Background/Objectives: Oncoplastic breast-conserving surgery (OBCS) with acellular dermal matrix (ADM) has gained prominence in contemporary breast cancer management, yet evidence-based guidelines for selecting optimal ADM techniques based on the tumor location remain undefined. This investigation evaluated the impact of the tumor quadrant location and ADM application methodology on aesthetic outcomes, patient satisfaction, and postoperative complications following OBCS.Methods: This retrospective comparative analysis examined 229 patients who underwent OBCS with immediate ADM-based volume replacement (2020–2022) utilizing three distinct techniques: the diced ADM with sheet technique (n = 102), the diced ADM with paste-type micronized technique (n = 70), or the diced ADM-only technique (n = 57). The outcomes were stratified by tumor location (superomedial, superolateral, inferomedial, and inferolateral) and evaluated using validated physician-assessed aesthetic scores (four-point scale), patient satisfaction metrics, and comprehensive complication profiling with 24-month minimum follow-up.Results: The tumor quadrant location significantly influenced aesthetic outcomes across all techniques (p< 0.001), with superolateral quadrants demonstrating superior results (3.5 ± 0.4). In the superomedial quadrant, the diced ADM with paste-type micronized technique yielded significantly higher aesthetic scores than the diced ADM-only technique (3.2 ± 0.5 vs. 2.8 ± 0.6,p= 0.032, Cohen’s d = 0.71). In the superolateral quadrant, the diced ADM-only technique achieved superior outcomes compared with the diced ADM with sheet technique (3.6 ± 0.4 vs. 3.4 ± 0.5,p= 0.020, d = 0.44). For inferomedial defects, the diced ADM with sheet technique demonstrated significant advantages over the diced ADM-only technique (2.9 ± 0.7 vs. 2.7 ± 0.7,p= 0.005, d = 0.29). A consistent discrepancy between physician and patient assessments was observed, particularly in medial quadrant reconstructions (mean difference: 0.2 points,p= 0.003).Conclusions: The optimal ADM technique varied significantly by tumor location. The diced ADM with paste-type micronized technique demonstrated superior outcomes in superomedial defects, the diced ADM with sheet technique provided essential structural support for inferomedial reconstructions, and the diced ADM-only technique achieved excellent results with reduced material requirements in superolateral locations. These findings provide preliminary evidence that may guide quadrant-specific ADM technique selection in OBCS, potentially enhancing aesthetic outcomes, patient satisfaction, and resource utilization.
**背景/目的：** 采用脱细胞真皮基质（ADM）的肿瘤整形保乳手术（OBCS）在当代乳腺癌治疗中日益重要，但基于肿瘤位置选择最佳ADM技术的循证指南尚未明确。本研究评估了肿瘤象限位置和ADM应用方法对OBCS术后美学效果、患者满意度及并发症的影响。 **方法：** 本回顾性比较分析纳入了229例接受OBCS并同期行ADM体积替代的患者（2020–2022年），采用了三种不同技术：片状切块ADM技术（n = 102）、糊状微粒化切块ADM技术（n = 70）和单纯切块ADM技术（n = 57）。根据肿瘤位置（内上、外上、内下、外下象限）对结果进行分层，并使用经过验证的医师评估美学评分（四点量表）、患者满意度指标以及至少24个月随访的全面并发症分析进行评估。 **结果：** 肿瘤象限位置对所有技术的美学效果均有显著影响（p < 0.001），其中外上象限效果最佳（3.5 ± 0.4）。在内上象限，糊状微粒化切块ADM技术的美学评分显著高于单纯切块ADM技术（3.2 ± 0.5 vs. 2.8 ± 0.6, p = 0.032, Cohen's d = 0.71）。在外上象限，单纯切块ADM技术的结果优于片状切块ADM技术（3.6 ± 0.4 vs. 3.4 ± 0.5, p = 0.020, d = 0.44）。对于内下象限缺损，片状切块ADM技术较单纯切块ADM技术显示出显著优势（2.9 ± 0.7 vs. 2.7 ± 0.7, p = 0.005, d = 0.29）。观察到医师与患者评估之间存在一致的差异，尤其是在内侧象限重建中（平均差异：0.2分，p = 0.003）。 **结论：** 最佳ADM技术因肿瘤位置不同而存在显著差异。糊状微粒化切块ADM技术在内上象限缺损中效果最佳；片状切块ADM技术为内下象限重建提供了必要的结构支撑；单纯切块ADM技术在外上象限以更少的材料需求取得了优异效果。这些发现提供了初步证据，可能有助于指导OBCS中基于肿瘤象限的ADM技术选择，从而可能改善美学效果、患者满意度并优化资源利用。
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