Objective To introduce the treatment experiences about the skin-sparing mastectomy and immediate breast reconstruction. Methods The skin-sparing mastectomy and immediate breast reconstruction by using transverse rectus abdominis myocutaneous （TRAM） flat were performed in 10 patients with early-stage breast cancer from May 2008 to December 2011 in our hospital. The patients’ data were retrospectively analyzed. Results There were postoperative complications after skin-sparing mastectomy and immediate breast reconstruction， including TRAM flat necrosis in 1 case， papillary necrosis in 1 case and fat necrosis in the reconstructed breast with oxter wound infection in 1 case. There was no incision hernia of abdominal wall or necrosis of all TRAM flat in any case. The patients’ satisfaction that evaluation for the breast shapes of reconstructed breasts was very satisfaction in 5 cases， part satisfaction in 4 cases， and dissatisfaction in 1 case， respectively. Conclusions Because of the minimal access approach and good breast shape， the skin-sparing mastectomy and immediate TRAM flat breast reconstruction is a safe and effective way for treating early-stage breast cancer.
Objective To investigate the location of the artery correlated with rectus abdominis musculocutaneous flap in order to promote the reconstruction of the breast after radical mastectocy for breast cancer.Methods An anatomic study was carried out on 15 cadavers of 30 sides，which were immersed in paraformaldehyde less than six months. Whole thoraepigastrica wall was cutted, which scale was from subclavian as upper limit to inguinal ligament, the lower limit across left and right of middle axillary. Veins or arteriesof inferior epigastrica and internal thorax in hang were injected with red or blue ink to show all of vessel branches. Results The external diameters of both the superior epigastric arteries and inferior vessels were 1.87±0.28 mm and 2.25±0.32 mm respectively. The myocutaneous arteries from inferior abdomen vessels had an intensive horizontal distribution on hylum. The perforators significantly decreased but could be found to pass through anterior rectus sheath in Rand. The distances between lateral perforators and Ⅰ,Ⅱ and Ⅲ parts in external edge of anterior rectus sheath were 1.22, 1.46 and1.57 cm, respectively; and the distances between medial perforators and Ⅰ, Ⅱ, and Ⅲ parts at median line were 1.54, 1.62, 1.66 cm. Perforators were more thick and intensive near hylum than in other part. The subcostal arteries derived from inferior abdomen artery and 1.25±0.37 cm away from costal arch. Afterdividing into subcostal artery, the outer diameter of 67 percent of subcostal artery was bigger than that of inferior abdomen arteries. The branches of subcostalarteries were distributed at the 2/3 lateral rectus abdominis, forming an extenive choke anastomosis system with intercostal anterior artery and vessels supplied diaphragmatic muscle. The rectus abdominis at the level of xyphoid was supplied by a branch came from inferoir thorax artery, which diverged epigastric vessels at the same time.Conclusion During the process of makingthe inferior transverse rectus abdominis musculocutaneous flap base on superior epigastric vessels and superoir rectus abdobminis, reservation of pro-theca edge 1 cm of rectus abdominis can protect inferior abdomen artery from injury. Reservation of more than 2 cm pro-theca and rectus abdominis below costal arch at the flag will protect effectively subcostal artery from injury. No damage of subcostal arteries can influence the survival of musculocutaneous flap.
OBJECTIVE: To investigate the effect of breast reconstruction with latissimus dorsi musculocutaneous flap. METHODS: Since 1994, 60 cases were performed breast reconstruction with latissimus dorsi musculocutaneous flap with fat tissue nourished by thoracodorsal artery according to the shape and volume of the normal breast on the other side. All of cases were followed up for 3 months to 5 years. RESULTS: Among the 60 cases, excellent effect was obtained in 41 cases (68.3%), good effect in 16 cases (26.7%), unsatisfactory in 3 cases (5.0%). CONCLUSION: Modified latissimus dorsi musculocutaneous flap to reconstruct breast overcome the shortcoming of volume deficiency of traditional latissimus dorsi in breast reconstruction, and it is a safe and easy-manipulated surgical operation.
ObjectiveTo explore the clinical efficacy of immediate breast reconstruction with extended latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy for patients with early-middle breast cancer. MethodsSixty patients diagnosed with early-middle breast cancer by needle biopsy from November 2009 to October 2012 in this hospital were divided into two groups according to the surgical method.The breast reconstruction group (30 cases) were performed immediate breast reconstruction with extended latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy, the control group (30 cases) were performed traditional modified radical mastectomy.The postoperative complications, clinical efficacy, quality of life, and recurrence and metastasis were compared in two groups. Results①The ipsilateral breast was completely missing in the control group.The aesthetic effect in the breast reconstruction group was satisfactory including excellent in 22 patients, good in 7 patients, general in 1 patient.②The rates of flaps effusion, flap necrosis, and affectied limb activity limitation had no significant differences in two groups (P > 0.05).The wound healing time, operation area drainage time, hospital stay, and post-operative chemotherapy start time all had no significant differences in two groups (P > 0.05).③The frequency of psycho-logical pressure (inferiority/anxiety/fear) and rate of un-satisfaction of secondary sexual characteristics (body/curve) in the breast reconstruction group were lower than those in the control group (P < 0.001).The rate of social interaction fitness in the breast reconstruction group was higher than that in the control group (P < 0.001).④The following-up time was 12 to 38 months with an average 25 months, one case died because of brain metastasis in the control group, the rest 59 patients had no local recurrence and distant metastasis. ConclusionsThe immediate breast reconstruction with exte-nded latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy can cure cancer on the basis of satisfactory cosmetic results of breast, excellent quality of life of patients, and fewer surgical complica-tions.It does not affect postoperative adjuvant radiochemotherapy and short-and long-term efficacy for breast cancer.
ObjectiveTo investigate the clinical application value of immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy for patients with breast cancer. MethodsA total of 28 patients with breast cancer undergoing immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy from January 2006 to December 2009 were included in this study. The perioperative results, breast appearance evaluation and followup results were analyzed. ResultsAll 28 patients received axillary lymph node dissection and the number of lymph node dissected was 14-32 (median 21). The operation time was 117-140 min (mean 126 min), blood loss was 82-124 ml (mean 98 ml), and the time to drainage tube removal was 3-5 d. No wound infection, skin necrosis, and foreign body reaction occurred in all the patients, especially in 22 patients underwent nippleareola complex-sparing mastectomy, no ischemia or necrosis occurred in nippleareola complex. For evaluation of breast appearance, excellent was in ten cases and good in 18 cases, thus, the excellent and good rate was 100%. All patients were followed up for 12-48 months (median 24 months) after operation, and distant metastasis, local recurrence, upper extremity edema, and dysfunction were not found. No fiber kystis contracture was found and all patients were satisfied with breast appearance and good handfeels. ConclusionsImmediate breast reconstruction using silicon implant after skinsparing modified radical mastectomy has the advantage of minimal invasion, safety, simple operation, and quick postoperative recovery for patients with breast cancer and the appearance of reconstructed breast is excellent, which can be clinically used widely.
Objective To review the application progress, mechanism, application points, limitations, and oncological safety of external volume expansion (EVE) assisted autologous fat grafting for breast reconstruction and provide a reference for optimizing the design of EVE. Methods Based on the latest relevant articles, the basic experiments and clinical applications of EVE were summarized. ResultsEVE can reduce interstitial fluid pressure, increase blood supply, and promote adipogenic differentiation, thereby benefiting the survival of transplanted fat. EVE assisted autologous fat grafting in clinical practice can improve the retention rate of breast volume and the outcome of breast reconstruction, meanwhile it doesn’t increase the risk of local recurrence. But there is no standard parameters for application, and there are many complications and limitations. ConclusionEVE improves the survival of transplanted fat, but its complications and poor compliance are obvious, so it is urgent to further investigate customized products for breast reconstruction after breast cancer and establish relevant application guidelines.
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.
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.
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 summarize the experiences of the breast reconstruction using the deep inferior epigastric perforator (DIEP) flaps. Methods From March 2000 to March 2005, 18 cases of breast defects were treated. Defect wascaused by mammary cancer in 17 cases and by Poland’s syndrome in 1 case. Preoperative radiotherapy was given in 7 patients. The size of the chest wall defects ranged from 25 cm×20 cm to 12 cm×8 cm. All the breasts were reconstructed with the DIEP flaps. The flap size ranged from 35 cm×22 cm to 12 cm×8 cm (mean 9.58 cm×26.85 cm). The internal mammary vessels were used as the recipient vessels in 15 patients who underwent delayed breast reconstruction. Among these cases, the bilateral deep inferior epigastric vessels were anastomosed with the proximal and distal ends of the internal mammary vessels separately in 13 cases and only unilateral deep inferior epigastric vessels were harvested and anastomosed to the proximal ends of the internal mammary vessels in 2 cases. The recipient vessels were the thoracodorsal vessels and thoracodorsal vessels plus the circumflex scapular vessels in the patients who underwent immediate breast reconstruction. Results Sixteen flaps survived completely postoperatively and the survival rate was 89%. Flap necrosis occurred in 2 patients; one underwent radiotherapy preoperatively while the other did not. The distal 1/3 portion of the flap necrosed in the patient with Poland’s syndrome. Nipple reconstruction and breast remolding were performed in 2 patients. Partial dehiscence of the median abdominal incision occurred in 2 patients at 2 weeks postoperatively and were repaired with resuturing andsplit-thickness skin grafting separately. Conclusion Breast reconstruction using the DIEP flaps not only can preserve the advantages of the traditional method using the transverse rectus ablominis myocutaneous flaps, but also can retain the maximal function of the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal method of the breast reconstruction.