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 review the latest progress in the major biological properties of adipose-derived stem cells (ADSCs) and ADSCs assisted autologous lipotransfer in breast repair and reconstruction. Methods Recent literature about ADSCs assisted autologous lipotransfer in breast repair and reconstruction was reviewed. Results ADSCs have multipotential differentiation capacity, and they could promote angiogenesis and regulate immune reactions. ADSCs assisted autologous lipotransfer can obtain satisfactory effectiveness in breast repair and reconstruction with few complications, but more studies are needed to confirm the long-term safety. Conclusion ADSCs assisted autologous lipotransfer has good effectiveness in breast repaired and reconstruction. But further clinical trials are needed to confirm the long-term safety.
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.
目的 探討高強度聚焦超聲(HIFU)治療乳房纖維腺瘤的臨床效果。 方法 分析、總結我院2002年10月至2005年9月50例經HIFU 治療的乳房纖維腺瘤患者的臨床資料。結果 患者住院時間短，平均2.9 d； 無并發癥發生； HIFU 治療后纖維腺瘤退變壞死，乳房包塊逐漸縮小、消失。結論 HIFU治療乳腺纖維腺瘤安全、有效、簡便，且不損害乳房形態和功能，臨床應用前景良好。
ObjectiveTo explore the clinical efficacy of volume displacement techniques for breast defects following breast conserving surgery. MethodsAfter inclusion and exclusion, the patients with breast defects following breast conserving surgery in the Minda Hospital of Hubei Minzu University from February 2013 to March 2020 were retrospectively enrolled, and were assigned into a volume displacement group and volume replacement group according to different surgical techniques. Then the outcomes were compared between the two groups, including short-term efficacy (incision length, operation time, intraoperative blood loss, volume of resected specimen, cosmetic effect, patients’ subjective satisfaction, total postoperative complications, and total hospitalization time) and long-term efficacy (local recurrence rate, 3-year tumor-free survival, and 3-year overall survival). ResultsA total of 208 eligible patients were included in this study, including 105 in the volume displacement group and 103 in the volume replacement group before propensity score matching (PSM); after PMS, a total of 62 patients were enrolled, including 33 in the volume displacement group and 29 in the volume replacement group. No statistical difference was reported in the baseline data between two groups (P>0.05), except that the maximum diameter of lesion in the volume displacement group was smaller than that in the volume replacement group (P<0.05). The incision length, operation time, total hospitalization time, total postoperative complication rate, local recurrence rate, 3-year tumor-free survival rate, and 3-year overall survival rate had no statistical differences between the two groups (P>0.05), whereas the intraoperative blood loss was less (t=3.294, P=0.002) and the volume of resected specimen was smaller (t=2.030, P=0.047) in the volume displacement group as compared with the volume replacement group, and the cosmetic effect and patients’ subjective satisfaction were better in the volume displacement group as compared with the volume replacement group (Z=2.297, P=0.022; Z=2.256, P=0.024). ConclusionThe study analysis with small size samples reveals that volume displacement technique for breast defects following breast conserving surgery can achieve a good cosmetic effect and high patients’ subjective satisfaction without increasing risk of postoperative complications and tumour recurrence, which demonstrates a good long-term efficacy profile.
Objective To study the cause of the low rate of breast conservation and reconstruction by investigating the approval degree of breast conserving therapy and breast reconstruction of women with breast diseases, to help the breast surgeons make better communication with the patients and make more pertinent choices of therapeutic methods. Methods The age, occupation, educational background, the attitudes towards breast conserving therapy and breast reconstruction， and the choice of operative method of breast reconstruction of 139 patients with breast cancer and 224 patients with benign breast disease were investigated by questionnaire. Results In breast cancer group, 23.9% （28/117） of patients chose breast conserving therapy and 35.9%（42/117） of patients chose breast reconstruction, while the rates of breast conservation and reconstruction were 53.3% （106/199） and 63.8% （127/199） in benign breast disease group. In both groups, the higher rates of breast conservation and reconstruction were associated with better educational background (in breast cancer group: P=0.029， P=0.296; in benign breast disease group: P=0.081, P=0.019） and lower age (all Plt;0.05). Patients engaged in commerce showed higher rates of breast conservation and reconstruction （in breast cancer group: P=0.013, P=0.042； in benign breast disease group: P=0.032, P=0.044）. Age, occupation or educational background was not related with the choice of operative method of breast reconstruction （Pgt;0.05). Conclusions Patients with lower age, better educational background, and better job condition have ber desire of breast conservation and reconstruction. Breast surgeons should enhance communication with those patients about relevant information of breast conservation and reconstruction to make the more pertinent choice of therapeutic methods.
ObjectiveTo understand the application of acellular dermal matrix (ADM) in implant-based breast reconstruction. MethodLiteratures on application of ADM in the implant-based breast reconstruction were reviewed. ResultsADM was widely used in the implant-based breast reconstruction and revisionary breast surgery. ADM could help to achieve a better reconstruction outcome by precisely locating the inferior mammary fold and strengthening the local control of the implant. However, whether ADM might increase the postoperative complications was controversial. ConclusionADM assisted implant-based breast reconstruction could achieve a better cosmetic outcome, but the large sample randomized controlled trial is needed to evaluate the application effect and risk of ADM.