Endoscopic technique is one of the important development directions of modern surgical techniques. Compared with the laparoscopic and thoracoscopic surgery, the development of endoscopic technology in breast surgery is generally slow due to the limitation of the physiological structure of this organ. The characteristics of endoscopic technology such as micro-incision trauma and remote operation are especially suitable for breast (cancer) surgery, which desires flawless skin surface and perfect remodeling. In the meantime, however, the obstacles of breast (cancer) endoscopic surgery include the establishment and maintenance of a satisfactory surgical field, the endoscopic exposure of large and heavy glands, the obstruction by the slope of the skeletal thorax, the remote operation that is difficult to accomplish with conventional endoscopic instruments, and the complete removal of large and tough glands and so on. By studying and pondering the experience of the pioneers of endoscopy, the endoscopic team of West China Hospital took five years to develop this novel one axillary-incision, single-port and liposuction-free endoscopic surgical approach which is low costing and only requires one-port operation platform. The original “inverse sequence method”, “Huaxi hole no. 1, 2, 3” and other endoscopy-assisted approach overcome the aforesaid obstacles. It has significantly reduced the technical threshold and operational difficulty of breast (cancer) endoscopic surgery and contributed our own wisdom to the vigorous development of breast endoscopic technology in China. The author shared her observations and thoughts on the technical details of breast endoscopic surgery based on her nearly 20 years of experience in endoscopic operation.
ObjectiveTo investigate effectiveness of the combination of serratus anterior muscle flap and breast implants for breast reconstruction after modified radical mastectomy.MethodsBetween January 2015 and December 2015, 25 female patients with breast cancer were enrolled, aged 24-62 years (mean, 40.6 years). The tumor located at left side in 9 cases and right side in 16 cases; 14 cases were in the left upper quadrant, 4 cases were in the left lower quadrant, 7 cases were on the top of the breast. All cases were invasive ductal carcinoma. According to TNM staging, 14 cases were at stageⅠand 11 cases were at stageⅡA. The diameter of lumps were all less than 3 cm. All those lumps were solitary and without distant metastasis. The sentinel nodes were all negative. After modified radical mastectomy, the breasts were reconstructed by serratus anterior muscle flap and breast implants. The nipples were spared in 22 cases.ResultsThe operation time was 113-148 minutes (mean, 136 minutes). All breasts survived and incisions healed at stageⅠ. There was no complication such as hematoma, infection, etc. All patients were followed up 6-18 months (mean, 15 months). Except 1 case, the others were evaluated according to the criteria of the reconstructed breast at 12 months after operation. Among them, 23 cases were evaluated as good and 1 case as fair. There was no tumor recurrence during the follow-up period.ConclusionThe combination of serratus anterior muscle flap and breast implants after the modified radical mastectomy is a handy approach of breast reconstruction which is less harmful with few postoperative complications. It also gains a high degree of satisfaction from patients for good breast shape.
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.
ObjectiveTo investigate the feasibility, safety, and clinical value of endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction performed as day surgery for breast cancer, aiming to provide a reference for major hospitals seeking to implement a day surgery model for breast cancer treatment. Methods We retrospectively analyzed 222 patients who underwent endoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction for breast cancer at West China Hospital of Sichuan University from June 2021 to December 2022 were included, and were divided into a day surgery group and a conventional inpatient group based on their admission model. The operative indicators, Breast-Q scores, preoperative waiting time, length of hospital stay, hospitalization costs and complications of the two groups were analyzed. ResultsExcept for intraoperative bleeding (P=0.007), the difference between the two groups in comparison of the rest of the operative indicators was not statistically significant (all P>0.05); there was no significant difference between the two groups in preoperative and postoperative Breast-Q scores (all P>0.05); the preoperative waiting time and length of stay in hospital of the day surgery group were 4.0 (3.0, 11.0) and 1.0 (1.0, 1.0) days, respectively, which were significantly shorter than that of the conventional inpatient group; except for postoperative pain scores (P<0.001), there was no statistically significant difference in complications between the two groups (all P>0.05).ConclusionEndoscopic-assisted skin-sparing mastectomy combined with immediate implant-based breast reconstruction in day surgery is feasible and safe.Without increasing postoperative complications, it effectively reduces hospitalization costs and shortens medical care time, demonstrating significant clinical value.
ObjectiveTo explore the surgical technique and preliminary safety and aesthetics results of immediate prepectoral implant-based breast reconstruction (BR) with titanium-coated polypropylene mesh (TiLoop Bra) after skin-sparing mastectomy (SSM) or nipple-areola-complex-sparing mastectomy (NSM) for breast cancer patients. MethodsThe clinical data of consecutive patients who underwent immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM in West China Hospital from January to July 2022 were retrospectively analyzed. The operation time, intraoperative blood loss, early complication were collected. The preliminary aesthetics results were assessed with the Ueda score and Harris score. Results All the patients were female with a mean age of 39.0±6.8 years. One patient had bilateral breast malignant tumors, and the others had unilateral malignant tumors. Six patients received neoadjuvant chemotherapy before surgery. The mean diameter of the tumors was 24.4±11.9 mm under the color ultrasound before the neoadjuvant chemotherapy. The mean operation time was 153.9±49.4 min. The mean intraoperative blood loss was 29.2±18.3 mL. There were 3 patients with tumor stage 0, 10 patients with stage Ⅰ, 6 patients with stage Ⅱ, 3 patients with stage Ⅲ and 1 patient was found no residual cancer after neoadjuvant chemotherapy. All the patients were successfully followed up with a median follow-up time of 4.8 (3.0-9.2) months. There were 2 (8.3%) patients with major complications, including 1 wound dehiscence and 1 hematoma, and 4 (16.7%) minor complications, including 2 wound dehiscence and 2 infection. The patients with excellent and good Ueda score and Harris score accounted for 82.6% and 87.0%, respectively. None of the patients had animation deformity, capsular contracture, nipple-areola or skin flaps necrosis, or implant loss. During the follow-up period, no local/regional recurrence or distant metastasis was found. Conclusion For selected reliable patients, immediate prepectoral implant-based BR with TiLoop Bra after SSM or NSM for breast cancer patients is safe and has good aesthetics results in the early postoperative period. It has broad application space in patients with suitable indications, and can be promoted as a routine operation.
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.
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 explore the value of the application of latissimus dorsi myocutaneous flap in the breast reconstruction. Methods The clinical data of the 36 patients with breast tumor who had undergone breast reconstruction with latissimus dorsi myocutaneous flap from January 2012 to December 2016 were collected retrospectively. The postoperative complications and cosmetic results were analyzed. Results Thirty-six patients with breast tumor who underwent breast reconstruction with latissmus dorsi myocutaneous flap, including 32 patients with immediate breast reconstruction and 4 patients with delayed breast reconstruction respectively. The operative time of the patients who undertwent immediate breast reconstruction was 235–490 min (mean of 325 min), the intraoperative blood loss was 200–260 mL (mean of 220 mL), and the hospitalization time was 18–33 d (mean of 23.6 d). The total operative time of patients who underwent delayed breast reconstruction was 325–550 min (mean of 355 min), the total intraoperative blood loss was 200–250 mL (mean of 220 mL), and the total hospitalization time was 27–45 d (mean of 32.5 d). The cosmetic results was excellent in 22 patients, good in 8 patients, fair in 6 patients, respectively, and fine rate was 83.3% (30/36). There was no flap loss, but donor site seroma occurred in 21 patients, partial necrosis of the surgical margin of back skin occurred in 1 patient, partial necrosis of the nipple and areola skin occurred in 2 patients. All the patients were followed-up for 3–60 months, and the mean follow-up time was 37 months. During the follow-up period, no patient occurred metastasis or recurrence. After undergoing radiotherapy, reconstructive breast volume of 2 patients significantly contracted. None of the patients had significant limb function. Conclusion The breast reconstruction with the latissimus dorsi myocutaneous flap is a simple, easy, and effective surgical procedure.
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.
ObjectiveTo evaluate the effect of post mastectomy radiation therapy (PMRT) on breast reconstruction after mastectomy in breast cancer patients, in order to provide evidence support for clinical treatment decision.MethodsFive databases searched in the current study include the Cochrane Library, PubMed, CNKI, VIP and WanFang database. A systematic search for control trials was performed in each database from the starting date of each database to March 1, 2021. After the two evaluators independently selected literatures, extracted data and conducted quality evaluation according to the inclusion and exclusion criteria, the meta analysis was carried out by Revman 5.3 software.ResultsA total of 9 cohort studies (3 447 cases) were included, including 699 cases in PMRT group and2 748 cases in non-radiotherapy group. The results of meta-analysis showed that: PMRT was associated with significant increase in capsular contracture. The incidence of capsular contracture increased from 4.34% in the non-radiotherapy group to 34.10% in patients receiving PMRT [OR=9.25, 95%CI (3.76, 22.78), P<0.000 01]. In addition, PMRT was associated with a significant increase in incidences of reconstructive failure [OR=2.55, 95%CI (1.74, 3.74), P<0.000 01] and revisional surgery [OR=2.24, 95%CI (1.58, 3.18), P<0.000 01]. Moreover it was associated with a significant reduction in patient satisfaction [OR=0.29, 95%CI (0.15, 0.57), P=0.000 30] and cosmetic outcome [OR=0.26, 95%CI (0.15, 0.43), P<0.000 01].ConclusionThis meta-analysis demonstrates that breast cancer patients who received PMRT after breast reconstruction, the rate of adverse events is increased and patients’ satisfaction and cosmetic outcome are decreased.