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.
【Abstract】ObjectiveTo review the status and controversy on skinsparing mastectomy (SSM) for breast cancer. MethodsThe pertinent literatures about SSM published recently to comprehend its relevant techniques and improvements in comparison with nonskinsparing mastectomy (NSSM) were analyzed and also the safety of SSM by analyzing the relationships between SSM and ductal carcinoma in situ, restrict nippleareola complex reservation, and postmastectomy radiotherapy were discussed. ResultsSkinsparing mastectomy combined with immediate breast reconstruction is a safe operative modality for T1/T2 tumor without skin adhesion, multicentric tumors, and ductal carcinoma in situ. What is more, it does not defer adjuvant therapy. However, it may be prudent to reserve the nippleareola complex only for peripherally located T1/T2 tumors and some other less serious invasion degree. Since the effect of SSM and immediate breast reconstruction on postmastectomy radiotherapy is confusing, there are still controversies on whether the patients who have already been operated should take radiotherapy. ConclusionSSM is a safe operative modality for selected patients with breast cancer, and delayed reconstruction may be a good choice for patients who would take postmastectomy radiotherapy.
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.
ObjectiveTo investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve.
MethodsOne hundred and sixty patients with breast cancer were divided into ultrasound knife group and electroscalpe group and then performed modified radical mastectomy with pectoral nerve and intercostobrachial nerve remainning. the pectoralis major thickness and paresthesia of skin of inner upper arm and axillary fossa were detected on the different time after operation.
Results①The age, body mass index, and mean opera-tion time had no significant differences between these two groups (P > 0.05).②On 6 months after operation, the thickness of bilateral pectoralis major was not significantly different in the ultrasound knife group (P > 0.05), which of injuried pectoralis major was significantly thinner than that of uninjuried pectoralis major in the electroscalpe group (P < 0.05).③The rates of paresthesia of skin on postoperative 3 months and 6 months in the ultrasound knife group were signifi-cantly lower than those in the electroscalpe group (P < 0.05).
ConclusionCompared with monopolar electro diathermy, the use of ultrasonic harmonic scalpel in modified radical mastectomy could better protect pectoral nerve and intercosto-brachial nerve, and thus decrease nerve parafunctional rate.
ObjectiveTo compare the differences in preventing subcutaneous effusion, skin flap necrosis, and patient comfort between simple negative pressure drainage and negative pressure drainage combined with chest compression bandaging after radical mastectomy for breast cancer.
MethodsOne hundred and ninety-six patients underwent radical mastectomy for breast cancer from January 2010 to December 2012 in this hospital were collected.The simple negative pressure drainage (SNPD group, n=84) and negative pressure drainage combined with chest compression bandaging (NPD+CB group, n=112) after radical mastectomy for breast cancer were used to prevent postoperative subcutaneous effusion.The postoperative complications, postoperative 3 d drainage volume, and patient comfort were compared in two groups.
ResultsOne hundred and ninety-six patients with breast cancer were females.The differences of general clinical data were not statistically significant in two groups (P > 0.05).The differences of chest wall mean extubation time, axillary mean extubation time, postoperative 3 d mean drainage volume, and incidences of subcutaneous effusion and skin flap necrosis were not statistically significant in two groups (P > 0.05).The rate of comfort satisfactory in the SNPD group was significantly higher than that in the NPD+CB group [76.2%(16/84) versus 22.3%(25/112), P < 0.001].The chemotherapy was not affected after operation in two groups.
ConclusionsComparing with negative pressure drainage combined with chest compression bandaging, simple negative pressure drainage do not increase postoperative subcutaneous effusion and skin flap necrosis, but it greatly improves the patients satisfactory rate.
ObjectiveTo investigate the effectiveness of axillary single-site laparoscopic subcutaneous mastectomy in treatment of gynecomastia (GYN) and the assessment method of glandular mass before operation. Methods A clinical data of 65 GYN patients admitted between August 2023 and February 2024 and matched the selection criteria was retrospectively analyzed. The patients were (30.8±7.9) years old, with a body mass index (BMI) of 27.3 (24.9, 29.8) kg/m2. According to Simon’s grading criteria, the GYN was classified as gade Ⅰ in 8 cases, grade Ⅱa in 32 cases, grade Ⅱb in 21 cases, and grade Ⅲ in 4 cases. All patients underwent bilateral axillary single-site laparoscopic subcutaneous mastectomy. The operation time, intraoperative blood loss, postoperative bilateral extubation time, total length of hospital stay, and the occurrence of related complications were recorded. The cosmetic outcome score was assessed by questionnaire at 2 months after operation. Preoperative BMI, lying/standing sternal notch to nipple (SN-N), and lying/standing nipple to nipple (N-N) were measured. The differences in SN-N between standing and lying positions (ΔSN-N) and in N-N between lying and standing positions (ΔN-N) were calculated. The intraoperative resected glandular mass was recorded. The glandular mass-related indicators (BMI, ΔSN-N, ΔN-N) were compared between Simon grades. Spearman’s correlation analysis and multiple linear regression analysis of glandular mass with BMI and ΔSN-N, ΔN-N and Simon grading (grades Ⅰ, Ⅱa, Ⅱb, and Ⅲ were assigned values of 1, 2, 3, and 4, respectively) of the corresponding side. ResultsAll operations were successfully completed with the operation time of 75.0 (60.0, 90.0) minutes, the intraoperative blood loss of 12.0 (11.0, 13.0) mL, and the bilateral extubation time of 1.5 (1.5, 1.5) days after operation. The total length of hospital stay was 3.0 (3.0, 3.0) days. Three cases of subcutaneous hematoma in the chest wall and 1 case of nipple areola numbness and discomfort occurred after operation, while the rest of the patients had no complication, such as postoperative haemorrhage, effusion, infection, and nipple areola necrosis. The subjective cosmetic scores were all 15 at 2 months after operation, which was very satisfactory. The differences in ΔSN-N of right side between Simon grade Ⅰ and grades Ⅱa, Ⅱb, Ⅲ and in ΔSN-N of left side between Simon grade Ⅰ and grades Ⅱb, Ⅲ were significant (P<0.05), while the differences between the remaining grades were not significant (P>0.05). The differences in ΔN-N between Simon grade Ⅱa and gradeⅡb and in BMI between Simon grade Ⅱb and grade Ⅲ were not significant (P>0.05), while the differences between the remaining grades were significant (P<0.05). The glandular masses of left and right breasts in 65 patients were 69.0 (52.1, 104.0) g and 73.0 (56.0, 94.0) g, respectively; and the difference between left and right breasts was not significant (Z=?0.622, P=0.534). The data of the right breast was selected for correlation analysis. Correlation analysis showed that the right glandular mass was positive correlated with BMI and Simon grading, ΔSN-N, and ΔN-N (P<0.05). Multiple linear regression analysis showed that Simon grading had a positive predictive effect on glandular mass, and the regression equation was as follows: right glandular mass=5.541+32.115×Simon grading (R2=0.354, P<0.001). ConclusionAxillary single-site laparoscopic subcutaneous mastectomy is an ideal surgical procedure for the treatment of GYN. BMI and Simon grading are closely related to GYN glandular mass, and have certain reference value for preoperative glandular mass assessment.
Objective To investigate the clinical application of da Vinci surgical system in nipple sparing mastectomy (NSM) and immediate one-stage implant-based breast reconstruction. Methods Five cases of breast cancer who underwent NSM and immediate implant-based breast reconstruction were analyzed from March 2022 to April 2022. Evaluation endpoints included the key points of operation, duration of surgery, postoperative complications, and patient-reported outcomes. Results Two patients underwent implant-based postpectoral breast reconstruction without mesh. Three patients received prepectoral reconstruction with biological mesh, 2 of which underwent bilateral breast reconstruction. Operating duration of 5 patients was 240–320 min, with an average of 291 min. The blood loss was 10–30 mL, with an average of 18 mL. No patient switched to open surgery due to the uncontrolled bleeding. The average drainage volume was 78 mL/d (60–100 mL/d) in the first 3 days and 38 mL/d (30–50 mL/d) in the 3 to 7 days after operation. The drainage tube was removed 10–18 days after operation, with an average of 13.2 days. No postoperative infections or nipple-areolar complex necrosis were observed. The inpatient stay was 1–3 days, with an average of 1.8 days. One month after operation, the BREAST-Q satisfaction score was 64–82, with an average of 76.20. The average cost for operation was 45 072 RMB (43 420–47 524 RMB). Conclusions The robotic NSM and immediate one-stage implant-based breast reconstruction is a safe procedure with better clinical outcomes and favorable patients’ satisfaction. However, the robotic system has longer operation time and higher cost. It still needs to be personalized in the clinical practice.
Objective
To investigate effect of optimizing operation procedure (OOP) on surgical outcomes of complete endoscopic subcutaneous mastectomy (CESM) in treatment of gynecomastia.
Methods
A total of 217 patients with gynecomastia underwent CESM from January 2014 to March 2017 in the Third People’s Hospital of Chengdu were collected according to the criteria for inclusion and exclusion, further, based on a propensity score-matching model, a total of 94 patients were evenly assigned to OOP group (April 2015 later) and non-OOP group (before April 2015). The CESM with or without OOP was performed in the OOP group or the non-OOP group, respectively. The operative time, postoperative length of stay, treatment expenses, and favorable cosmetic effect were compared in these two groups.
Results
The differences in the general clinical data in both groups were not statistically significant (P>0.05). The operative time (min) was shorter (139.90±37.18versus 175.20±46.99, P=0.002), the postoperative length of stay (d) was shorter too (7.13±1.46 versus 8.47±2.71, P=0.021), and the treatment expenses (yuan) were more less (11 426.80±1 861.19 versus 12 315.75±1 306.64, P=0.036) in the OOP group as compared with the non-OOP group. Meanwhile the favorable cosmetic effect of the self-evaluation score in the OOP group was significantly higher than that in the non-OOP group (7.33±1.16 versus 5.97±1.16, P<0.05).
Conclusion
This study demonstrates that using optimizing standard CESM could shorten operative time, reduce treatment expenses, and improve satisfaction of patients.
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.
Objective To evaluate the effect of postmastectomy radiotherapy(PMRT)on the rate of loco-regional recurrence and survival for breast cancer patients undergoing radical mastectomy with one to three positive lymph nodes. Methods The database of Pubmed, Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, CBM, CNKI, VIP, and Chinese Cancer were searched. All randomized controlled trials about postmastectomy radiotherapy on breast cancer patients with 1-3 positive lymph nodes were considered for inclusion. Revman 5.3 was used in the meta analysis. Results Four trials enrolled 1 254 breast cancer women with 1-3 positive lymph nodes were included. The studies were high quality according to the evaluations of the quality criteria. After 10 to 20 years follow-up, the results showed that, 460 patients were analyzed in the result of loco-regional recurrence, the hazard ratio (HR) was 0.23, 95%CI (0.15, 0.37), the result showed statistical difference (P＜0.000 01), and the heterogeneity was existed (P=0.09,I2=59%). One thousand two hundred and fifty-four patients were analyzed in the result of overall survival, theHR was 0.82, 95%CI (0.71, 0.93), the result showed statistical difference (P=0.002 ), and there did not existed heterogeneity (P=0.65,I2=0%). Four hundred and sixty patients were analyzed in the result of metastasis-free survival, theHR was 0.71, 95%CI (0.56, 0.90), the result showed statistical difference (P=0.005), and there did not existed heterogeneity (P=0.63,I2=0%). Nine hundred and seventy-seven patients were analyzed in the result of disease free survival, theHR was 0.74, 95%CI (0.66, 0.85), the result showed statistical difference (P＜0.000 01), and there did not existed heterogeneity (P=0.49,I2=0%). Conclusion Through this systematic review, we consider that postmastectomy radiotherapy could reduce the loco-regional recurrence and increase the overall survival for long-term.
