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.
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.
Latissimus dorsi muscle flap (LDMF) is an important autogenous tissue for autogenous breast reconstruction after mastectomy. LDMF harvesting using a conventional open method is traumatic, and the scar is obvious. With the application of minimally invasive technology in various surgical fields, endoscopic and robotic technology for breast surgery, especially LDMF breast reconstruction, is also becoming mature. Endoscopic or robotic LDMF breast reconstruction has the advantages of no incision in the back, superior cosmetic effect of back, clear vision of surgical field, and low incidence of postoperative complications. It is a safe and effective method of breast reconstruction.
ObjectiveTo explore the method of implant coverage with local soft tissue in immediate implant-based breast reconstruction and to evaluate the early effectiveness.
MethodsBetween April 2014 and August 2015, 11 patients with breast cancer underwent immediate breast reconstruction with implants after mastectomy, and the clinical data were reviewed retrospectively. The age ranged 29-48 years (mean, 36 years). The disease duration was from 7 days to 12 months (median, 3 months). According to tumor staging, 3 cases were rated as TisN0M0, 4 cases as T1N0M0, and 4 cases as T2N0M0. The implants were covered with local soft tissue according to the volume of mastectomy and contralateral breast size, including pectoralis major myocutaneous flaps with inframammary adipofasical flaps (3 cases), with serratus anterior fascial flap (5 cases), with rectus sheath fascial flap (1 case), and with serratus anterior fascial flap and rectus sheath fascial flap (2 cases). The size of pectoralis major myocutaneous flaps ranged from 15 cm×9 cm to 20 cm×15 cm, and the serratus anterior fascial flaps from 10 cm×8 cm to 15 cm×10 cm, and the rectus sheath fascial flap from 8 cm×6 cm to 10 cm×8 cm.
ResultsOne patient had partial nipple necrosis postoperatively and was cured, and no other postoperative complications of hematoma, infection, or implant exposure was found. The patients were followed up 4-13 months (median, 8 months). The reconstructive outcomes were excellent in 10 cases and good in 1 case, with an excellent and good rate of 100%. During follow-up, no rupture or exposure of the implant was observed; capsular contracture (Baker grade II) occurred in 1 case.
ConclusionAdequate coverage of implants with different local soft tissue flaps can achieve satisfactory early effectiveness in immediate implant-based breast reconstruction after mastectomy.
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.
ObjectiveTo introduce a contralateral mastoplasty in breast reconstruction with prosthesis after breast cancer surgery in order to gain bilateral breasts symmetry.MethodsBetween January 2016 and June 2018, 11 female patients with breast cancer were treated, aged 34-64 years old (mean, 49.6 years). There were 5 cases in left side and 6 cases in right side. There were 3 cases of invasive carcinoma and 8 cases of intraductal carcinoma. The diameter of tumor was 0.2-4.1 cm (mean, 2.5 cm). The disease duration ranged from 1 to 15 months (mean, 6 months). According to Regnault grading criteria, there were 7 cases of mild breast ptosis and 4 cases of moderate breast ptosis. Simple nipple-sparing mastectomy and reconstruction using prosthesis of the affected side, and folding and lifting of the nipple-areolar complex of the healthy side were performed.ResultsThe operation time was 144-188 minutes (mean, 158 minutes). The hospital stay was 6-9 days (mean, 7.5 days). Postoperatively, poor incision healing occurred in 1 case and healed after symptomatic treatment. The other incisions healed well and no surgical-related complications occurred. All patients were followed up 6-30 months (mean, 16 months). At 3 months after operation, the expert group adopted the self-made rating scale to evaluate the bilateral breasts symmetry, and the score was 8-10 (mean, 8.9). The patients were evaluated for their satisfaction according to the self-made score scale, and the score was 8-10 (mean, 9.1).ConclusionAfter immediate breat reconstruction with prosthesis after breast cancer surgery, the satisfied bilateral breasts appearances and symmetry can be obtained by contralateral mastoplasty.
Objective
To summarize types of post-mastectomy breast reconstruction and present situation.
Method
The relevant literatures about post-mastectomy breast reconstruction in recent years were reviewed.
Results
With the increasing incidence of the breast cancer and the progressing of the treatment methods, it has become a trend for the post-mastectomy breast reconstruction. If the patient’s condition is allowed, the post-mastectomy breast reconstruction can be performed. At present, the post-mastectomy breast reconstruction mainly include the implant based reconstruction, autologous tissue reconstruction, autologous fat transplantation, etc.. There are different options for the breast reconstruction according the indicators and it had the corresponding complications. So the selection of reconstruction technique depend on the individual requirements, determining by the patient choice, advice of the reconstructive surgeon, and anticipated post-mastectomy therapy, particularly the needs for the radiotherapy and chemotherapy, etc..
Conclusions
Post-mastectomy breast reconstruction is common abroad, corresponding research has been carried out in our country, experiences in learning are shairing. With deepening of domestic and foreign exchanges and progressing of technology, it is believed that post-mastectomy breast reconstruction might become one of conventional reconstruction options in future.
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.
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 compare the satisfaction and safety of patients undergoing prepectoral breast reconstruction (PBR) versus subpectoral dual-plane breast reconstruction (SBR) with implants combined with mesh after open total mastectomy for breast cancer. MethodsA prospective cohort study on clinical data of breast cancer patients who underwent open total mastectomy and received either PBR or SBR with implants and mesh for immediate breast reconstruction from June 2021 to October 2022 at West China Hospital of Sichuan University were performed. The pain scores on postoperative days 1, 3, 7, and 14, the postoperative use of analgesics within 14 days, and the incidence of postoperative complications, breast satisfaction, and quality of life during follow-up periods were compared between the two groups. ResultsA total of 62 female patients were included, with 35 in the PBR group, having an average age of (39.6±6.5) years, and 27 in the SBR group, having an average age of (41.5±9.9) years. The pain scores of the SBR group on postoperative days 3 (P=0.032), 7 (P＜0.001), and 14 (P＜0.001) were significantly higher than those of the PBR group, and a higher proportion of patients in the SBR group used analgesics within postopeartive 14 days (P=0.001). The median follow-up time was 28.4 months for the PBR group and 34.9 months for the SBR group. There was no statistical difference in the overall (P=0.583), major (P=0.526), or minor (P=0.532) complication rates between the two groups during follow-up. One (2.9%) patient in the PBR group and 2 (7.4%) patients in the SBR group lost their implants (P=0.575). There were 4 patients of movement deformities and 4 patients of chest muscle pain in the SBR group, whereas no patients in the PBR group had these complications (P=0.031). Encapsular contracture occurred in 5 (14.3%) patients in the PBR group and 11 (40.7%) patients in the SBR group (P=0.023). The incidences of ripple sign (25.7% vs. 3.7%, P=0.047) and implant contour visibility (40.0% vs. 11.1%, P=0.020) were significantly higher in the PBR group than those in the SBR group. At 24 months post-surgery, breast satisfaction scores [(67.9±13.1) points vs. (52.6±16.9) points, P=0.025] and chest function satisfaction [(70.7±13.4) points vs. (58.7±14.3) points, P=0.035] were higher in the PBR group. No local recurrence, distant metastasis, or deaths occurred in the PBR group during the follow-up period, while 1 patient of local recurrence and distant metastasis occurred in the SBR group, with no deaths. ConclusionCompared to SBR, PBR is more in line with the physiological and anatomical levels of the breast, effectively avoiding postoperative movement deformities and chest muscle pain, with a lower incidence of capsular contracture, and higher postoperative breast satisfaction and chest function satisfaction. It is a safe and feasible reconstruction method. For some specific patients, especially those with higher physical activity demands, it is a better reconstruction choice.
