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 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.
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 evaluate the application effect of acellular dermal matrix (ADM) in immediate breast reconstruction after mammary mastectomy with prosthetic implants. Methods The clinical data of 68 patients with breast cancer undergoing immediate breast reconstruction with prosthetic implantation in our hospital were retrospectively analyzed and divided into ADM group (n=43) and non-ADM group (n=25), according to the use of ADM in the posterior space of pectoralis major muscle while prosthesis implantation or not. The size of breast prosthesis, operative time, intraoperative blood loss, drainage duration, total drainage, total hospital stay, postoperative complications, postoperative cosmetic effect and quality of life of patients were compared between the two groups. Results Patients in the ADM group showed no statistically significant difference regarding operative time, drainage duration, total drainage, hospital stay, postoperative complications and intraoperative removed gland volume with the non-ADM group (P>0.05). The average intraoperative blood loss in the ADM group was less than that of the non-ADM group, the average volume of prosthesis in the ADM group was bigger than that of the non-ADM group, the volume difference between prosthesis and removed gland in the ADM group was smaller than that of the non-ADM group, which was considered statistically significant difference (P<0.05). The subjective satisfaction and objective measurement scores of patients in the ADM group were significantly better than those of the non-ADM group, especially in the symmetry of breast, surgical scar and distance of lateral displacement of nipple (P<0.05). The postoperative quality of life in the ADM group was significantly better than that of the non-ADM group in terms of body image, sexual function and sexual interest (P<0.01). Conclusions It is safe and feasible to use ADM-assisted the immediate breast reconstruction after nipple-sparing mammary mastectomy with prosthetic implantation. As an extension of the pectoralis major muscle, ADM can enlarge the posterior space for the prosthesis implantation, making the choice of the prosthesis much more easier. The combined application of ADM can obtain a better cosmetic effect, meanwhile improving the postoperative quality of life and satisfaction of patients.
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.
ObjectiveTo investigate the effectiveness of endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. Methods The clinical data of 138 female patients with breast cancer who met the selection criteria between April 2019 and December 2023 were retrospectively analyzed. The mean age of the patients was 43.8 years (range, 27-61 years). The maximum diameter of the tumors ranged from 1.00 to 7.10 cm, with an average of 2.70 cm. Pathological examination showed that 108 cases were positive for both estrogen receptor and progesterone receptor, and 40 cases were positive for human epidermal growth factor receptor 2. All patients underwent endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants. The operation time, intraoperative blood loss, prosthesis size, and occurences of nipple-areola complex (NAC) ischemia, flap ischemia, infection, and capsular contracture were recorded. The Breast-Q2.0 score was used to evaluate breast aesthetics, patient satisfaction, and quality of life (including the social mental health score, breast satisfaction score, and chest pain score). Patients were divided into two groups based on the time of operation after the technique was implemented: group A (within 1 year, 25 cases) and group B (after 1 year, 113 cases). The above outcome indicators were compared between the two groups. Furthermore, based on the postoperative follow-up duration, patients were classified into a short-term group (follow-up time was less than 1 year) and a long-term group (follow-up time was more than 1 year). The baseline data and postoperative Breast-Q2.0 scores were compared between the two groups. ResultsThe average operation time was 120.76 minutes, the average intraoperative blood loss was 23.77 mL, and the average prosthesis size was 218.37 mL. Postoperative NAC ischemia occurred in 21 cases (15.22%), flap ischemia in 30 cases (21.74%), infection in 23 cases (16.67%), capsular contracture in 33 cases (23.91%), and prosthesis removal in 2 cases (1.45%). The operation time of group A was significantly longer than that of group B (P<0.05), and there was no significant difference in intraoperative blood loss, prosthesis size, and related complications between the two groups (P>0.05). All patients were followed up 3-48 months (mean, 20 months). There were 33 cases in the short-term group and 105 cases in the long-term group. There was no significant difference in baseline data such as age, body mass index, number of menopause cases, number of neoadjuvant chemotherapy cases, number of axillary lymph node dissection cases, breast cup size, degree of breast ptosis, and postoperative radiotherapy constituent ratio between the two groups (P>0.05). At last follow-up, the breast satisfaction score in the patients’ Breast-Q2.0 score ranged from 33 to 100, with an average of 60.9; the social mental health score ranged from 38 to 100, with an average of 71.3; the chest pain score ranged from 20 to 80, with an average of 47.3. The social mental health score of the long-term group was significantly higher than that of the short-term group (P<0.05); there was no significant difference in breast satisfaction scores and chest pain scores between the two groups (P>0.05). No patient died during the follow-up, and 2 patients relapsed at 649 days and 689 days postoperatively, respectively. The recurrence-free survival rate was 98.62%. Conclusion Endoscopic radical mastectomy for breast cancer combined with total pectoral muscle reconstruction with breast implants has fewer complications and less damage, and the aesthetic effect of reconstructed breast is better.
Objective To investigate the benefits and drawbacks of breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap for breast cancer and treatment experience of postoperative operation-related complications. Methods A retrospective analysis was performed on clinical data of 26 female patients with breast cancer who met the selection criteria between September 2021 and March 2023 aging 48.7 years (range, 26-69 years). All tumors were unilateral, with 17 on the left side and 9 on the right side. The tumor size ranged from 1.0 to 7.0 cm, with an average of 2.7 cm. The pathological staging included T1 in 11 cases, T2 in 14 cases, and T3 in 1 case; N0 in 10 cases, N1 in 11 cases, N2 in 2 cases, and N3 in 3 cases; no distant metastasis (M0) occurred when first diagnosed. Among them, 10 cases underwent breast conserving surgery, and 16 cases underwent nipple-sparing mastectomy. All patients underwent breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap. The operation time, incision length, and postoperative drainage volume in 3 days were recorded. Breast-Q “Satisfaction with back” scale was conducted to evaluate patients’ satisfaction with back at 6 months after operation. Results The operation time was 280-480 minutes (mean, 376.7 minutes), the incision length was 10-15 cm (mean, 12.2 cm), the postoperative drainage volume in 3 days was 500-1 600 mL (mean, 930.2 mL). There were 4 cases of postoperative seroma, 1 case of incision rupture, 1 case of paresthesia of the thoracic wall, and 1 case of edema of the ipsilateral upper limb. All patients were followed up 12-30 months (mean, 20.1 months). No latissimus dorsi muscle flap necrosis, latissimus dorsi muscle atrophy, or shoulder joint dysfunction occurred during follow-up; 2 patients had recurrence of lymph nodes in the ipsilateral axilla after operation, but no distant metastasis occurred. Breast-Q score at 6 months after operation was 64-100 (mean, 79.5). The average score was 78.6 (range, 64-100) in patients underwent nipple-sparing mastectomy and 81.0 (range, 78-100) in patients underwent breast conserving surgery. Conclusion Breast reconstruction with endoscopic-assisted harvesting of the latissimus dorsi muscle flap for breast cancer is proven to be a surgical approach with safety and cosmetic effects with mild postoperative operation-related complications and considerable patient satisfaction.
ObjectiveTo evaluate the effect of post mastectomy radiation therapy (PMRT) on breast reconstruction after mastectomy in breast cancer patients, in order to provide evidence support for clinical treatment decision.MethodsFive databases searched in the current study include the Cochrane Library, PubMed, CNKI, VIP and WanFang database. A systematic search for control trials was performed in each database from the starting date of each database to March 1, 2021. After the two evaluators independently selected literatures, extracted data and conducted quality evaluation according to the inclusion and exclusion criteria, the meta analysis was carried out by Revman 5.3 software.ResultsA total of 9 cohort studies (3 447 cases) were included, including 699 cases in PMRT group and2 748 cases in non-radiotherapy group. The results of meta-analysis showed that: PMRT was associated with significant increase in capsular contracture. The incidence of capsular contracture increased from 4.34% in the non-radiotherapy group to 34.10% in patients receiving PMRT [OR=9.25, 95%CI (3.76, 22.78), P<0.000 01]. In addition, PMRT was associated with a significant increase in incidences of reconstructive failure [OR=2.55, 95%CI (1.74, 3.74), P<0.000 01] and revisional surgery [OR=2.24, 95%CI (1.58, 3.18), P<0.000 01]. Moreover it was associated with a significant reduction in patient satisfaction [OR=0.29, 95%CI (0.15, 0.57), P=0.000 30] and cosmetic outcome [OR=0.26, 95%CI (0.15, 0.43), P<0.000 01].ConclusionThis meta-analysis demonstrates that breast cancer patients who received PMRT after breast reconstruction, the rate of adverse events is increased and patients’ satisfaction and cosmetic outcome are decreased.
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.
