ObjectiveTo explore the methods of breast reconstruction surgery with laparoscopically harvested pedicled omental flap (LHPOF), and analyze the patient’ evaluation, operation process and postoperative follow-up. MethodsPatients with pathologically proven breast cancer or plasma cell mastitis who underwent LHPOF breast reconstructive surgery were retrospectively collected from the Department of Breast and Thyroid Surgery of The Second Affiliated Hospital of Chongqing Medical University from February 2022 to December 2023. ResultsA total of 16 patients were collected. The mean age of patients was 43.3 (ranging from 27 to 68) years old, the mean body mass index of patients was 23.0 kg/m2 (ranging from 18.3 to 28.6 kg/m2). One patient underwent transplant omental flat removal surgery due to postoperative flap thrombosis, and one patient choose to give up breast reconstruction due to insufficient flap volume. The single-stage surgery was performed successfully in the rest patients with no requirement of laparotomy. All patients made an uneventful recovery after surgery. During the follow-up period, which averaged 13 months and ranged from 9 to 17 months, the major symptoms were mild epigastric bulge (2 patients) and flap atrophy (1 patient), no serious flap-related or donor site-related complications such as flap loss, bowel dysfunction and abdominal incisional hernia. In general, the aesthetic results were satisfactory. ConclusionsUsing LHPOF in immediate breast reconstruction surgery can achieve satisfied aesthetic result, for the soft and natural appearance of the reconstructed breast. In the mean time, compared with other autologous tissue reconstruction approaches, LHPOF has lower incidences of complications of donor-site and flap-site.
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.
The report of brachial plexus injuries following radical mastectomy in patients with breast cancer was rare even though the operation was a main measure in treating with breast cancer. Nine patients treated from Oct. 1989 to Feb.1991 were summarized. The results were not ideal.
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.
【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.
Objective To explore the preventive effectiveness of early physiotherapy on arm lymphedema after modified radical mastectomy for breast cancer. Methods A total of 206 patients who underwent modified radical mastectomy for breast cancer in The First Affiliated Hospital of Henan University from June 2014 to June 2016, enrolled in this randomized controlled clinical trial. Then these patients were randomly divided into intervention group and control group equally. Patients in the control group received routine treatment, and the patients in the intervention group began to use the air pressure pump combined with the microwave physiotherapy on the second day after the radical surgery. The incidences of limb lymphedema in 6 months and 1 year after operation between the 2 groups were compared, and the influencing factors of arm lymphedema were explored. Results The clinical data of 195 patients were analyzed at end, including 99 patients of the intervention group and 96 patients of the control group. ① There were statistical significance in the incidences of arm lymphedema in 6 months and 1 year after operation between the 2 groups (P<0.05), that incidences of arm lymphedema in the intervention group were both lower than those of the control group at the2 time points [6 months after operation: 2.0% (2/99)vs. 9.4% (9/96); 1 year after operation: 5.1% (5/99) vs. 17.7% (17/96)]. ② The results of non-conditional logistic regression analysis shown that, age (OR=1.45, P=0.008), tumor location (OR=1.72, P<0.001), TNM stage (OR=2.01, P=0.033), the number of invasive axillary lymph nodes (OR=1.15, P=0.005), and postoperative radiotherapy (OR=1.23, P=0.016) were the influencing factors of arm lymphedema after modified radical mastectomy for breast cancer, patients with age older than 60 years, tumor position at the outside area, stage Ⅲ of TNM, the number of invasive axillary lymph nodes >5, and patients received radiotherapy after operation had high risk of arm lymphedema. Conclusion Early physiotherapy can effectively prevent the occurrence of arm lymphedema after modified radical mastectomy for breast cancer, and early physiotherapy should be performed for patients with high risk of arm lymphedema.
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 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.
ObjectiveTo summarize the treatment measures and experience for one patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer. MethodsThe discussion on MDT (multi-disciplinary team) of a breast cancer patient admitted to The First Hospital of Lanzhou University in March 2018 and the results of the discussion on acute pulmonary thromboembolism after operation were summarized. ResultsThis patient had many high risk factors for deep venous thrombosis of the lower extremities, such as obesity, advanced age, hypertension, malignant tumor, and surgical stress. The operative time was about 90 min and the blood loss was 30 mL, without nerve and vascular injuries. Acute pulmonary thromboembolism occurred suddenly on 10 days after operation, which led to heart failure. Eventually, the patient died of the peripheral circulatory insufficiency caused by respiratory failure and heart failure. ConclusionSurgeons should pay great attention to the perioperative management of the patients with many high-risk factors, who may occur acute pulmonary thromboembolism caused by deep venous thrombosis of lower limbs after radical mastectomy.
Objective To investigate feasibility and preliminary oncological safety of surgical innovations in breast cancer patients who have undergone nipple-skin-sparing mastectomy (NSSM) for nipple discharge or central lesions and tumors that do not involve the nipple-areola skin. MethodsBetween May 2018 and November 2023, patients diagnosed with breast cancer presenting nipple discharge or lesions in the central area underwent NSSM. The imaging assessment revealed no involvement of the nipple-areola-skin by the tumor. We performed a surgical removal of the affected mammary duct and simultaneously made a circular incision measuring 3-4 mm in diameter at the apex of the nipple. The study also involved the collection of clinical data, early complications, oncological outcomes and conducting aesthetic analysis of the nipple using the BREAST-Q scale. Results The surgical procedure was conducted on a cohort of 39 female patients at age of 27-57(39.0±7.6) years. The postoperative pathological stages of breast cancer were distributed as follows: stage 0 in 2 patients (5.1%), stageⅠ in 1 patients (2.6%), ⅡA stage in 15 patients (38.5%), ⅡB stage in 21 patients (53.8%). Tumor type: simple carcinoma in situ in 5 patients (12.8%), invasive carcinoma in 14 patients (35.9%), including invasive carcinoma with carcinoma in situ in 20 patients (51.3%). During the median follow-up period of 15.0 (2-66) months, 3 patients (7.7%) developed decolorization caused by mild nipple ischemia; there was no nipple necrosis; 1 patient (2.6%) failed nipple reconstruction (no milk column, the milk column disappeared due to external dressing compression after operation). There were no incision complications, subcutaneous emphysema or intramammary hematoma in all patients. Two patients (5.1%) underwent prosthesis removal and nipple areola excess skin resection because of prosthesis cavity infection and final exposure caused by debridement, dressing change, redrainage and so on. As of April 2024, no tumor recurrence or metastasis was found during the follow-up period. The satisfaction of patients with nipple was 97.4% according to BREAST-Q score. ConclusionThe satisfaction of breast cancer patients diagnosed with nipple discharge or lesions in the central area, but without involvement of the nipple areola skin, and who underwent subcutaneous mastectomy with immediate reconstruction is significantly enhanced. Furthermore, there is no increased risk of tumor recurrence or metastasis in short-term.