the variations in postoperative complications among different surgical techniques, a summary is presented in Table 1 .

With the ongoing refinement of breast-conserving techniques, the concept of oncoplastic surgery has emerged as a critical advancement in the field. According to the American Society of Breast Surgeons, oncoplastic techniques are generally categorized into two approaches: volume displacement and volume replacement (8). Volume displacement involves redistributing the remaining breast tissue to fill the defect after resection, while volume replacement entails augmenting the defect using flaps or implants to restore volume after partial mastectomy. The Clough classification further divides oncoplastic procedures into Level I and Level II. Level I procedures involve the resection of less than 20% of breast tissue and typically include minor reshaping techniques such as glandular mobilization and nipple–areola complex repositioning. Level II procedures address more extensive resections (20%–50% of breast tissue) and require volume displacement or replacement to restore breast contour (22). A Spanish study found that the 10-year incidence of cosmetic sequelae following Level I and Level II oncoplastic surgery was 11.5% and 20.0%, respectively (23). In addition, patients with noticeable breast deformities often experience substantial psychological distress, which negatively affects self-esteem and body image, leading to symptoms of anxiety and depression (24). Therefore, achieving optimal aesthetic outcomes not only helps reduce postoperative psychological burden but also significantly improves patients’ overall quality of life (25).

A study by P.Berrino et al. demonstrated that 78% of patients with Grade II deformities who underwent corrective surgery achieved good to excellent cosmetic outcomes (26). Similarly, a retrospective study by Michael S. Chin and colleagues involving 12 patients who received reduction mammoplasty or mastopexy reported satisfactory aesthetic results and acceptable breast symmetry in all cases (27). Sherif Youssif et al. treated 30 patients with post-BCS deformities using flap-based reconstruction methods—including muscle-sparing latissimus dorsi (MSLD) flaps, TDAP flaps, and ICAP flaps—and found a 94% overall satisfaction rate among patients (28). These findings support the conclusion that correcting post-BCS deformities significantly improves breast appearance and, in turn, enhances patients’ quality of life.

In previous studies, a lack of standardized tools for evaluating patient satisfaction and aesthetic outcomes has been noted, with most satisfaction data derived from case series being largely subjective. In response, several objective assessment tools have recently been introduced for evaluating postoperative outcomes. For instance, computer-based programs such as BCCT. Core (Breast Cancer Conservative Treatment: Core) have been widely promoted for the objective scoring of cosmetic outcomes in breast-conserving treatment (29); Digital 3D scanning technologies have also been utilized to quantify morphological changes in breast contour with greater precision (30); Additionally, patient-reported outcome measures (PROMs), such as the BREAST-Q, EORTC QLQ-C30, and QLQ-BRECON23, have been incorporated to assess patient satisfaction and quality of life more comprehensively (31). The use of these tools enables a more accurate and multidimensional assessment of postoperative outcomes from the patient’s perspective.

A study conducted by the University of Texas found that among women dissatisfied with their cosmetic outcomes following BCS, 46.2% expressed interest in undergoing breast reconstruction (32). Notably, 70% of participants in the study were of Hispanic descent. Panchal et al. reported on the evolving trends in post-mastectomy breast reconstruction in the United States, noting that by 2015, the average reconstruction rate had risen to 54% (33). Compared to patients in Western countries, who generally demonstrate a stronger desire for correction, Chinese women with post-BCS deformities exhibit relatively low levels of willingness to pursue reconstructive surgery. A multicenter domestic survey reported that only 9.6% of breast cancer patients expressed interest in reconstruction (34). This hesitation may be attributed to a complex interplay of factors, including age, employment status, educational background, household income, financial burden, and awareness or perception of reconstructive options. As shown in Table 2 .

For patients with a strong desire for correction, selecting an appropriate surgical approach is crucial. Common techniques include: 1. Flap-based reconstruction – such as local tissue advancement flaps, latissimus dorsi (LD) flaps, thoracodorsal artery perforator (TDAP) flaps, and deep inferior epigastric perforator (DIEP) flaps; 2. Reduction mammaplasty, mastopexy, or implant placement; 3. Autologous fat grafting or liposuction; 4. Scar revision or secondary reconstruction modifications. As shown in Table 3 . Selection should consider various factors, including defect size and location, breast volume, and surgeon expertise. Studies indicate that for patients with unsatisfactory cosmetic results, local flap reconstruction and fat grafting are more commonly used on the affected side, while reduction mammaplasty is more often performed on the contralateral breast to improve symmetry (64). Autologous fat grafting is especially promising due to its minimal scarring and relatively low complication rates (65). It is generally preferred for small-volume defects, whereas flap reconstruction or reduction/mastopexy with contralateral adjustment is recommended for larger defects. Currently, no universally accepted standard exists for selecting the optimal surgical approach, and evidence-based guidelines are yet to be established.

In addition to surgical repair, a comprehensive patient-centered strategy should incorporate psychological support. As shown in Figure 1 . Surgical treatment can alter body image, which in turn influences both the patient’s willingness to undergo correction and the choice of procedure. Surgeons should explore patients’ perspectives on appearance and body image (66), and consider preoperative cognitive behavioral therapy or stress management interventions (67), Postoperative body image education and peer support groups can further facilitate recovery. Artificial intelligence (AI) and deep learning also show promise in preoperative planning and outcome prediction (68). For example, AI-based breast imaging analysis can simulate postoperative contours and guide personalized surgical planning (69). Three-dimensional surface imaging (3D-SI) provides objective quantification of cosmetic outcomes (30). Such tools may significantly enhance the precision and personalization of deformity correction.

To address the multifaceted factors influencing Chinese women’s willingness to undergo corrective surgery after BCS, several practical strategies should be implemented—ranging from physician communication and public education to policy reform and insurance coverage.

First, medical professionals should enhance health education regarding breast deformity correction and diversify the channels through which patients receive information. Lack of knowledge or misconceptions may deter patients from pursuing corrective procedures. Surgeons should use verbal explanations, visual aids, internet resources, and videos to communicate accurate, evidence-based information (70). In recent years, shared decision-making (SDM) and patient education have been increasingly emphasized (71). When multiple surgical options are available, patients should be provided with counseling services and actively involved in treatment planning. Surgeons must also take patients’ aesthetic preferences into account—for example, offering tailored reconstructive approaches based on different breast shapes—and consider simultaneous contralateral surgery (e.g., reduction or mastopexy) to achieve symmetry.

Second, surgeons should implement personalized psychological interventions. Existing studies show that cognitive behavioral therapy (CBT) aimed at reducing body image anxiety can significantly improve postoperative adjustment (67). Fear of cancer recurrence (FCR) is a major concern among survivors and is defined as “fear, worry, or concern about cancer returning or progressing.” (72). Simard et al. found that FCR negatively impacts emotional well-being, quality of life, and daily functioning. Tailored CBT interventions have been shown to significantly reduce FCR and related maladaptive behaviors (73). These interventions have demonstrated clinical efficacy and feasibility in large randomized controlled trials, such as the SWORD study (74), and case reports have further illustrated their practical application (75). Introducing such interventions in China would represent both a clinical advancement and a systemic challenge.

Finally, more attention should be paid to spousal support and healthcare policy. Partners should be encouraged to respect and support patients’ decisions, empowering them to pursue surgery with confidence. Economic concerns are among the primary reasons for declining reconstruction (76), underscoring the importance of financial support from spouses and families. The Women’s Health and Cancer Rights Act (WHCRA), enacted in the United States in 1998, significantly strengthened the protection of patients’ rights to undergo breast reconstruction. A study by Rachel L. Yang et al. demonstrated that following the implementation of this legislation, the rate of immediate breast reconstruction increased by 4.2-fold among Medicaid patients, 2.9-fold among Medicare patients, 2.6-fold among privately insured patients, and 2.1-fold among self-paying patients (77). A study from Fudan University Shanghai Cancer Center indicated that the low rate of breast reconstruction in China may be related to limited medical resources. At present, most cancer hospitals in China do not have plastic surgery departments, and the number of breast surgeons is relatively low with heavy workloads, which hinders the application of reconstructive techniques and prolongs the learning curve (78). Based on this, National health authorities should consider expanding insurance coverage for deformity correction procedures and improving resource allocation to help alleviate financial barriers and improve access to care.