Objective
To introduce an surgical technique of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision.
Methods
Between January 2017 and February 2018, 15 female patients with breast cancer (stageⅠ in 5 cases and stage Ⅱ in 10 cases) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. They were 27-45 years old (mean, 37.5 years). The disease duration ranged from 1 to 24 months (mean, 8 months). The tumor located at the left breast in 8 cases and at the right breast in 7 cases. The diameter of tumor ranged from 1.5 to 3.0 cm (mean, 2.6 cm). The distance between tumor and nipple was 1.8-4.0 cm (mean, 2.3 cm).
Results
After operation, the nipple epidermal necrosis occurred in 1 case, and subcutaneous effusion in 1 case. No subcutaneous emphysema or skin flap necrosis occurred. Postoperative pathological examination showed that 1 case was nipple involvement and was treated with nipple resection. All patients were followed up 7-17 months (mean, 11 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 4 cases of excellent, 10 cases of good, and 1 case of poor. No tumor recurrence or metastasis occurred during follow-up.
Conclusion
It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction.
ObjectiveTo optimize the perioperative management experiences for breast cancer patients undergoing direct-to-implant-based breast reconstruction, and provide reference for clinical practice. Methods A comprehensive review of recent domestic and international literature was conducted to systematically summarize the key points of perioperative management for direct-to-implant-based breast reconstruction, including preoperative health education, intraoperative strategies, and postoperative management measures, along with an introduction to the clinical experiences of West China Hospital of Sichuan University. ResultsStandardized perioperative management can effectively reduce the incidence of complications and achieve excellent cosmetic outcomes and quality of life after operation. Preoperative management includes proactive health education to alleviate patients’ anxiety and improve treatment compliance, as well as comprehensive assessment by surgeons of the patient’s physical condition and reconstructive expectations to select the most appropriate implant. Intraoperative management consists of strict aseptic technique, minimizing implant exposure, preserving blood supply to the nipple-areola complex (e.g., by using minimally invasive techniques or indocyanine green angiography, etc), and meticulous hemostasis. Postoperative management encompasses multimodal analgesia, individualized drain management (such as early removal or retaining a small amount of fluid to optimize contour), infection prevention and control (including topical and systemic antibiotics, ultrasound-guided minimally invasive drainage), guidance on rehabilitation exercises (early activity restriction followed by gradual recovery), and regular follow-up to evaluate aesthetic results and monitor for complications. ConclusionEstablishing a standardized, multidisciplinary perioperative management framework markedly enhances surgical safety and patient satisfaction, thereby providing a replicable benchmark for direct-to-implant-based breast reconstruction across diverse clinical settings.
Endoscopic technique is one of the important development directions of modern surgical techniques. Compared with the laparoscopic and thoracoscopic surgery, the development of endoscopic technology in breast surgery is generally slow due to the limitation of the physiological structure of this organ. The characteristics of endoscopic technology such as micro-incision trauma and remote operation are especially suitable for breast (cancer) surgery, which desires flawless skin surface and perfect remodeling. In the meantime, however, the obstacles of breast (cancer) endoscopic surgery include the establishment and maintenance of a satisfactory surgical field, the endoscopic exposure of large and heavy glands, the obstruction by the slope of the skeletal thorax, the remote operation that is difficult to accomplish with conventional endoscopic instruments, and the complete removal of large and tough glands and so on. By studying and pondering the experience of the pioneers of endoscopy, the endoscopic team of West China Hospital took five years to develop this novel one axillary-incision, single-port and liposuction-free endoscopic surgical approach which is low costing and only requires one-port operation platform. The original “inverse sequence method”, “Huaxi hole no. 1, 2, 3” and other endoscopy-assisted approach overcome the aforesaid obstacles. It has significantly reduced the technical threshold and operational difficulty of breast (cancer) endoscopic surgery and contributed our own wisdom to the vigorous development of breast endoscopic technology in China. The author shared her observations and thoughts on the technical details of breast endoscopic surgery based on her nearly 20 years of experience in endoscopic operation.
ObjectiveTo investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.MethodWe searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.ResultsIn the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.ConclusionsThe question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.
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.
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.
From 1985 through May of 1989, a total of 6 cases of breast carcinomas underwent primary reconstruction of breast immediately following radical mastectomy by using transposition of vaseularized latissimus dorsi myocutaneous flap for reconstruction of breast. The re- sults of all these 6 cases were satisfactory. The design of the operation and the operative technique were detailed. The importance of the reconstruction of breast immediately after the radical mastectomy and the advantages of using vascularized latissimus dousi myocutanous flap for reconstruction were discussed.
Objective
To evaluate the feasibility of immediate breast reconstruction with silicone prosthesis for breast tumor.
Methods
The clinical data of the 42 patients with breast tumor who had undergone breast reconstruction with silicone prosthesis from January 2012 to June 2017 were collected retrospectively. The postoperative complications and cosmetic results were analyzed.
Results
All patients underwent operation successfully. The surgical time was 230–435 min (mean of 325 min), the intraoperative blood loss was 100–160 mL (mean of 130 mL), and the hospitalization time was 18–33 d (mean of 24 d). The cosmetic results was excellent in 26 patients, good in 8 patients, bad in 8 patients, and fine rate was 81.0% (34/42). Rate of patients’ overall satisfaction with breast reconstruction was 73.8% (31/42) and rate of aesthetic satisfaction was 78.6% (33/42). After operation, seroma occurred in 2 patients, and the ischemic necrosis in nipple and areola occurred in 3 patients. All the patients were followed-up for 4–70 months, and the median follow-up time was 37 months. During the follow-up period, no patient had metastasis or recurrence. Six patients received radiotherapy, among them 2 patients appeared Ⅱ-grade capsular contracture.
Conclusion
The breast reconstruction with silicone prosthesis is a simple, easy, and effective surgical procedure.
Objective To discuss the effectiveness of breast reconstruction with dual plane prosthesis implantation or anterior pectoralis prosthesis implantation under endoscopy by using prospective comparative study, in order to provide a reference for clinical surgical selection. Methods A total of 54 female patients with breast cancer admitted between January 2023 and December 2023 and met the selection criteria were selected as research subjects. According to the random number table, 54 patients were divided into trial group and control group with 27 cases in each. The patients in the trial group and control group were treated with dual plane prosthesis implantation and anterior pectoralis prosthesis implantation for breast reconstruction after glandular resection under endoscopy, respectively. There was no significant difference between the two groups (P>0.05) in the terms of age, body mass index, affected side, breast clinical stages, molecular typing, disease duration, breast volume of healthy side, breast ptosis of affected side, and preoperative Breast-Q score (social mental health, sexual health, breast satisfaction, chest somatic health). The operation-related indicators (operation time, total volume of drainage within 7 days after operation, extubation time, and hospital stay), occurrence of complications, breast reconstruction efficacy related indicators (transverse and longitudinal distance difference), and the pre- and post-operative differences (change values) of Breast-Q scores for each item were compared between the two groups. Results There was no significant difference in operation time, total volume of drainage within 7 days after operation, extubation time, and hospital stay between the two groups (P>0.05). All patients of the two groups were followed up 3-12 months (mean, 6.3 months). Three patients (11.11%) in trial group and 5 patients (18.52%) in control group experienced complications, and there was no significant difference in the occurrence of complications (P>0.05). At 7 days after operation, the transverse and longitudinal distance differences were significantly less in trial group than in control group (P<0.05). The Breast-Q scores of the two groups at 7 days after operation were significantly higher in all items than those before operation (P<0.05), but there was no significant difference in all change values between the two groups (P>0.05). ConclusionFor patients with breast cancer, comparison of breast reconstruction with anterior pectoralis prosthesis implantation, breast reconstruction with dual plane prosthesis implantation has better breast reconstruction effectiveness and higher safety.
