From 1985 through May of 1989, a total of 6 cases of breast carcinomas underwent primary reconstruction of breast immediately following radical mastectomy by using transposition of vaseularized latissimus dorsi myocutaneous flap for reconstruction of breast. The re- sults of all these 6 cases were satisfactory. The design of the operation and the operative technique were detailed. The importance of the reconstruction of breast immediately after the radical mastectomy and the advantages of using vascularized latissimus dousi myocutanous flap for reconstruction were discussed.
Objective To summarize types of post-mastectomy breast reconstruction and present situation. Method The relevant literatures about post-mastectomy breast reconstruction in recent years were reviewed. Results With the increasing incidence of the breast cancer and the progressing of the treatment methods, it has become a trend for the post-mastectomy breast reconstruction. If the patient’s condition is allowed, the post-mastectomy breast reconstruction can be performed. At present, the post-mastectomy breast reconstruction mainly include the implant based reconstruction, autologous tissue reconstruction, autologous fat transplantation, etc.. There are different options for the breast reconstruction according the indicators and it had the corresponding complications. So the selection of reconstruction technique depend on the individual requirements, determining by the patient choice, advice of the reconstructive surgeon, and anticipated post-mastectomy therapy, particularly the needs for the radiotherapy and chemotherapy, etc.. Conclusions Post-mastectomy breast reconstruction is common abroad, corresponding research has been carried out in our country, experiences in learning are shairing. With deepening of domestic and foreign exchanges and progressing of technology, it is believed that post-mastectomy breast reconstruction might become one of conventional reconstruction options in future.
ObjectiveTo analyze the value of indocyanine green (ICG) fluorescence imaging in the evaluation of blood flown of ipple-areola complex (NAC) and implant selection during single-port endoscopic breast reconstruction. Methods From November 2018 to March 2020, 19 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital were retrospectively collected. ICG fluorescence imaging technology was used to evaluate the blood supply pattern and the risk of ischemic necrosis of NAC, so as to guide the selection of implant. At the same time, 14 patients who underwent single-port inflatable endoscopic nipple-sparing mastectomy combined with breast reconstruction in Beijing Friendship Hospital from February 2017 to October 2018 were selected as the historical control group (control group). NAC ischemic necrosis, breast satisfaction and implant removal were compared between the two groups. Results In the ICG group, there were3 cases of V1 pattern and 2 cases of NAC ischemic necrosis (1 case of grade 1, 1 case of grade 2). There was no NAC ischemic necrosis in 16 patients with V2 mode and V3 mode. No implant loss occurred in any of the patients. In the control group, 5 cases had NAC ischemic necrosis (all were severe ischemic necrosis), and 2 cases had implant loss. The rate of severe NAC ischemic necrosis in the ICG group was lower than that in the control group (P<0.01), but there was no significant difference in implant loss rate between the two groups (P=0.17). The breast satisfaction score of the ICG group was higher than that of the control group (P<0.01), but there were no significant difference in satisfaction scores of chestwell-being, psychological well-being and sexual well-being between the two groups (P>0.05). Conclusions ICG imaging can be used to evaluate the blood supply pattern during the operation of prosthetic body mass reconstruction, guide the choice of implant in immediate breast reconstruction, so as to further improve postoperative breast satisfaction.
ObjectiveTo compare the satisfaction and safety of patients undergoing prepectoral breast reconstruction (PBR) versus subpectoral dual-plane breast reconstruction (SBR) with implants combined with mesh after open total mastectomy for breast cancer. MethodsA prospective cohort study on clinical data of breast cancer patients who underwent open total mastectomy and received either PBR or SBR with implants and mesh for immediate breast reconstruction from June 2021 to October 2022 at West China Hospital of Sichuan University were performed. The pain scores on postoperative days 1, 3, 7, and 14, the postoperative use of analgesics within 14 days, and the incidence of postoperative complications, breast satisfaction, and quality of life during follow-up periods were compared between the two groups. ResultsA total of 62 female patients were included, with 35 in the PBR group, having an average age of (39.6±6.5) years, and 27 in the SBR group, having an average age of (41.5±9.9) years. The pain scores of the SBR group on postoperative days 3 (P=0.032), 7 (P＜0.001), and 14 (P＜0.001) were significantly higher than those of the PBR group, and a higher proportion of patients in the SBR group used analgesics within postopeartive 14 days (P=0.001). The median follow-up time was 28.4 months for the PBR group and 34.9 months for the SBR group. There was no statistical difference in the overall (P=0.583), major (P=0.526), or minor (P=0.532) complication rates between the two groups during follow-up. One (2.9%) patient in the PBR group and 2 (7.4%) patients in the SBR group lost their implants (P=0.575). There were 4 patients of movement deformities and 4 patients of chest muscle pain in the SBR group, whereas no patients in the PBR group had these complications (P=0.031). Encapsular contracture occurred in 5 (14.3%) patients in the PBR group and 11 (40.7%) patients in the SBR group (P=0.023). The incidences of ripple sign (25.7% vs. 3.7%, P=0.047) and implant contour visibility (40.0% vs. 11.1%, P=0.020) were significantly higher in the PBR group than those in the SBR group. At 24 months post-surgery, breast satisfaction scores [(67.9±13.1) points vs. (52.6±16.9) points, P=0.025] and chest function satisfaction [(70.7±13.4) points vs. (58.7±14.3) points, P=0.035] were higher in the PBR group. No local recurrence, distant metastasis, or deaths occurred in the PBR group during the follow-up period, while 1 patient of local recurrence and distant metastasis occurred in the SBR group, with no deaths. ConclusionCompared to SBR, PBR is more in line with the physiological and anatomical levels of the breast, effectively avoiding postoperative movement deformities and chest muscle pain, with a lower incidence of capsular contracture, and higher postoperative breast satisfaction and chest function satisfaction. It is a safe and feasible reconstruction method. For some specific patients, especially those with higher physical activity demands, it is a better reconstruction choice.
Objective To explore the value of the application of latissimus dorsi myocutaneous flap in the breast reconstruction. Methods The clinical data of the 36 patients with breast tumor who had undergone breast reconstruction with latissimus dorsi myocutaneous flap from January 2012 to December 2016 were collected retrospectively. The postoperative complications and cosmetic results were analyzed. Results Thirty-six patients with breast tumor who underwent breast reconstruction with latissmus dorsi myocutaneous flap, including 32 patients with immediate breast reconstruction and 4 patients with delayed breast reconstruction respectively. The operative time of the patients who undertwent immediate breast reconstruction was 235–490 min (mean of 325 min), the intraoperative blood loss was 200–260 mL (mean of 220 mL), and the hospitalization time was 18–33 d (mean of 23.6 d). The total operative time of patients who underwent delayed breast reconstruction was 325–550 min (mean of 355 min), the total intraoperative blood loss was 200–250 mL (mean of 220 mL), and the total hospitalization time was 27–45 d (mean of 32.5 d). The cosmetic results was excellent in 22 patients, good in 8 patients, fair in 6 patients, respectively, and fine rate was 83.3% (30/36). There was no flap loss, but donor site seroma occurred in 21 patients, partial necrosis of the surgical margin of back skin occurred in 1 patient, partial necrosis of the nipple and areola skin occurred in 2 patients. All the patients were followed-up for 3–60 months, and the mean follow-up time was 37 months. During the follow-up period, no patient occurred metastasis or recurrence. After undergoing radiotherapy, reconstructive breast volume of 2 patients significantly contracted. None of the patients had significant limb function. Conclusion The breast reconstruction with the latissimus dorsi myocutaneous flap is a simple, easy, and effective surgical procedure.
Objective To discuss the effectiveness of breast reconstruction with dual plane prosthesis implantation or anterior pectoralis prosthesis implantation under endoscopy by using prospective comparative study, in order to provide a reference for clinical surgical selection. Methods A total of 54 female patients with breast cancer admitted between January 2023 and December 2023 and met the selection criteria were selected as research subjects. According to the random number table, 54 patients were divided into trial group and control group with 27 cases in each. The patients in the trial group and control group were treated with dual plane prosthesis implantation and anterior pectoralis prosthesis implantation for breast reconstruction after glandular resection under endoscopy, respectively. There was no significant difference between the two groups (P>0.05) in the terms of age, body mass index, affected side, breast clinical stages, molecular typing, disease duration, breast volume of healthy side, breast ptosis of affected side, and preoperative Breast-Q score (social mental health, sexual health, breast satisfaction, chest somatic health). The operation-related indicators (operation time, total volume of drainage within 7 days after operation, extubation time, and hospital stay), occurrence of complications, breast reconstruction efficacy related indicators (transverse and longitudinal distance difference), and the pre- and post-operative differences (change values) of Breast-Q scores for each item were compared between the two groups. Results There was no significant difference in operation time, total volume of drainage within 7 days after operation, extubation time, and hospital stay between the two groups (P>0.05). All patients of the two groups were followed up 3-12 months (mean, 6.3 months). Three patients (11.11%) in trial group and 5 patients (18.52%) in control group experienced complications, and there was no significant difference in the occurrence of complications (P>0.05). At 7 days after operation, the transverse and longitudinal distance differences were significantly less in trial group than in control group (P<0.05). The Breast-Q scores of the two groups at 7 days after operation were significantly higher in all items than those before operation (P<0.05), but there was no significant difference in all change values between the two groups (P>0.05). ConclusionFor patients with breast cancer, comparison of breast reconstruction with anterior pectoralis prosthesis implantation, breast reconstruction with dual plane prosthesis implantation has better breast reconstruction effectiveness and higher safety.
ObjectiveTo explore the methods of breast reconstruction surgery with laparoscopically harvested pedicled omental flap (LHPOF), and analyze the patient’ evaluation, operation process and postoperative follow-up. MethodsPatients with pathologically proven breast cancer or plasma cell mastitis who underwent LHPOF breast reconstructive surgery were retrospectively collected from the Department of Breast and Thyroid Surgery of The Second Affiliated Hospital of Chongqing Medical University from February 2022 to December 2023. ResultsA total of 16 patients were collected. The mean age of patients was 43.3 (ranging from 27 to 68) years old, the mean body mass index of patients was 23.0 kg/m2 (ranging from 18.3 to 28.6 kg/m2). One patient underwent transplant omental flat removal surgery due to postoperative flap thrombosis, and one patient choose to give up breast reconstruction due to insufficient flap volume. The single-stage surgery was performed successfully in the rest patients with no requirement of laparotomy. All patients made an uneventful recovery after surgery. During the follow-up period, which averaged 13 months and ranged from 9 to 17 months, the major symptoms were mild epigastric bulge (2 patients) and flap atrophy (1 patient), no serious flap-related or donor site-related complications such as flap loss, bowel dysfunction and abdominal incisional hernia. In general, the aesthetic results were satisfactory. ConclusionsUsing LHPOF in immediate breast reconstruction surgery can achieve satisfied aesthetic result, for the soft and natural appearance of the reconstructed breast. In the mean time, compared with other autologous tissue reconstruction approaches, LHPOF has lower incidences of complications of donor-site and flap-site.
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.
ObjectiveTo explore the feasibil ity and rel iabil ity of rib-sparing technique for internal mammary vessels exposure and anastomosis in breast reconstruction and thoracic wall repair with deep inferior epigastric perforator (DIEP) flaps. MethodsBetween November 2009 and September 2011, 11 female patients with post-mastectomy deformities were treated. The mean age was 42 years (range, 33-65 years). Of them, 10 patients underwent breast reconstruction with the DIEP flaps, and 1 patient received defect repair for chronic thoracic wall irradiated ulcer with the DIEP flap. The size of the flap ranged from 18 cm×9 cm to 28 cm×12 cm. Rib-sparing technique was applied in all these cases. The internal mammary vessels were exposed by dissection intercostal space and anastomosed with the deep inferior epigastric vessels. The donor sites were closed directly in all cases. ResultsIn all cases, the rib-sparing technique for internal mammary vessels exposure and anastomosis was successfully performed. The mean time for internal mammary vessels exposure was 52 minutes (range, 38-65 minutes). The mean exposure length of the internal mammary vessels was 1.7 cm (range, 1.3-2.2 cm). All flaps survived completely postoperatively, and wounds and incisions at donor sites healed primarily. All patients were followed up 8-26 months (mean, 12 months). All patients were satisfied with the reconstructive outcomes. No collapse deformity or discomfort of the thoracic wall occurred. ConclusionThe rib-sparing technique for internal mammary vessels exposure and anastomosis is a rel iable and reproducible approach to reconstruct the breast and repair the thoracic wall with DIEP flap, and it can reduce collapse deformity of the thoracic wall.
Objective To explore the clinical and aesthetic results of single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral implant-based breast reconstruction (IBBR) for breast cancer patients. MethodsThe clinical data of consecutive female patients who underwent single axillary approach reverse sequence endoscopic nipple-sparing mastectomy of breast cancer combined with subpectoral IBBR from May 2020 to December 2022 were retrospectively analyzed. The patient demographics, perioperative parameters, complications and aesthetic results were collected. Results A total of 62 patients (74 breasts) were included. The mean age of patients was (39.0±7.8) years. The total mean operation time was (185.2±45.5) minutes. Five (8.1%) patients suffered from surgical complications. Two (3.2%) patients experienced major complications, and 3 (4.8%) suffered from minor complications. No patient experienced partial nipple-areola complex necrosis. Seventeen (27.4%) patients experienced implant related complications, of which 11 (17.7%) experienced capsular contracture. During a median follow-up time of 30 months ranging from 11 to 42 months, no patient experienced locoregional recurrence, distant metastasis or death. Thirty-seven (88.1%) patients evaluated their breasts as good or excellent. In the surgeon-reported cosmetic results, 40 (95.2%) patients achieved excellent or good results. ConclusionThis surgical technique is characterized by minimal trauma, short operation time, high safety, and excellent cosmetic outcomes for patients with small breasts and mild ptosis, making it worthy of further promotion.