Objective To evaluate the effect of the combined method of l iposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia. Methods From June 2004 to June 2006, 40 patients, aged 11-41 years old, were treated, with no-nodule (n=10), nodule (n=22) and female-breast-l ike with nodules (n=8). Three patients were unilateral and 37 ones were bilateral. The levels of serum prolactin, luteinizing hormone, foll icle stimulating hormone, estradiol, testosterone and cortisol were normal in 38 patients, while in the other 2 patients, the levels ofserum prolactin, luteinizing hormone, foll icle stimulating hormone and estradiol were higher than normal, and the testosterone level was lower. Li posuction alone was performed in 10 no-nodule patients (lei po-type), and combined l i posuction and semicircular periareolar incision glandular organ partial resection were conducted in the other 30 patients (lei po-glandular type). Results Except for 2 cases in which hematoma and a small amount of effusion were found on the first and second day postoperatively and then obtained heal ing by first intention right after hematoma removal in time, all the other patients’ incisions obtained heal ing by first intention. Ni pple numbness occurred in 3 cases on the first day postoperatively and no special treatment was conducted. There was still nipple hypesthesia in these 3 cases after 6-month follow-up. There were no compl ications such as hematoma, effusion, nipple and mammary areola necrosis, and nipple hypesthesia in other patients. All the 40 patients were followed up for 6-24 months (13 months on average). They were satisfied with their chest figures and no recurrence was observed. Conclusion The combined method of l iposuction and semicircular periareolar incision glandular organ partial resection in the treatment of gynecomastia has many advantages, such as safe, micro-scars, natural and beautiful male breast figures as well as high patients’ satisfaction.
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 explore the effectiveness of modified inferior pedicle technique with inverted T pattern for severe breast hypertrophy.MethodsBetween January 2016 and May 2017, 15 patients of severe breast hypertrophy had undergone breast reduction using inferior pedicle technique with inverted T pattern combined with dermal suspension sling technique. The patients were 20 to 49 years old, with an average age of 31.6 years. Body mass index ranged from 24.9 to 32.5 kg/m2, with an average of 30.8 kg/m2. Among them, 11 cases had a history of childbearing. The degree of breast ptosis was rated as degree Ⅱ in 6 cases and degree Ⅲ in 9 cases. The unilateral breast reduced 615 g on average (range, 480-1 050 g).ResultsThe skin flap necrosis at the " T” trilateral junction occurred in 3 cases, and healed after dressing changes. The incisions of 12 cases healed and no fat liquefaction, hematoma, or seroma occurred. The sensation of nipple and areola declined at early period after operation in 2 cases, and gradually recovered. All patients were followed up 6-18 months (mean, 13 months). The shapes of bilateral breasts and the height and symmetry of nipple-areolar complex were good, and no obvious scar was found. The effectiveness was evaluated by surgeon and showed that there were 12 cases with satisfactory breast shape and 3 cases with unsatisfactory breast shape; 3 cases with obvious scare and 12 cases with insignificant scar; 13 cases with normal nipple sensation and 2 cases with hypoesthesia; 11 cases with symmetric nipples and 4 cases with asymmetric nipples. The effectiveness was evaluated by patients and showed that the satisfactory breast shape in 10 cases, relatively satisfactory breast shape in 4 cases, and unsatisfactory breast shape in 1 case; highly acceptable scar in 9 cases, moderately acceptable scar in 4 cases, and unacceptable scar in 2 cases; overall satisfactory in 10 cases, relatively satisfactory in 4 cases, and unsatisfactory in 1 case, with the overall satisfaction rate of 93.3% (14/15).ConclusionFor severe breast hypertrophy, the modified inferior pedicle technique with inverted T pattern can obtain satisfactory appearance and avoid the mastoptosis.
Objective To introduce the treatment experiences about the skin-sparing mastectomy and immediate breast reconstruction. Methods The skin-sparing mastectomy and immediate breast reconstruction by using transverse rectus abdominis myocutaneous （TRAM） flat were performed in 10 patients with early-stage breast cancer from May 2008 to December 2011 in our hospital. The patients’ data were retrospectively analyzed. Results There were postoperative complications after skin-sparing mastectomy and immediate breast reconstruction， including TRAM flat necrosis in 1 case， papillary necrosis in 1 case and fat necrosis in the reconstructed breast with oxter wound infection in 1 case. There was no incision hernia of abdominal wall or necrosis of all TRAM flat in any case. The patients’ satisfaction that evaluation for the breast shapes of reconstructed breasts was very satisfaction in 5 cases， part satisfaction in 4 cases， and dissatisfaction in 1 case， respectively. Conclusions Because of the minimal access approach and good breast shape， the skin-sparing mastectomy and immediate TRAM flat breast reconstruction is a safe and effective way for treating early-stage breast cancer.
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.
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.
Objective To summarize the research progress of combined surgical treatment of lymphedema based on vascularized lymph node transfer (VLNT), and to provide systematic information for combined surgical treatment of lymphedema. MethodsLiterature on VLNT in recent years was extensively reviewed, and the history, treatment mechanism, and clinical application of VLNT were summarized, with emphasis on the research progress of VLNT combined with other surgical methods. Results VLNT is a physiological operation to restore lymphatic drainage. Multiple lymph node donor sites have been developed clinically, and two hypotheses have been proposed to explain its mechanism for the treatment of lymphedema. But it has some inadequacies such as slow effect and limb volume reduction rate less than 60%. To address these inadequacies, VLNT combined with other surgical methods for lymphedema has become a trend. VLNT can be used in combination with lymphovenous anastomosis (LVA), liposuction, debulking operation, breast reconstruction, and tissue engineered material, which have been shown to reduce the volume of affected limbs, reduce the incidence of cellulitis, and improve patients’ quality of life. ConclusionCurrent evidence shows that VLNT is safe and feasible in combination with LVA, liposuction, debulking operation, breast reconstruction, and tissue engineered material. However, many issues need to be solved, including the sequence of two surgeries, the interval between two surgeries, and the effectiveness compared with surgery alone. Rigorous standardized clinical studies need to be designed to confirm the efficacy of VLNT alone or in combination, and to further discuss the subsistent issues in the use of combination therapy.
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 location of the artery correlated with rectus abdominis musculocutaneous flap in order to promote the reconstruction of the breast after radical mastectocy for breast cancer.Methods An anatomic study was carried out on 15 cadavers of 30 sides，which were immersed in paraformaldehyde less than six months. Whole thoraepigastrica wall was cutted, which scale was from subclavian as upper limit to inguinal ligament, the lower limit across left and right of middle axillary. Veins or arteriesof inferior epigastrica and internal thorax in hang were injected with red or blue ink to show all of vessel branches. Results The external diameters of both the superior epigastric arteries and inferior vessels were 1.87±0.28 mm and 2.25±0.32 mm respectively. The myocutaneous arteries from inferior abdomen vessels had an intensive horizontal distribution on hylum. The perforators significantly decreased but could be found to pass through anterior rectus sheath in Rand. The distances between lateral perforators and Ⅰ,Ⅱ and Ⅲ parts in external edge of anterior rectus sheath were 1.22, 1.46 and1.57 cm, respectively; and the distances between medial perforators and Ⅰ, Ⅱ, and Ⅲ parts at median line were 1.54, 1.62, 1.66 cm. Perforators were more thick and intensive near hylum than in other part. The subcostal arteries derived from inferior abdomen artery and 1.25±0.37 cm away from costal arch. Afterdividing into subcostal artery, the outer diameter of 67 percent of subcostal artery was bigger than that of inferior abdomen arteries. The branches of subcostalarteries were distributed at the 2/3 lateral rectus abdominis, forming an extenive choke anastomosis system with intercostal anterior artery and vessels supplied diaphragmatic muscle. The rectus abdominis at the level of xyphoid was supplied by a branch came from inferoir thorax artery, which diverged epigastric vessels at the same time.Conclusion During the process of makingthe inferior transverse rectus abdominis musculocutaneous flap base on superior epigastric vessels and superoir rectus abdobminis, reservation of pro-theca edge 1 cm of rectus abdominis can protect inferior abdomen artery from injury. Reservation of more than 2 cm pro-theca and rectus abdominis below costal arch at the flag will protect effectively subcostal artery from injury. No damage of subcostal arteries can influence the survival of musculocutaneous flap.