{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:30:11Z","timestamp":1786609811535,"version":"build-2736575974"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T00:00:00Z","timestamp":1779494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004206","name":"The University of Osaka","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004206","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Today"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Breast-conserving surgery with radiotherapy offers outcomes comparable to those of mastectomy. However, margin control and cosmetic results remain challenging, especially for deep or unfavorably located tumors. This study evaluated the S-SMARTS technique (suture-based marking, scar minimizing, and axillary-lateral thoracic fat flap reconstruction with tissue sliding), a hidden-scar, volume displacement method using axillary and lateral thoracic fat flaps. In this single-center retrospective study (Osaka University, Jan 2020\u2013Apr 2025), 44 patients underwent breast-conserving surgery using S-SMARTS. The margin status and cosmetic outcomes (via BCCT.core) were analyzed. Negative margins were achieved in 95.5% of cases on the initial excision and 100% after intraoperative frozen section. The BCCT.core assessment demonstrated that 76.2% of the cases had \u201cGood\/Excellent\u201d and 23.8% had \u201cFair\u201d outcomes. Multivariate analyses were performed to explore any potential predictors of margin positivity. However, no statistically robust predictors were identified. S-SMARTS demonstrates technical feasibility and acceptable early oncologic and aesthetic outcomes in a single-surgeon cohort. Further comparative and multi-institutional studies are warranted to validate its oncologic impact, reproducibility, and patient-reported aesthetic benefits.<\/jats:p>","DOI":"10.1007\/s00595-026-03285-1","type":"journal-article","created":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T05:11:06Z","timestamp":1779513066000},"page":"2103-2109","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aesthetic-oriented breast reconstruction: a feasibility study of a novel technique combining Suture-Based Marking Scar Minimising and Axillary-Lateral Thoracic Fat Flap Reconstruction with Tissue Sliding (S-SMARTS)"],"prefix":"10.1007","volume":"56","author":[{"given":"Hui Ying","family":"Khoo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5963-652X","authenticated-orcid":false,"given":"Yoshiaki","family":"Sota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenzo","family":"Shimazu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,23]]},"reference":[{"issue":"11","key":"3285_CR1","doi-asserted-by":"publisher","first-page":"6413","DOI":"10.1245\/s10434-023-13784-x","volume":"30","author":"E Vasilyeva","year":"2023","unstructured":"Vasilyeva E, Hamm J, Nichol A, Isaac KV, Bazzarelli A, Brown C, et al. Breast-conserving therapy is associated with improved survival without an increased risk of locoregional recurrence compared with mastectomy in both clinically node-positive and node-negative breast cancer patients. Ann Surg Oncol. 2023;30(11):6413\u201324. https:\/\/doi.org\/10.1245\/s10434-023-13784-x.","journal-title":"Ann Surg Oncol"},{"issue":"6","key":"3285_CR2","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1002\/jso.27408","volume":"128","author":"K Armstrong","year":"2023","unstructured":"Armstrong K, Maxwell J. Oncoplastic surgery for breast cancer: Global perspectives and trends. J Surg Oncol. 2023;128(6):967\u201371. https:\/\/doi.org\/10.1002\/jso.27408.","journal-title":"J Surg Oncol"},{"issue":"2","key":"3285_CR3","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1002\/jso.27294","volume":"128","author":"MM Karamchandani","year":"2023","unstructured":"Karamchandani MM, Jonczyk MM, De La Cruz Ku G, Gaffney KA, Wareham C, Nardello S, et al. The adoption of oncoplastic surgery: Is there a learning curve? J Surg Oncol. 2023;128(2):189\u201395. https:\/\/doi.org\/10.1002\/jso.27294.","journal-title":"J Surg Oncol"},{"key":"3285_CR4","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.breast.2021.08.012","volume":"60","author":"H Wj","year":"2021","unstructured":"Wj H, As E, Js R, C P, Dh B. Rates of margin positive resection with breast conservation for invasive breast cancer using the ncdb. Breast. 2021;60:86\u20139. https:\/\/doi.org\/10.1016\/j.breast.2021.08.012.","journal-title":"Breast"},{"key":"3285_CR5","doi-asserted-by":"publisher","unstructured":"Bundred JR, Michael S, Stuart B, Cutress RI, Beckmann K, Holleczek B, et al. Margin status and survival outcomes after breast cancer conservation surgery: Prospectively registered systematic review and meta-analysis. BMJ. 2022;378(e070346). https:\/\/doi.org\/10.1136\/bmj-2022-070346.","DOI":"10.1136\/bmj-2022-070346"},{"issue":"6","key":"3285_CR6","doi-asserted-by":"publisher","first-page":"e2316878","DOI":"10.1001\/jamanetworkopen.2023.16878","volume":"6","author":"SL Kastora","year":"2023","unstructured":"Kastora SL, Holmquist A, Valachis A, Rocco N, Meattini I, Somaiah N, et al. Outcomes of different quality of life assessment modalities after breast cancer therapy: A network meta-analysis. JAMA Netw Open. 2023;6(6):e2316878. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.16878.","journal-title":"JAMA Netw Open"},{"issue":"3","key":"3285_CR7","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s10549-017-4306-5","volume":"164","author":"C Dahlb\u00e4ck","year":"2017","unstructured":"Dahlb\u00e4ck C, Ullmark JH, Rehn M, Ringberg A, Manjer J. Aesthetic result after breast-conserving therapy is associated with quality of life several years after treatment. Swedish women evaluated with bcct.Core and breast-q\u2122. Breast Cancer Res Treat. 2017;164(3):679\u201387. https:\/\/doi.org\/10.1007\/s10549-017-4306-5.","journal-title":"Breast Cancer Res Treat"},{"key":"3285_CR8","doi-asserted-by":"publisher","unstructured":"Franca FC, de Oliveira-Junior I, Morgan AM, Haikel RL, da Costa Vieira RA. Breast-conserving surgery with the geometric compensation\/split reduction technique. Indications, oncologic safety and cosmesis. A cohort series and systematic review of the literature. Surg Oncol. 2022;44(101839). https:\/\/doi.org\/10.1016\/j.suronc.2022.101839.","DOI":"10.1016\/j.suronc.2022.101839"},{"key":"3285_CR9","doi-asserted-by":"publisher","unstructured":"Soliani Bastos MC, Bagnoli F, Rinaldi JF, Jo\u00e3o TBF, de Oliveira VM. Dermoglandular advancement-rotation flap for conservative treatment of breast cancer - description of technique, objective and subjective assessments. Front Oncol. 2023;13(1137924). https:\/\/doi.org\/10.3389\/fonc.2023.1137924.","DOI":"10.3389\/fonc.2023.1137924"},{"issue":"1","key":"3285_CR10","doi-asserted-by":"publisher","first-page":"80","DOI":"10.4048\/jbc.2015.18.1.80","volume":"18","author":"Y Nohara","year":"2015","unstructured":"Nohara Y, Hanamura N, Zaha H, Kimura H, Kashikura Y, Nakamura T, et al. Cosmetic evaluation methods adapted to asian patients after breast-conserving surgery and examination of the necessarily elements for cosmetic evaluation. J Breast Cancer. 2015;18(1):80\u20136. https:\/\/doi.org\/10.4048\/jbc.2015.18.1.80.","journal-title":"J Breast Cancer"},{"issue":"1","key":"3285_CR11","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1002\/bjs.10963","volume":"106","author":"C Dahlb\u00e4ck","year":"2019","unstructured":"Dahlb\u00e4ck C, Ringberg A, Manjer J. Aesthetic outcome following breast-conserving surgery assessed by three evaluation modalities in relation to health-related quality of life. Br J Surg. 2019;106(1):90\u20139. https:\/\/doi.org\/10.1002\/bjs.10963.","journal-title":"Br J Surg"}],"container-title":["Surgery Today"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00595-026-03285-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00595-026-03285-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00595-026-03285-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T08:01:02Z","timestamp":1786608062000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00595-026-03285-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,23]]},"references-count":11,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["3285"],"URL":"https:\/\/doi.org\/10.1007\/s00595-026-03285-1","relation":{},"ISSN":["0941-1291","1436-2813"],"issn-type":[{"value":"0941-1291","type":"print"},{"value":"1436-2813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,23]]},"assertion":[{"value":"4 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 March 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"We have no conflicts of interest to declare.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Ethics Committee of Osaka University (Approval No. K25093). Informed consent was obtained using an opt-out approach. All analyses were conducted in accordance with the Institutional Ethical Guidelines and the Declaration of Helsinki and its later amendments.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}}]}}