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.
ObjectiveTo summarize the difficulties and key points of free deep inferior epigastric artery perforator flap (DIEP) transplantation in breast shaping of two-staged breast reconstruction with vertical scar.MethodsThe clinical data of 32 postoperative breast cancer patients after mastectomy who underwent free DIEP transplantation for breast reconstruction between October 2015 and October 2019, whose original surgical incisions were all vertical and longitudinal, were retrospectively analysed. All the patients were female, aged from 31 to 42 years, with an average of 34.6 years. The disease duration of breast cancer ranged from 9 to 48 months (mean, 22.8 months). Free DIEP pedicled with contralateral vessels were used in all cases, and the recipient vessels were intrathoracic vessels. Among them, 17 flaps were placed longitudinally, 15 flaps were placed obliquely; Z-shaped flaps were used in 18 cases to adjust the chest wall skin contracture, and contralateral breast reduction and mastopexy were accomplished at the same time in 23 cases.ResultsAll DIEP survived completely, and all donor and recipient sites healed by first intention. Internal thoracic lymph node metastasis was found in 1 case and treated with radiotherapy. All 32 cases were followed up 9-48 months, with an average of 19.4 months. The appearance and texture of all flaps were satisfactory, and only linear scar was left in donor site. Eleven patients underwent further autologous fat transplantation and nipple reconstruction. All patients had no effect on abdominal wall activity, and no local recurrence and metastasis was found.ConclusionIt is difficult to use free DIEP for two-staged breast reconstruction in patients received mastectomy with vertical longitudinal scar left. Combined with different breast shaping techniques, the outcomes can significantly improve.
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.
Objective To investigate if intercostal neurovascular perforator can nourish lower abdominal flap. Methods Between June 2017 and December 2020, in 39 female patients with predominant perforator originated from intercostal nerve nutrient vessels, main trunk of the deep inferior epigastric vessels was chosen to be the pedicle to harvest free lower abdominal flap for breast reconstruction. The age of the patients ranged from 28 to 52 years, with an average of 38.6 years. There were 16 cases on the left and 23 cases on the right. The duration of breast cancer was 3-32 months, with an average of 21.8 months. Pathological stage was stageⅡin 31 cases and stage Ⅲ in 8 cases. Among them, 25 cases were primary tumor resection and one stage breast reconstruction and 14 cases were delayed breast reconstruction. Results The lower abdominal flap pedicled with one side pedicle was harvested in 32 cases, all of which were supplied by the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator; 7 cases were harvested with bilateral pedicled lower abdominal flaps, of which 4 cases were supplied by the main trunk of the deep inferior epigastric vessel combined with intercostal neurovascular perforator on one side and deep inferior epigastric artery perforator on the other side, and the other 3 cases were supplied by bilateral main trunk of the deep inferior epigastric vessel and the intercostal neurovascular perforator. In the flaps nourished with the main trunk of the deep inferior epigastric vessel combined with the intercostal neurovascular perforator, the intercostal neurovascular perforators were one branch type in 15 cases, one branch+reticular type in 19 sides, and reticular type in 8 sides. The size of flap ranged from 26 cm×10 cm to 31 cm×13 cm; the thickness was 2.5-5.5 cm (mean, 2.9 cm); the vascular pedicle length was 7.0-11.5 cm (mean, 9.2 cm); the weight of the flap was 350-420 g (mean, 390 g). All the flaps survived completely and the incisions at donor sites healed by first intention. All patients were followed up 14-35 months (mean, 25.4 months). The shape, texture, and elasticity of reconstructed breasts were good and no flap contracture happened. Only linear scar left at the donor site, the function of abdomen was not affected. No local recurrence happened. ConclusionWhen the direct perforator of the deep inferior epigastric artery may not provide reliable blood supply for the lower abdominal flap, the intercostal neurovascular perforator with deep inferior epigastric vessels can ensure the blood supply of the free lower abdominal flap.
【Abstract】 Objective To discuss the aesthetic effect and appl ication of refined incisions in breast reconstructionfor breast cancer patients by the transverse rectus abdominis myocutaneous (TRAM) flap. Methods From January 2001 toOctober 2006, 77 cases with breast cancer were treated with TRAM flap to immediate breast recontruction. The patients were all femals, with an average age of 45 years (ranging from 26 years to 53 years). There were 39 cases of left breast and 38 cases of right breast. The disease course was from 1 day to 180 days. There were 11 cases of stage I , 60 cases of stage II and 6 cases of stage III, among which 34 cases were located in the upper outer quadrant, 15 in the lower outer quadrant, 22 in the upper inner quadrant and 6 in the lower inner quadrant. The size of tumors varied from 1 cm to 4 cm. As to the pathologic type, 60 cases were invasive ductal cancers, 12 ductal cancers in situ, 5 invasive lobular cancers; positive lymph node (number: 1-7) happened in 29 cases, while negative lymph node happened in 48 cases. Among the 77 cases, regular shuttle incisions were performed in 35 cases, and refined circle incisions were performed in 42 cases, which were 2 cm away from the breast tumor border. Axillary incision was necessary for the breast tumors located in upper inner, lower inner and upper outer quadrants in order to perform axillary mastectomy. Ten cases were ni pple-areola sparing. The shape, symmetry and incision scar of the reconstructed breast were evaluated and graded. Results There were 6 cases out of 77 cases of breast reconstruction in which partial necrosis happened and the necrosis rate was 7.79%. The time of follow-up was from 13 months to72 months, with an average of 39 months. No recurrence or matastasis happened in 76 cases, and distant metastasis happened only in 1 case. There were 40 cases out of 42 cases with refined incisions which were scored more than 3, and the satisfaction rate was 95.24%. There were 31 cases out of 35 cases with regular incisions which were scored more than 3, and the satisfaction rate was 88.57%. Conclusion The reasonable refined incision based on the location of the tumor is effective to improve the satisfaction rate for the shape of the reconstructed breast.
Objective To summarize the anatomical types of the concomitant veins of deep inferior epigastric artery and the corresponding choice of anastomosis methods, and to evaluate the indications and safety of various methods. MethodsBetween October 2015 and June 2021, 296 female patients received breast reconstruction with autologous free lower abdominal flap, including 154 cases of immediate breast reconstruction and 142 cases of delayed breast reconstruction. The average age of the patients was 36.5 years, ranged from 26 to 62 years. Unilateral free deep inferior epigastric artery perforator flap transplantation was performed in 172 cases, and unilateral free muscle-sparing rectus abdominis myocutaneous flap transplantation was performed in 124 cases. The internal thoracic vessels were selected as the recipient vessels in all cases. The length of vascular pedicle ranged from 9.5 to 13.0 cm, with an average of 11.2 cm. The concomitant veins of deep inferior epigastric artery included three anatomical types: one-branch type in 26 cases (8.8%), two-branch type in 180 cases (60.8%), and Y-shaped structure in 90 cases (30.4%). Anastomosis of inferior epigastric artery was performed with the proximal end of internal thoracic artery, while that of vein should be adjusted according to the diameter, length, wall thickness, and branches of the vein. The specific classification of venous anastomosis included: ① The sole concomitant vein of deep inferior epigastric artery was anastomosed with the internal mammary vein (26 cases); ② The two concomitant veins of deep inferior epigastric artery were anastomosed with the internal mammary vein respectively (151 cases); ③ The larger one of two concomitant veins of deep inferior epigastric artery was anastomosed with the internal mammary vein, and the other one was ligated and discarded (29 cases); ④ The two concomitant veins of deep inferior epigastric artery were Y-shaped, and the common trunk segment was directly anastomosed with the internal mammary vein (31 cases); ⑤ The smaller branch of the concomitant veins of Y-shaped structure was ligated, and the thicker branch was anastomosed with the internal mammary vein (17 cases); ⑥ The concomitant veins of Y-shaped structure were anastomosed with the internal mammary veins respectively (42 cases). Results Among the patients who underwent venous anastomosis according to scheme ④, 3 cases had venous crisis of flap after operation, of which 1 case was successfully rescued by emergency exploration; the other 2 cases had flap necrosis, of which 1 case survived after being repaired by pedicled latissimus dorsi flap, and 1 case closed the wound directly. Flaps with other venous anastomosis protocols survived completely. All 296 patients were followed up 12-70 months, with an average of 37.5 months. The reconstructed breast has good shape, good elasticity, and no skin flap contracture. The donor site of the flap only left linear scar, and the abdominal wall function was not affected. ConclusionThe method of direct anastomosis of concomitant veins of deep inferior epigastric artery with Y-shaped structure is relatively risky, and the vessels are prone to be twisted and compressed, leading to the occurrence of venous crisis. It can improve the safety of surgery if only one large vein is anastomosed or two veins are separated to anastomose respectively.
ObjectiveTo explore the techniques and short-term effectivness of contralateral breast symmetrization mammaplasty in breast reconstruction.
MethodsBetween February 2014 and December 2015, 11 patients received immediate or delayed breast reconstruction after nipple-sparing mastectomy (6 and 5 cases respectively) for contralateral breast symmetrization mammaplasty. The age ranged 36-55 years (mean, 45 years). The disease duration was from 7 days to 6 months (mean, 2.5 months) in 6 patients undergoing immediate breast reconstruction. According to tumor TNM staging, 2 cases were rated as TisN0M0, 3 cases as T1N0M0, and 1 case as T2N0M0. The duration was from 2 to 25 years (mean, 8 years) in 5 patients undergoing delayed breast reconstruction. The implant (7 cases) and latissimus dorsi (4 cases) were used for breast reconstruction; and breast augmentation (6 cases) and breast reduction (5 cases) were performed for contralateral breast symmetrization.
ResultsOne patient had local poor wound healing postoperatively and was cured; primary healing was obtained in the other patients, and no other postoperative complication of infection, implant exposure or capsular contracture was found. The patients were followed up 3 to 24 months (mean, 12 months). The reconstructive outcomes were excellent in 9 cases and good in 2 cases, with an excellent and good rate of 100%. There was no recurrence or metastasis.
ConclusionSimultaneous contralateral symmetrization with augmentation/reduction mammaplasty after breast reconstruction can obtain satisfactory symmetric outcomes.
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.
