The report of brachial plexus injuries following radical mastectomy in patients with breast cancer was rare even though the operation was a main measure in treating with breast cancer. Nine patients treated from Oct. 1989 to Feb.1991 were summarized. The results were not ideal.
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 progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. MethodThe studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. ResultsThe ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. ConclusionsWhether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.
ObjectiveTo investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. Methods The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed. The mean age of the patients was 43.8 years (range, 27-61 years). The maximum diameter of the tumors ranged from 1.00 to 7.10 cm, with an average of 2.70 cm. Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor, and 40 cases were positive for human epidermal growth factor receptor 2. All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The operation time, intraoperative blood loss, prosthesis size, and occurences of nipple-areola complex (NAC) ischemia, flap ischemia, infection, and capsular contracture were recorded. The Breast-Q2.0 score was used to evaluate breast aesthetics, patient satisfaction, and quality of life (including the social mental health score, breast satisfaction score, and chest pain score). Patients were divided into two groups based on the time of operation after the technique was implemented: group A (within 1 year, 25 cases) and group B (after 1 year, 113 cases). The above outcome indicators were compared between the two groups. Furthermore, based on the postoperative follow-up duration, patients were classified into a short-term group (follow-up time was less than 1 year) and a long-term group (follow-up time was more than 1 year). The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups. ResultsThe average operation time was 120.76 minutes, the average intraoperative blood loss was 23.77 mL, and the average prosthesis size was 218.37 mL. Postoperative NAC ischemia occurred in 21 cases (15.22%), flap ischemia in 30 cases (21.74%), infection in 23 cases (16.67%), capsular contracture in 33 cases (23.91%), and prosthesis removal in 2 cases (1.45%). The operation time of group A was significantly longer than that of group B (P<0.05), and there was no significant difference in intraoperative blood loss, prosthesis size, and related complications between the two groups (P>0.05). All patients were followed up 3-48 months (mean, 20 months). There were 33 cases in the short-term group and 105 cases in the long-term group. There was no significant difference in baseline data such as age, body mass index, number of menopause cases, number of neoadjuvant chemotherapy cases, number of axillary lymph node dissection cases, breast cup size, degree of breast ptosis, and postoperative radiotherapy constituent ratio between the two groups (P>0.05). At last follow-up, the breast satisfaction score in the patients’ Breast-Q2.0 score ranged from 33 to 100, with an average of 60.9; the social mental health score ranged from 38 to 100, with an average of 71.3; the chest pain score ranged from 20 to 80, with an average of 47.3. The social mental health score of the long-term group was significantly higher than that of the short-term group (P<0.05); there was no significant difference in breast satisfaction scores and chest pain scores between the two groups (P>0.05). No patient died during the follow-up, and 2 patients relapsed at 649 days and 689 days postoperatively, respectively. The recurrence-free survival rate was 98.62%. Conclusion Endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants has fewer complications and less damage, and the aesthetic effect of reconstructed breast is better.
Objective To introduce an surgical technique of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Methods Between January 2017 and February 2018, 15 female patients with breast cancer (stageⅠ in 5 cases and stage Ⅱ in 10 cases) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. They were 27-45 years old (mean, 37.5 years). The disease duration ranged from 1 to 24 months (mean, 8 months). The tumor located at the left breast in 8 cases and at the right breast in 7 cases. The diameter of tumor ranged from 1.5 to 3.0 cm (mean, 2.6 cm). The distance between tumor and nipple was 1.8-4.0 cm (mean, 2.3 cm). Results After operation, the nipple epidermal necrosis occurred in 1 case, and subcutaneous effusion in 1 case. No subcutaneous emphysema or skin flap necrosis occurred. Postoperative pathological examination showed that 1 case was nipple involvement and was treated with nipple resection. All patients were followed up 7-17 months (mean, 11 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 4 cases of excellent, 10 cases of good, and 1 case of poor. No tumor recurrence or metastasis occurred during follow-up. Conclusion It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction.
【Abstract】ObjectiveTo review the status and controversy on skinsparing mastectomy (SSM) for breast cancer. MethodsThe pertinent literatures about SSM published recently to comprehend its relevant techniques and improvements in comparison with nonskinsparing mastectomy (NSSM) were analyzed and also the safety of SSM by analyzing the relationships between SSM and ductal carcinoma in situ, restrict nippleareola complex reservation, and postmastectomy radiotherapy were discussed. ResultsSkinsparing mastectomy combined with immediate breast reconstruction is a safe operative modality for T1/T2 tumor without skin adhesion, multicentric tumors, and ductal carcinoma in situ. What is more, it does not defer adjuvant therapy. However, it may be prudent to reserve the nippleareola complex only for peripherally located T1/T2 tumors and some other less serious invasion degree. Since the effect of SSM and immediate breast reconstruction on postmastectomy radiotherapy is confusing, there are still controversies on whether the patients who have already been operated should take radiotherapy. ConclusionSSM is a safe operative modality for selected patients with breast cancer, and delayed reconstruction may be a good choice for patients who would take postmastectomy radiotherapy.
Objective To evaluate the feasibility, oncological safety, and aesthetic result of skin-spring mastectomy (SSM) or nipple-spring mastectomy (NSM) in breast reconstruction of implant (permanent gel or expander) for breast cancer patients who were not fit for the breast conserving surgery (BCS). Methods Between October 2005 and July 2011, 89 women with breast caner underwent SSM or NSM, with an average age of 42.4 years (range, 19-55 years) and an average disease duration of 5.7 months (range, 1-24 months). The pathological examination revealed invasive ductal carcinoma in 55 cases, ductal carcinoma in situ (DCIS) in 15 cases, invasive ductal carcinoma + DCIS in 8 cases, DCIS with infiltration in 10 cases, and occult breast cancer in 1 case. According to tumor staging criterion of American Joint Committee on Cancer (AJCC), 15 cases were rated as stage 0, 51 cases as stage I, 22 cases as stage II, and 1 case as unclear. Finally, 33 patients underwent SSM and 56 patients underwent NSM according to the location and diameter of tumor and the infiltration of tumor to nipple. Secondary breast reconstruction was performed with permanent gel replacement after axillary lymph node dissection in 9 patients with positive sentinel lymph node and 1 patient with occult breast cancer; immediate breast reconstruction was performed with permanent gel in the other patients. All the patients received the chemotherapy or/and radiotherapy according to the National Comprehensive Cancer Network (NCCN) guideline. Results Complications occurred in 5 patients undergoing breast reconstruction of permanent gel after NSM, including 1 case of haemorrhage, 2 cases of infection, and 2 cases of local skin necrosis. Primary healing of incision was obtained in the others. No nipple necrosis was observed in patients undergoing NSM. All the patients were followed up 14-88 months (median, 40 months). At 10 months after operation, the aesthetic results were excellent in 40 cases, good in 33 cases, fair in 14 cases, and poor in 2 cases, with an excellent and good rate of 82%. No recurrence or metastasis was found during follow-up. Conclusion The SSM or NSM is feasible and oncological safe for patients who are not fit for BCS, with satisfactory aesthetic result.
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.
Objective To evaluate the effect of postmastectomy radiotherapy(PMRT)on the rate of loco-regional recurrence and survival for breast cancer patients undergoing radical mastectomy with one to three positive lymph nodes. Methods The database of Pubmed, Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, CBM, CNKI, VIP, and Chinese Cancer were searched. All randomized controlled trials about postmastectomy radiotherapy on breast cancer patients with 1-3 positive lymph nodes were considered for inclusion. Revman 5.3 was used in the meta analysis. Results Four trials enrolled 1 254 breast cancer women with 1-3 positive lymph nodes were included. The studies were high quality according to the evaluations of the quality criteria. After 10 to 20 years follow-up, the results showed that, 460 patients were analyzed in the result of loco-regional recurrence, the hazard ratio (HR) was 0.23, 95%CI (0.15, 0.37), the result showed statistical difference (P＜0.000 01), and the heterogeneity was existed (P=0.09,I2=59%). One thousand two hundred and fifty-four patients were analyzed in the result of overall survival, theHR was 0.82, 95%CI (0.71, 0.93), the result showed statistical difference (P=0.002 ), and there did not existed heterogeneity (P=0.65,I2=0%). Four hundred and sixty patients were analyzed in the result of metastasis-free survival, theHR was 0.71, 95%CI (0.56, 0.90), the result showed statistical difference (P=0.005), and there did not existed heterogeneity (P=0.63,I2=0%). Nine hundred and seventy-seven patients were analyzed in the result of disease free survival, theHR was 0.74, 95%CI (0.66, 0.85), the result showed statistical difference (P＜0.000 01), and there did not existed heterogeneity (P=0.49,I2=0%). Conclusion Through this systematic review, we consider that postmastectomy radiotherapy could reduce the loco-regional recurrence and increase the overall survival for long-term.
Objective To evaluate the value of extended latissimus dorsi flap (ELDF) in immediate breast reconstruction in patients with breast cancer after modified radical mastectomy. Methods Thirty-six patients with breast cancer who accepted modified radical mastectomy and 12 patients with breast cancer who accepted immediate breast reconstruction after modified radical mastectomy from January 2008 to June 2009 were included. The complications, cosmetical results and quality of life of these patients were compared. The shape of breast reconstruction was also evaluated. Results All of 12 patients succeeded in proceeding immediate breast reconstruction with ELDF. The evaluation of shape of breast reconstruction was good in 6 cases, secondary in 4 cases, and bad in 2 cases, which was beyond that in patients of radical operation group (Plt;0.001). There was no statistical difference in operation complications as hydrops, necrosis, affecting limb shoulder joint motion, drainage time, hospital stay, and starting time for adjuvant therapy between two groups (Pgt;0.05). The patients in breast reconstruction group had a better quality of life compared with the patients in radical operation group (Plt;0.001). In breast reconstruction group, 10 patients received adjuvant chemoradiotherapy and no necrosis was showed in local flap grafting. After the follow-up of 2-17 months (median 8 months), no local recurrence and metastasis was demonstrated in two groups patients. Conclusions There are good cosmetic results after immediate breast reconstruction with ELDF, and it is easy to operate. It is a safe and feasible therapeutics method for early breast cancer.