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.
Objective To explore the interaction of postmastectomy radiotherapy （PMRT） and breast reconstruction， and elucidate how to choose the type and timing of breast reconstruction. Method Literatures about PMRT and breast reconstruction were reviewed. Results PMRT might increase the incidence of complications and impair the cosmetic satisfaction of breast reconstruction. Breast reconstruction might also compromise the effect of PMRT. Conclusions In patients who will receive or have already received PMRT， the optimal approach is delayed autologous tissue reconstruction after PMRT. If PMRT appears likely but may not be required at the time of mastectomy，delayed-immediate reconstruction may be considered， or immediate autologous tissue reconstruction may be considered in case of patients awareness of the increased complications and impaired cosmetic outcomes from PMRT.
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.
Objective To review the application progress of non-biological meshes for breast reconstruction (BR). Methods The related home and abroad researches in BR were reviewed and summarized. Results Non-biological meshes can be divided into degradable and nondegradable. The former has many types, whether its degradation rate can match with the grow rate of repair tissue will significantly affect the wound healing and tissue intergradation. TiLOOP, on behalf of the latter, has a good postoperative performance due to its nano TiO2 layer, lightness and flexibility. Non-biological meshes have been gradually used to cover and fix implant in BR. Compared with biological meshes, non-biological meshes are cheaper and have a more positive postoperative performance generally, but definite comparison can’t be concluded due to the limited data. Conclusion As non-biological meshes are applied to BR preliminarily, their effectiveness are still needed to be observed further.
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.
ObjectiveTo explore the surgical technique and preliminary safety and aesthetics results of immediate prepectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) after skin-sparing mastectomy (SSM) or nipple-areola-complex-sparing mastectomy (NSM) for breast cancer patients. MethodsThe clinical data of consecutive patients who underwent immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM in West China Hospital from January to July 2022 were retrospectively analyzed. The operation time, intraoperative blood loss, early complication were collected. The preliminary aesthetics results were assessed with the Ueda score and Harris score. Results All the patients were female with a mean age of 39.0±6.8 years. One patient had bilateral breast malignant tumors, and the others had unilateral malignant tumors. Six patients received neoadjuvant chemotherapy before surgery. The mean diameter of the tumors was 24.4±11.9 mm under the color ultrasound before the neoadjuvant chemotherapy. The mean operation time was 153.9±49.4 min. The mean intraoperative blood loss was 29.2±18.3 mL. There were 3 patients with tumor stage 0, 10 patients with stage Ⅰ, 6 patients with stage Ⅱ, 3 patients with stage Ⅲ and 1 patient was found no residual cancer after neoadjuvant chemotherapy. All the patients were successfully followed up with a median follow-up time of 4.8 (3.0-9.2) months. There were 2 (8.3%) patients with major complications, including 1 wound dehiscence and 1 hematoma, and 4 (16.7%) minor complications, including 2 wound dehiscence and 2 infection. The patients with excellent and good Ueda score and Harris score accounted for 82.6% and 87.0%, respectively. None of the patients had animation deformity, capsular contracture, nipple-areola or skin flaps necrosis, or implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Conclusion For selected reliable patients, immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM for breast cancer patients is safe and has good aesthetics results in the early postoperative period. It has broad application space in patients with suitable indications, and can be promoted as a routine operation.
ObjectiveTo explore the surgical technique and preliminary results of endoscopic nipple-sparing mastectomy (E-NSM) and immediate pre-pectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) via single axillary incision for breast cancer patients.MethodsThe clinical data of 9 consecutive female patients who underwent E-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra from March to May 2021 were retrospectively analyzed. The mean age of patients was 40.6 (22-60) years. The operation time, early complications were collected, and the patients' social and mental health, breast satisfaction and chest function before and after the operation were assessed with the BREAST-Q questionnaire.ResultsAll the patients had unicentric tumor with a mean diameter of 2.4 (0.6-4.7) cm. The mean distance from the tumor to the nipple was 2.5 (2-4) cm. There were 2 patients with tumor stage 0 and 7 patients with stageⅠ. The mean operation time was 161.1 (125-201) min, the mean blood loss was 41.1 mL and the hospital stay time was 1.5 d. There were 5 patients in the day-care unit. All the patients were successfully followed up with a median follow-up time of 1 (1-2) month. One (11.1%) patient with depigmentation of the nipple-areola complex caused by mild ischemia. None of the patients had incision complications, subcutaneous emphysema, hematoma, infection, nipple-areola or skin flaps necrosis, implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Chest well-being was decreased in the first month after the surgery compared with preoperative status, and the difference was statistically significant (P=0.001). There was no statistical difference in the breast satisfaction or psychosocial function scores between pre- and post-operation (P>0.05).ConclusionE-NSM and immediate pre-pectoral implant-based BR with TiLoop Bra via single axillary incision has minimal trauma, rapid postoperative recovery, short operation time, few early complications and good early cosmetic effect, and the short-term result is satisfactory.
ObjectiveTo explore the clinical application of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction of breast cancer patients after mastectomy.MethodsBetween August 2016 and February 2017, the combined transverse upper gracilis flap and adductor magnus perforator flap was used in 12 cases of breast cancer patients who received modified radical surgery for breast reconstruction. All patients were females with the age of 32 to 59 years (mean, 41.5 years). There were 7 cases in left side and 5 cases in right side. Eight cases were received breast reconstruction by one-stage operation and 4 cases by two-stage operation. In one-stage operation cases, pathological diagnosis includes invasive ductal carcinoma in 4 cases and invasive lobular carcinoma in 4 cases. The disease duration ranged from 2 to 9 months (mean, 4.5 months). In two-stage operation cases, the time interval between mastectomy and breast reconstruction ranged from 12 to 70 months (mean, 37.4 months). The length of flap was 20-28 cm, the width of flap was 5.5-7.5 cm, the thickness of flap was 2.5-4.5 cm. The length of gracilis flap pedicle was 6.5-9.2 cm, the length of adductor magnus perforator flap pedicle was 7.5-10.4 cm. The weight of flap was 295-615 g.ResultsThe ischemia time of flap ranged from 95 to 230 minutes (mean, 135 minutes). All flaps were successfully survived. All incisions of recipient donor sites healed by first intention. All patients were followed up 7-14 months (mean, 9.5 months). The reconstructed breasts’ shape, texture, and elasticity were good and no flap contracture deformation happened. Only linear scar left in the donor sites, but the function of thighs was not affected. No local recurrence happened during follow-up.ConclusionWith appropriate patient selection and surgical technique, the combined transverse upper gracilis flap and adductor magnus perforator flap can be a valuable option as an alternative method for autologous breast reconstruction.
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.
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.