Endoscopic technology can reduce the surgical incision, and on the basis of ensuring tumor safety, effectively improve aesthetic outcomes and enhance patient satisfaction. Endoscopic breast-conserving surgery can offer benefits to scar appearance for patients with early breast cancer; however, for patients with tumors in the lower quadrant, the trauma of surgery should be carefully considered. Endoscopic breast reconstruction provides a preferred option for the patients underwent total mastectomy by reshaping a scarless breast. The choice of surgery should be considered by oncological safety, postoperative aesthetic effects, patient’s willingness, and medical conditions. The more high-quality clinical studies are needed to provide reference for decision-making. The development of endoscopic technology will provide better treatment options for patients with breast cancer.
Objective To evaluate the application effect of acellular dermal matrix (ADM) in immediate breast reconstruction after mammary mastectomy with prosthetic implants. Methods The clinical data of 68 patients with breast cancer undergoing immediate breast reconstruction with prosthetic implantation in our hospital were retrospectively analyzed and divided into ADM group (n=43) and non-ADM group (n=25), according to the use of ADM in the posterior space of pectoralis major muscle while prosthesis implantation or not. The size of breast prosthesis, operative time, intraoperative blood loss, drainage duration, total drainage, total hospital stay, postoperative complications, postoperative cosmetic effect and quality of life of patients were compared between the two groups. Results Patients in the ADM group showed no statistically significant difference regarding operative time, drainage duration, total drainage, hospital stay, postoperative complications and intraoperative removed gland volume with the non-ADM group (P>0.05). The average intraoperative blood loss in the ADM group was less than that of the non-ADM group, the average volume of prosthesis in the ADM group was bigger than that of the non-ADM group, the volume difference between prosthesis and removed gland in the ADM group was smaller than that of the non-ADM group, which was considered statistically significant difference (P<0.05). The subjective satisfaction and objective measurement scores of patients in the ADM group were significantly better than those of the non-ADM group, especially in the symmetry of breast, surgical scar and distance of lateral displacement of nipple (P<0.05). The postoperative quality of life in the ADM group was significantly better than that of the non-ADM group in terms of body image, sexual function and sexual interest (P<0.01). Conclusions It is safe and feasible to use ADM-assisted the immediate breast reconstruction after nipple-sparing mammary mastectomy with prosthetic implantation. As an extension of the pectoralis major muscle, ADM can enlarge the posterior space for the prosthesis implantation, making the choice of the prosthesis much more easier. The combined application of ADM can obtain a better cosmetic effect, meanwhile improving the postoperative quality of life and satisfaction of patients.
ObjectiveTo summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.MethodsThe clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.ResultsAll DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.ConclusionIt is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.
ObjectiveTo explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness. MethodsBetween April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as TisN0M0, 4 cases as T1N0M0, and 4 cases as T2N0M0. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm×9 cm to 20 cm×15 cm, and the serratus anterior fascial flaps from 10 cm×8 cm to 15 cm×10 cm, and the rectus sheath fascial flap from 8 cm×6 cm to 10 cm×8 cm. ResultsOne patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case. ConclusionAdequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.
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 understand the current research status of conservative mastectomy with breast reconstruction for breast cancer, so as to provide a reference for surgeons and patients with breast cancer to choose surgical method. MethodThe recently domestic and foreign literature on the research of conservative mastectomy with breast reconstruction for breast cancer was reviewed and summarized. ResultsAt present, conservative mastectomy mainly included nipple sparing mastectomy, skin sparing mastectomy, and skin reduction mastectomy. All three surgical methods were safe and effective in the treatment of breast cancer, and the complications could be controlled. When combined with breast reconstruction, the better cosmetic effect could be obtained, and the postoperative satisfaction and quality of life of patients were markedly improved. ConclusionsAfter comprehensively preoperative evaluation for patients with breast cancer, conservative mastectomy provides a treatment choice for them. After conservative mastectomy, individualized reconstruction scheme is formulated according to size and sagging degree of breast, as well as individual expectations of patients, which can obtain a higher quality of life while treating diseases for patients with breast cancer.
ObjectiveTo introduce a contralateral mastoplasty in breast reconstruction with prosthesis after breast cancer surgery in order to gain bilateral breasts symmetry.MethodsBetween January 2016 and June 2018, 11 female patients with breast cancer were treated, aged 34-64 years old (mean, 49.6 years). There were 5 cases in left side and 6 cases in right side. There were 3 cases of invasive carcinoma and 8 cases of intraductal carcinoma. The diameter of tumor was 0.2-4.1 cm (mean, 2.5 cm). The disease duration ranged from 1 to 15 months (mean, 6 months). According to Regnault grading criteria, there were 7 cases of mild breast ptosis and 4 cases of moderate breast ptosis. Simple nipple-sparing mastectomy and reconstruction using prosthesis of the affected side, and folding and lifting of the nipple-areolar complex of the healthy side were performed.ResultsThe operation time was 144-188 minutes (mean, 158 minutes). The hospital stay was 6-9 days (mean, 7.5 days). Postoperatively, poor incision healing occurred in 1 case and healed after symptomatic treatment. The other incisions healed well and no surgical-related complications occurred. All patients were followed up 6-30 months (mean, 16 months). At 3 months after operation, the expert group adopted the self-made rating scale to evaluate the bilateral breasts symmetry, and the score was 8-10 (mean, 8.9). The patients were evaluated for their satisfaction according to the self-made score scale, and the score was 8-10 (mean, 9.1).ConclusionAfter immediate breat reconstruction with prosthesis after breast cancer surgery, the satisfied bilateral breasts appearances and symmetry can be obtained by contralateral mastoplasty.
Objective To summarize the research progress of combined surgical treatment of lymphedema based on vascularized lymph node transfer (VLNT), and to provide systematic information for combined surgical treatment of lymphedema. MethodsLiterature on VLNT in recent years was extensively reviewed, and the history, treatment mechanism, and clinical application of VLNT were summarized, with emphasis on the research progress of VLNT combined with other surgical methods. Results VLNT is a physiological operation to restore lymphatic drainage. Multiple lymph node donor sites have been developed clinically, and two hypotheses have been proposed to explain its mechanism for the treatment of lymphedema. But it has some inadequacies such as slow effect and limb volume reduction rate less than 60%. To address these inadequacies, VLNT combined with other surgical methods for lymphedema has become a trend. VLNT can be used in combination with lymphovenous anastomosis (LVA), liposuction, debulking operation, breast reconstruction, and tissue engineered material, which have been shown to reduce the volume of affected limbs, reduce the incidence of cellulitis, and improve patients’ quality of life. ConclusionCurrent evidence shows that VLNT is safe and feasible in combination with LVA, liposuction, debulking operation, breast reconstruction, and tissue engineered material. However, many issues need to be solved, including the sequence of two surgeries, the interval between two surgeries, and the effectiveness compared with surgery alone. Rigorous standardized clinical studies need to be designed to confirm the efficacy of VLNT alone or in combination, and to further discuss the subsistent issues in the use of combination therapy.
Objective To investigate the results of skinsparing mastectomy and immediate breast reconstruction with transverse rectus abdomins musculotaneous(TRAM) flap or latissimus dorsi musculocutaneousflap plus placement of a mammary implant.Methods From June 1997 to June 2002, 11 patients were proven to have ductal carcinoma in situor huge breast carcinoid by pathological examination. The site of the biopsy incision was around the areola. The patients underwent mastectomy with skin sparing by a circumareolar incision and immediate breast reconstruction withTRAM flap or latissimus dorsi musculocutaneous flap plus placement of mammary implant.Autogenous tissue was used to fill the skin envelop. The second stage operation of nipple-areola reconstruction was performed on the replaced skin.Results Eleven patients were followed up 1 month to 6 years.The operative result was good and all patients had no relapse. The reconstructed breast achieved good results in shape, colour, sensation, symmetry and incision scar. Conclusion The skin sparing mastectomy and immediate autograft tissue breast reconstruction is an ideal reconstructive method for the patients with breast ductal carcinoma in situ or huge breast carcinoid in condition that there were strict operative indication and relapse can be prevented.
ObjectiveTo compare the surgical data, safety, cosmetic outcomes, and quality of life of patients underwent single axillary incision endoscopic nipple-sparing mastectomy and immediate breast reconstruction with endoscopic harvesting of latissimus dorsi muscle flap (abbreviation as the “endoscopic group”) and traditional open surgery of latissimus dorsi muscle flap harvesting for breast reconstruction after mastectomy (abbreviation as the “open group”). MethodsThe patients were collected, who underwent latissimus dorsi breast reconstruction at the West China Hospital of Sichuan University and the Fourth People’s Hospital of Sichuan Province from January 2021 to June 2024 from a prospective maintenance database, and then were assigned into an endoscopic group and open group according to the surgical method. Their basic information, information relevant operation, postoperative complications, and patient reported outcomes (BREAST-Q scale) score were compared between the two groups. ResultsA total of 73 patients were enrolled, including 23 patients in the endoscopic group and 50 patients in the open group. There were no statistically significant differences in the age, body mass index, breast sagging, tumor location, tumor N stage, pathological type, adjuvant therapy, etc. between the patients of two groups, except for a higher proportion of T4 stage patients in the open group as compared with the endoscopic group (P＜0.001). A longer size of latissimus dorsi muscle flap was harvested in the endoscopic group as compared with the open group (P=0.002). There were no statistically significant differences in the total surgical complications, major complications, minor complications, and implant-related complications between the patients of two groups (P>0.05). The most common complication in the patients of both groups was back seroma, 21.7% (5/23) in the endoscopic group and 22.0% (11/50) in the open group. The total length of incisions in the endoscopic group was significantly shorter than that in the open group (P<0.001), and the points of the breast satisfaction (P=0.045), back satisfaction (P<0.001), and sexual well-being (P=0.028) of the patients in the endoscopic group were significantly higher than those in the open group. The major complications did not happen in the endoscopic group, but happened in 2 cases in the open group (1 patient due to ischemic necrosis of the latissimus dorsi muscle and 1 patient due to breast infection resulting in implant removal). During the follow-up period, 3 (6.0%) patients had distant metastasis (all were lung metastasis) in the open group, and there was no local or regional recurrence, distant metastasis, and specific death of breast cancer in the endoscopic group. ConclusionsThe results of this study suggest that, for patients who have skin invasion but who desire breast reconstruction or have failed by prosthetic breast reconstruction (such as skin flap necrosis), traditional open surgery of latissimusdorsi flap harvesting for breast reconstruction is worth choosing. However, for breast cancer patients who do not need additional skin breast reconstruction, endoscopic latissimus dorsi breast reconstruction has greater advantages in cosmetic effect, and it is safe and effective.