ObjectiveTo evaluate the clinical and cosmetic outcome of patients with early breast cancer underwent oncoplastic techniques in breast conserving surgery. MethodsClinical data of 59 patients with early stage breast cancer who underwent oncoplastic techniques in the breast conserving surgery were analyzed retrospectively from January 2007 to March 2011. Cosmetic outcome score and patient satisfaction questionnaire were also assessed. ResultsThe age of the patients was (53.5±9.8) years (range, 32 to 77 years). The diameter of tumors was (1.6±0.7) cm (range, 0.5 to 4.0 cm). The foci located at upper quadrant in 38, lower quadrant in 17, central area in 4. During operation, single incision approach was used in 25 patients, two incisions approach in 34 patients. A variety of methods were used to repair breast defects including mammary gland direct suture in 9 patients, mammary gland pedicle flaps in 35, local flaps or adipofascial flap in 9, latissimus dorsi myocutaneous flaps in 2, and reduction mammaplasty with “J” or double ring incision in 4. The mean followup period was 30 months (range, 3 to 53 months), no local recurrence was detected. However, bone metastases was found in one patient on 14 months after operation. Fifty-three patients (89.8%) had good to excellent aesthetic results with cosmetic outcome score ≥26. Patient satisfaction questionnaire showed that 40 patients (67.8%) were excellent, 14 (23.7%) good, 3 (5.1%) fair, and 2 (3.4%) poor. ConclusionOncoplastic techniques in the breast conservative therapy for early stage breast cancer is a safe and effective procedure, with highly satisfactory cosmetic outcomes in the majority of patients.
Objective To explore the tumor shrinking pattern, the image evaluation methods of the residual lesions after neoadjuvant chemotherapy, and the indications, the resection range, the surgical margins, the management of sentinel lymph node biopsy (SLNB) and axillary lymph nodes of breast conserving surgery after neoadjuvant chemotherapy. Methods Domestic and foreign literatures about the breast conserving surgery after neoadjuvant chemotherapy were collected and reviwed. Results Breast conserving surgery after neoadjuvant chemotherapy raised the rate of breast conserving surgery and improved the postoperative life quality of patients, while the overall survival rate had no significant difference compared with mastectomy. Tumor shrinking pattern and its related factors after neoadjuvant chemotherapy remain required further study. At present, the indications for breast conserving surgery after neoadjuvant chemotherapy still mainly refered to that for early stage breast cancer. Resection range was more recognized to the scope of residual tumor lesions after chemotherapy. The margins were more widely accepted as which were without tumor involved. Although there were some controversies about the use of SLNB and the management of axillary lymph nodes based on the results of SLNB in breast conserving surgery after neoadjuvant chemotherapy, it was still considered necessary at the basis of the accurate biopsy technique acquired. Conclusions At present, breast conserving treatment after neoadjuvant chemotherapy is considered safe and effective. However, it is necessary to proceed cautiously under the conditions of adequate communication of local recurrence rate, standardized local treatment, standard postoperative radiotherapy, systemic adjuvant therapy, and regular follow-up.
目的 评价术前立体超选择性动脉灌注化疗在ⅡB～ⅢA期乳腺癌保留乳房手术中的价值。方法 36例乳腺癌患者，其中ⅡB期10例、ⅢA期26，术前采用立体超选择性动脉灌注丝裂霉素、表阿霉素和5-氟尿嘧啶，化疗后再进行手术。结果 36例患者灌注化疗后病灶缓解32例，好转3例，无明显变化1例; 缓解率达88.9%（32/36），该32例患者肿瘤直径均缩小到2 cm以下，获得保乳手术机会。结论 术前立体超选择性动脉灌注化疗可使局部晚期乳腺癌降期获得保乳机会。
目的探讨保乳手术对Ⅳ期乳腺癌的应用价值。方法对13例Ⅳ期乳腺癌保乳手术患者进行回顾性分析。结果13例患乳成形形态良好，体积较对侧缩小1/4～1/3，平均随访2年，仅1例局部复发。结论Ⅳ期乳腺癌有保乳手术的相对适应证，作为综合治疗的一部分，保乳手术在有效减瘤的同时，能最大限度地改善患者的生活质量。
ObjectiveTo investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.MethodWe searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.ResultsIn the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.ConclusionsThe question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.
ObjectiveTo summarize the application of adjacent tissue flap for reconstruction of partial breast defect in breast conserving surgery. MethodsThe relevant literatures in recent 5 years were reviewed, and the oncoplastic techniques, classification of the adjacent tissue flaps, were summarized. Furthermore, the indications, advantages and disadvantages of the adjacent tissue flaps were evaluated. ResultsCurrently, there were various ways to reconstruct the breast defect following breast conserving surgery. For the patient, whose breast defect volume was bigger, the application of the adjacent tissue flap was one of the effective methods to obtain better aesthetic outcomes. The adjacent tissue flaps included the following:the lateral thoracodorsal fasciocutaneous flap, thoracodorsal artery perforator flap, inframammary adipofascial flap of the anterior rectus sheath, inter-costal artery perforator flap, internal mammary artery pedicled fasciocutaneous island flap, and so on. ConclusionThe adjacent tissue flap replacement technique in breast conserving surgery for reconstruction of the breast defect is a safe and effective procedure, and patients are satisfied with breast shape and overall cosmetic outcomes for it.
ObjectiveTo compare the differences in surgical efficiency, surgical safety, aesthetic outcomes, and oncological safety between axillary single-incision endocsopic breast-conserving surgery (ASIEBS) and conventional open breast-conserving surgery (COBS), and to evaluate the clinical value of ASILBCS based on the “HUAXI hole 3” technique. MethodsA retrospective cohort study was conducted on the clinicopathologic data of patients who underwent breast-conserving surgery for breast cancer at West China Hospital of Sichuan University from January 2021 to September 2024. The patients were assigned into an ASILBCS group and a COBS group based on the surgical approach. Both groups received standardized surgical treatment and postoperative follow-up. The observation indicators included baseline characteristics, intraoperative data, postoperative complications, aesthetic outcome (by Ueda score and Harris score evaluation), and oncological safety (local recurrence and distant metastasis). ResultsA total of 67 patients were enrolled, with 41 in the ASIEBS group and 26 in the COBS group. There was no statistically significant differences in the comparison of other baseline data between the two groups (P>0.05), except for the proportions of patients with diabetes mellitus and those positive for human epidermal growth factor receptor 2 (P＜0.05). The ASIEBS group showed superior aesthetic outcomes compared to the COBS group (Ueda score: P=0.013; Harris score: P=0.047). However, the ASIEBS group had higher median total hospitalization costs (12 779.00 yuan vs. 12 354.50 yuan, Z=–2.16, P=0.03). The median follow-up time was 31.43 months in the ASIEBS group and 21.20 months in the COBS group (Z=–2.36, P=0.02). During follow-up, only one patient with local recurrence occurred in the ASIEBS group, and no distant metastasis or death event was observed in both groups. ConclusionThe ASIEBS based on the “HUAXI hole 3” technique is comparable to COBS in terms of surgical efficiency, surgical safety, and oncological safety, while offering superior aesthetic outcomes.
ObjectiveTo investigate the factors of breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy when choosing surgical mode.MethodsA questionnaire survey was conducted on 228 breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy. Chi square test, nonparametric rank sum test and binary logistic regression were used to analyze the factors affecting the choice of surgical mode.ResultsUnivariate analysis showed that age, clinical stage, family history of cancer, molecular type, neoadjuvant chemotherapy effect, surgeon’s recommendation, chemotherapy side effects, and surgical complications were the factors affecting patient’s chose for breast-conserving surgery (P<0.05). Multivariate analysis showed that the effect of neoadjuvant chemotherapy [OR=0.312, 95%CI (0.255, 0.662), P<0.001] and the surgeon’s recommendation [OR=53.947, 95%CI (4.570, 6.239), P=0.002] were independent factors that affected the choice of surgery.ConclusionsThe decision of the surgical mode is a process in which doctors and patients participate together. Individualized neoadjuvant chemotherapy improves the remission rate and the progress of the surgeon’s comprehensive treatment strategy can play a role in improving the breast-conserving rate and the rate of breast-conserving success. Doctors should give positive guidance in accordance with the specific situation of the patient to make the best choice.
Objective To review the development of endoscopic techniques in breast surgery, focusing on their use in benign breast lump resection and breast-conserving surgery for cancer, and also summarize the development and application of these techniques in China, highlighting promotion and homogenization challenges and future directions. Methods A systematic review of relevant literature was conducted to trace the historical evolution, clinical applications, and related research of endoscopic techniques in breast surgery, emphasizing their advantages and disadvantages of endoscopic benign breast lump resection and breast-conserving surgery for cancer. Results Endoscopic benign breast lump resection and breast-conserving surgery for cancer have improved patients’ postoperative psychological health and quality of life, particularly in scar-free surgery. However, challenges such as limited intraoperative visibility and prolonged surgery time lead to controversy in clinical practice. Conclusion Despite significant advancements, endoscopic techniques in breast surgery also face challenges. Future efforts should focus on technological improvements and clinical research to address these issues, promoting widespread application and standardization. The key to future development lies in the promotion and homogenization of these technologies.