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.
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.
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 explore the feasibility of homemade domestic breast palpation imaging (BPI) instead of clinical breast palpation examination (CBE) for screening breast masses. MethodsThe patients who received breast ultrasonography (BUS), BPI examinations and CBE in the Sichuan Cancer Hospital from March 2022 to September 2022 were retrospectively collected. The result of BUS examination was used as the criteria to compare the efficiency and difference between the BPI examination and CBE in detecting breast masses. The effects of the patients’ body mass index, breast volume, tumor location, benign and malignant tumor, and maximum tumor diameter on the accuracy of breast tumor detection by BPI system were further analyzed. ResultsA total of 102 patients were included in this study. Among the 90 patients with breast mass detected by BUS, 76 cases were detected by BPI and 51 cases were detected by CBE. In the 12 patients without tumor mass detected by BUS, only 11 cases patients without tumor mass were detected by BPI and CBE. The sensitivity and accuracy of breast tumor mass screening by the BPI were higher than those by the CBE (84.4% vs. 56.7%, 85.2% vs. 60.7%, respectively), and the specificity was similar (91.6%, both). The area under the receiver operating characteristic curve (95% confidence interval, 95%CI) of BPI and CBE for screening breast masses were 0.903 (0.791, 0.970) and 0.799 (0.747, 0.851), respectively. The former was higher than the latter (Z=2.494, P=0.013). The consistencies were moderate (Kappa=0.518, P<0.001), general (Kappa=0.204, P=0.002), moderate (Kappa=0.518, P<0.001) between the BPI and BUS, between CBE and BUS, and between BPI and CBE for screening breast masses, respectively. The results of multivariate analysis of binary logistics regression indicated that the benign tumor mass was not easily detected [OR (95%CI） was 9.600（1.328, 69.400), P=0.025] and the tumor mass with breast volume ＜350 mL was easily detected [OR (95%CI） was 0.157 (0.030, 0.818), P=0.028], the diameter of tumor mass had no obvious influence on breast tumor mass screening by the BPI. ConclusionAccording to the preliminary results of this study, BPI can improve the sensitivity of detecting breast masses and make up for the lack of objective records of CBE, but BPI cannot replace CBE at present.
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 describe the role of breast palpation imaging (PI) in breast cancer screening. Method We searched the latest research and previous literatures of PI in the diagnosis of breast cancers, and made an review after reading the articles. Results PI had better diagnostic efficiency than clinical breast examination (CBE) in breast cancer screening. PI combined with mammography (MG) and/or breast ultrasound (BUS) could further improve the diagnostic efficiency. Conclusion PI has important value in breast cancer screening, and is an important supplement to existing breast cancer screening methods.
