ObjectiveTo investigate the clinical application value of immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy for patients with breast cancer. MethodsA total of 28 patients with breast cancer undergoing immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy from January 2006 to December 2009 were included in this study. The perioperative results, breast appearance evaluation and followup results were analyzed. ResultsAll 28 patients received axillary lymph node dissection and the number of lymph node dissected was 14-32 (median 21). The operation time was 117-140 min (mean 126 min), blood loss was 82-124 ml (mean 98 ml), and the time to drainage tube removal was 3-5 d. No wound infection, skin necrosis, and foreign body reaction occurred in all the patients, especially in 22 patients underwent nippleareola complex-sparing mastectomy, no ischemia or necrosis occurred in nippleareola complex. For evaluation of breast appearance, excellent was in ten cases and good in 18 cases, thus, the excellent and good rate was 100%. All patients were followed up for 12-48 months (median 24 months) after operation, and distant metastasis, local recurrence, upper extremity edema, and dysfunction were not found. No fiber kystis contracture was found and all patients were satisfied with breast appearance and good handfeels. ConclusionsImmediate breast reconstruction using silicon implant after skinsparing modified radical mastectomy has the advantage of minimal invasion, safety, simple operation, and quick postoperative recovery for patients with breast cancer and the appearance of reconstructed breast is excellent, which can be clinically used widely.
Objective To investigate the role of bone morphogenetic protein 2 (BMP-2) combined with hypoxic microenvironment in chondrogenic phenotype differentiation of bone marrow mesenchymal stem cells (BMSCs) of rat in vitro. Methods BMSCs were harvested from 4-week-old female Sprague Dawley rats. BMSCs at passage 2 were divided into 4 groups according different culture conditions: normoxia control group (group A), normoxia and BMP-2 group (group B), hypoxia control group (3% oxygen, group C), and hypoxia and BMP-2 group (group D). Then the cellular morphology was observed under inverted phase contrast microscope. Alcian blue immunohistochemical staining was used to detect the glycosaminoglycans (GAG), Western blot to detect collagen type II and hypoxia-inducible factor 1α (HIF-1α), and RT-PCRto detect the expressions of chondrogenic related genes, osteogenic related genes, and hypoxia related genes. Results At 21 days after induction of BMP-2 and hypoxia (group D), BMSCs became round, cell density was significantly reduced, and lacuna-l ike cells were wrapped in cell matrix, while the changes were not observed in groups A, B, and C. Alcian blue staining in group D was significantly bluer than that in other groups, and staining became darker with induction time, and the cells were stained into pieces of deeply-stained blue at 21 days. Light staining was observed in the other groups at each time point. The expression level of collagen type II protein in group D was significantly higher than those in other groups (P lt; 0.05). HIF-1α protein expression levels of groups C and D were significantly higher than those of groups A and B (P lt; 0.05). The expressions of collagen II α1 (COL2 α1) and aggrecan mRNA (chondrogenic related genes) were highest in group D, while the expressions of COL1 α1, alkaline phosphatase, and runt-related transcri ption factor 2 mRNA (osteogenic related genes) were the highest in group B (P lt; 0.05). Compared with groups A and B, HIF-1α (hypoxic related genes) in groups C and D significantly increased (P lt; 0.05). Conclusion BMP-2 combined with hypoxia can induce differentiation of BMSCs into the chondrogenic phenotype, and inhibit osteoblast phenotype differentiation. HIF-1α is an important signaling molecule which is involved in the possible mechanism to promote chondrogenic differentiation process.