{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T07:46:18Z","timestamp":1791963978219,"version":"4.3.4"},"reference-count":31,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Volume\u2010replacement oncoplastic breast\u2010conserving surgery (VR\u2010OBCS) reconstructs the lumpectomy cavity with autologous tissue and spares the contralateral breast. Chest\u2010wall perforator flaps (CWPFs)\u2014lateral, anterior, and medial intercostal artery perforator (LICAP, AICAP, MICAP) flaps\u2014together with a pedicled latissimus dorsi (LD) flap form the usual toolkit, but most programs depend on hand\u2010held color Doppler for perforator mapping and indocyanine\u2010green (ICG) angiography for perfusion assessment, neither of which is widely available in resource\u2010limited oncology units. We evaluated whether a structured radiological assessment using ARR, BEV, and aORV could facilitate preoperative planning for volume replacement oncoplastic breast\u2010conserving surgery (VR\u2010OBCS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive women undergoing VR\u2010OBCS at an Indian tertiary cancer center (January 2023\u2013March 2025) were reviewed retrospectively. Eligibility required an anticipated resection ratio (ARR)\u00a0\u2265\u00a00.15 or expected poor cosmesis after standard BCS; an ARR of 0.20\u20130.40 was the usual planning range for perforator\u2010based volume replacement. Flap choice followed a quadrant\u2010based map; the pedicled LD flap was reserved for defined indications. Perforator zones were identified by intercostal\u2010space counting; color Doppler and ICG were never used. The primary endpoint was primary R0 resection (SSO\u2013ASTRO 2014 \u201cno ink on tumor\u201d); secondary endpoints included flap loss, Clavien\u2013Dindo morbidity, oncological events, and 12\u2010month BREAST\u2010Q satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>One hundred thirty women (mean age 47.7\u00a0\u00b1\u00a05.5\u00a0years) were treated: LICAP in 68 (52.3%), MICAP in 29 (22.3%), AICAP in 21 (16.2%), and pedicled LD in 12 (9.2%); 42.3% received neoadjuvant chemotherapy. Primary R0 was 95.4%, with all six margin\u2010positive women achieving R0 at re\u2010excision (final R0 100%). No total or partial flap loss occurred. Thirty\u2010day morbidity was 25.4% (maximum Clavien\u2013Dindo IIIa) and late morbidity 16.9%. At a median follow\u2010up of 15.9\u00a0months (IQR 12.3\u201322.6), no locoregional or distant recurrence and no disease\u2010related death were recorded. The median BREAST\u2010Q Satisfaction\u2010with\u2010Breasts score was 86 (IQR 78\u201392); none preferred mastectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Simple preoperative calculation of BEV, aORV, and ARR can guide selection between standard or type I oncoplastic BCS, perforator\u2010flap volume replacement, and muscle\u2010based reconstruction. This approach achieved reliable margin clearance, preserved flap viability, and high patient satisfaction without Doppler or ICG, making it a practical planning tool for resource\u2010limited centers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.70569","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:30:57Z","timestamp":1789558257000},"page":"2796-2808","source":"Crossref","is-referenced-by-count":0,"title":["Anticipated Resection Ratio (ARR) Based Flap Selection for Volume\u2010Replacement Oncoplastic Breast\u2010Conserving Surgery: 130 Breast Cancer Patients Cohort From a South Asian Tertiary Cancer Center"],"prefix":"10.1002","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5390-5482","authenticated-orcid":false,"given":"Ashutosh","family":"Mishra","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology Dr. B.\u00a0R. Ambedkar Institute Rotary Cancer Hospital (IRCH) All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7470-0965","authenticated-orcid":false,"given":"Gajendra","family":"Pandit","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Dr. B.\u00a0R. Ambedkar Institute Rotary Cancer Hospital (IRCH) All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1547-1726","authenticated-orcid":false,"given":"Anik","family":"Rathee","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Dr. B.\u00a0R. Ambedkar Institute Rotary Cancer Hospital (IRCH) All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8265-9674","authenticated-orcid":false,"given":"Ekta","family":"Dhamija","sequence":"additional","affiliation":[{"name":"Department of Radio Diagnosis Dr. B.\u00a0R. Ambedkar Institute Rotary Cancer Hospital (IRCH) All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6500-1061","authenticated-orcid":false,"given":"Ajay","family":"Gogia","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.\u00a0R. Ambedkar Institute Rotary Cancer Hospital (IRCH) All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3296-1041","authenticated-orcid":false,"given":"Amit","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology Dr. B.\u00a0R. Ambedkar Institute Rotary Cancer Hospital (IRCH) All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1934-8408","authenticated-orcid":false,"given":"Atul","family":"Batra","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology Dr. B.\u00a0R. Ambedkar Institute Rotary Cancer Hospital (IRCH) All India Institute of Medical Sciences  New Delhi India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3567-6292","authenticated-orcid":false,"given":"Jyoutishman","family":"Saikia","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology National Cancer Institute All India Institute of Medical Sciences  Jhajjar Haryana India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9326-271X","authenticated-orcid":false,"given":"Sachidanand J.","family":"Bharati","sequence":"additional","affiliation":[{"name":"Department of Oncoanaesthesia &amp; Palliative Medicine Dr. B.\u00a0R. 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