S-SMARTS Technique Demonstrates Early Promise in Breast Reconstruction Study

Investigators from Osaka University reported favorable early oncologic and cosmetic outcomes with a novel breast-conserving surgery reconstruction approach known as S-SMARTS, according to a feasibility study published online ahead of print in Surgery Today.

The S-SMARTS technique—short for suture-based marking, scar minimizing, and axillary-lateral thoracic fat flap reconstruction with tissue sliding—was developed as a hidden-scar, volume displacement procedure intended to improve cosmetic outcomes following breast-conserving surgery while maintaining adequate margin control.

In the single-center retrospective analysis, researchers evaluated 44 patients who underwent breast-conserving surgery using the S-SMARTS technique between January 2020 and April 2025 at Osaka University. The study assessed surgical margin status and aesthetic outcomes using BCCT.core software analysis.

According to the investigators, negative margins were achieved in 95.5% of patients after the initial excision. Following intraoperative frozen section analysis, all patients ultimately achieved negative margins.

Cosmetic Outcomes Evaluated Following S-SMARTS Reconstruction

Cosmetic assessments showed that 76.2% of patients achieved “Good” or “Excellent” outcomes on BCCT.core evaluation, while the remaining 23.8% were categorized as “Fair.” No statistically robust predictors of margin positivity were identified in multivariate analyses.

The authors noted that breast-conserving surgery with radiotherapy has outcomes comparable to mastectomy, although achieving favorable cosmetic results can remain difficult in patients with deep or anatomically unfavorable tumors.

“S-SMARTS demonstrates technical feasibility and acceptable early oncologic and aesthetic outcomes in a single-surgeon cohort,” the authors wrote. “Further comparative and multi-institutional studies are warranted to validate its oncologic impact, reproducibility, and patient-reported aesthetic benefits.”

Source

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). Surg Today. Published online May 23, 2026. doi:10.1007/s00595-026-03285-1