Abstract:Background and Aims Oncoplastic breast-conserving surgery (OBCS) integrates oncologic and plastic surgical techniques and includes two primary approaches: volume displacement and volume replacement. The pedicled lateral thoracic artery perforator (LTAP) flap is a commonly used technique for volume replacement. Although recent studies in China have confirmed its safety in OBCS, its patient-reported outcomes have not been systematically evaluated, and comparative data with volume displacement techniques remain lacking. Therefore, this study was performed to compare the clinical outcomes and patient satisfaction of LTAP flap versus mammoplasty (volume displacement) in OBCS, to inform surgical decision-making.Methods A retrospective case-control study was conducted, including 106 patients with unilateral stage 0-Ⅲ breast cancer who underwent OBCS at the Affiliated Hospital of Southwest Medical University from January 2023 to June 2024. Patients were divided into the LTAP flap group (27 cases) and the mammoplasty group (79 cases) based on the surgical technique. Intraoperative variables, cosmetic outcomes, postoperative complications, and Breast-Q scores before and after surgery were compared between the two groups.Results There were no significant differences between the two groups in clinicopathological characteristics or preoperative Breast-Q scores (all P>0.05). The LTAP group had longer operative times, larger excised tissue volumes, and greater postoperative drainage volumes (all P<0.001). Postoperative cosmetic outcomes were significantly better in the LTAP group, with a higher rate of excellent-to-good cosmetic results (88.9% vs. 57.3%) and higher Breast-Q scores in breast satisfaction, psychosocial well-being, and physical well-being (all P<0.05). There were no significant differences in complication rates or local recurrence between the two groups (all P>0.05).Conclusion In OBCS, the LTAP flap demonstrates comparable safety to mammoplasty while achieving superior cosmetic outcomes and patient satisfaction. It is particularly suitable for patients with small breast volumes requiring large tissue excision and holds promise for broader clinical application.