Breast-conserving surgery (BCS) is increasingly preferred for early-stage breast cancer; however, conventional oncoplastic approaches may not adequately address large or irregular defects. Acellular dermal matrix (ADM), particularly paste-type formulations, offers a potential solution for volume replacement, though evidence regarding safety, integration, and imaging outcomes remains limited. This retrospective review included 74 patients who underwent BCS with intraoperative paste-type ADM between June 2022 and August 2023. MRI and ultrasonography evaluated ADM integration and postoperative morphology, and complications were recorded. Stratified statistical analyses examined associations among imaging results, clinicopathologic characteristics, ADM volume, and outcomes. Paste-type ADM demonstrated safe integration with a low complication rate (4.1%) and no severe events such as infection or extrusion. MRI showed favorable integration grades (G0–G1) in over half of the patients. Ultrasonography identified three post-ADM morphologies: mass-like, cystic, and gap-type, which were associated with initial ADM volume and patient characteristics. No clinical or imaging variables predicted adverse outcomes, and minor complications were managed conservatively. Paste-type ADM is a reliable, safe, and robust option for volume replacement in breast-conserving surgery, with favorable integration confirmed by MRI and ultrasonography. These findings support its broader use in oncoplastic breast surgery, improving reconstructive strategies and facilitating enhanced oncologic and aesthetic outcomes through multidisciplinary imaging surveillance.
Shin et al. (2026) studied this question.