ObjectiveTo optimize the perioperative management experiences for breast cancer patients undergoing direct-to-implant-based breast reconstruction, and provide reference for clinical practice. Methods A comprehensive review of recent domestic and international literature was conducted to systematically summarize the key points of perioperative management for direct-to-implant-based breast reconstruction, including preoperative health education, intraoperative strategies, and postoperative management measures, along with an introduction to the clinical experiences of West China Hospital of Sichuan University. ResultsStandardized perioperative management can effectively reduce the incidence of complications and achieve excellent cosmetic outcomes and quality of life after operation. Preoperative management includes proactive health education to alleviate patients’ anxiety and improve treatment compliance, as well as comprehensive assessment by surgeons of the patient’s physical condition and reconstructive expectations to select the most appropriate implant. Intraoperative management consists of strict aseptic technique, minimizing implant exposure, preserving blood supply to the nipple-areola complex (e.g., by using minimally invasive techniques or indocyanine green angiography, etc), and meticulous hemostasis. Postoperative management encompasses multimodal analgesia, individualized drain management (such as early removal or retaining a small amount of fluid to optimize contour), infection prevention and control (including topical and systemic antibiotics, ultrasound-guided minimally invasive drainage), guidance on rehabilitation exercises (early activity restriction followed by gradual recovery), and regular follow-up to evaluate aesthetic results and monitor for complications. ConclusionEstablishing a standardized, multidisciplinary perioperative management framework markedly enhances surgical safety and patient satisfaction, thereby providing a replicable benchmark for direct-to-implant-based breast reconstruction across diverse clinical settings.
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 the 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, and they 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) days and 1.0 (1.0, 1.0) days, respectively, which were significantly shorter than that of the conventional inpatient group; the postoperative pain score in the day surgery group [1.0 (1.0, 1.0) points] was lower than that in the conventional inpatient group [3.0 (3.0, 3.0) points], with a statistically significant difference between the two groups (P<0.001). Additionally, the total hospitalization costs for the day surgery group and conventional inpatient group were 50 656.5 (48 145.3, 62 597.3) RMB and 53 689.3 (50 469.1, 64 826.5) RMB, respectively.The total hospitalization cost in the day surgery group was significantly lower than that in the conventional inpatient group, with a statistically significant difference between the two groups (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.
Objective To evaluate the aesthetic outcomes and safety of titanium-coated polypropylene mesh (TCPM) in immediate implant-based breast reconstruction (IBBR) following single-axillary approach endoscopic nipple-sparing mastectomy (NSM), and to provide references for the clinical application of synthetic meshes. Methods A retrospective analysis was conducted on 173 female patients who underwent immediate IBBR following single-axillary approach endoscopic NSM between May 2020 and June 2024. Patients were divided into a non-mesh group (n=100) and a mesh group (n=73) based on TCPM utilization. Baseline data, including body mass index (BMI), smoking history, alcohol consumption history, diabetes mellitus, hypertension, menstrual status, and postoperative radiotherapy, chemotherapy, and endocrine therapy, showed no significant differences between the two groups (P>0.05), whereas patients in the mesh group were significantly older than those in the non-mesh group (P<0.05). Postoperative complications, capsular contracture (Baker grading), prosthesis texture, aesthetic outcomes (modified Ueda score), and patient satisfaction [evaluated via the Breast Reconstruction Patient-Reported Outcome Scale (BREAST-Q)] were compared between the two groups. Ordinal logistic regression analysis was performed to identify independent factors influencing aesthetic outcomes. Results All patients were successfully followed up postoperatively. The follow-up duration was 30.50 (23.24, 40.04) months in the non-mesh group and 23.95 (18.52, 32.57) months in the mesh group, with no significant difference between the two groups (P>0.05). Regarding complications, no significant difference was observed between the two groups in the incidence of postoperative fever, upper limb lymphedema, seroma, wound dehiscence, operative site hemorrhage, or skin necrosis (P>0.05). However, the non-mesh group demonstrated significantly better outcomes than the mesh group in Baker grading for capsular contracture, implant texture, and aesthetic ratings (P<0.05). According to the postoperative BREAST-Q assessment, the non-mesh group scored higher in satisfaction with the reconstruction outcome and satisfaction with the surgeon (P<0.05). No significant difference was noted between the groups regarding psychosocial well-being, sexual health, breast appearance, implant contour, satisfaction with chest recovery, or satisfaction with the medical team (P>0.05). Univariate ordinal logistic regression analysis revealed that menstrual status, mesh usage, and postoperative radiotherapy, endocrine therapy, upper limb lymphedema were associated with breast aesthetic outcomes (P<0.05). Multivariate ordinal logistic regression analysis further confirmed that postoperative radiotherapy and mesh usage were independent risk factors for diminished aesthetic outcomes (P<0.05). Conclusion In immediate IBBR following single-axillary approach endoscopic NSM, omitting TCPM mesh superior aesthetic outcomes, a more natural breast texture, and a lower incidence of severe capsular contracture without increasing the risk of complications. Therefore, the routine application of TCPM in this specific surgical procedure warrants cautious consideration.