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 analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.
ObjectiveTo understand the progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. MethodThe studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. ResultsThe ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. ConclusionsWhether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.
ObjectiveTo investigate the effect of breast conservation therapy (BCT) and mastectomy (Mast) on the prognosis of early luminal breast cancer (ELBC).MethodsBy retrieving the PubMed, Embase, Web of Science, CNKI, Wanfang data, and VIP databases, the meta-analysis was performed on the documents that met the inclusion criteria. The Review Manager 5.3 and Stata 12.0 were used for statistical analysis.ResultsA total of 25 articles were included, involving 13 032 patients with ELBC, of which 8 419 underwent the BCT and 4 613 underwent the Mast. The results of meta-analysis showed that there was no significant difference in the postoperative local regional relapse (LRR) between the BCT and the Mast in the treatment of all patients with ELBC [OR=0.84, 95% CI (0.43, 1.64), P=0.61]. For treating with BCT, the local relapse (LR), distant metastasis rate (DMR), disease-free survival (DFS), and overall survival (OS) in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the DMR and DFS in the patients with luminal A/B ELBC were better than those in the patients with luminal-HER2 ELBC (P<0.05). For treating with Mast, the LRR, LR, DMR, and OS in the patients with luminal A ELBC were better than those in the patients with luminal B ELBC (P<0.05); Using the same method, the LRR in the patients with luminal A/B ELBC was better than that in the patients with luminal-HER2 ELBC (P<0.05).ConclusionsFor patients with ELBC, similar LRR can be obtained by BCT and Mast treatment. Regardless of the surgical strategy, patients with luminal A ELBC are more likely to obtain relatively ideal clinical prognosis. Luminal-HER2 ELBC has the worst prognosis after BCT treatment.
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.
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.
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 the effectiveness of axillary single-site laparoscopic subcutaneous mastectomy in treatment of gynecomastia (GYN) and the assessment method of glandular mass before operation. Methods A clinical data of 65 GYN patients admitted between August 2023 and February 2024 and matched the selection criteria was retrospectively analyzed. The patients were (30.8±7.9) years old, with a body mass index (BMI) of 27.3 (24.9, 29.8) kg/m2. According to Simon’s grading criteria, the GYN was classified as gade Ⅰ in 8 cases, grade Ⅱa in 32 cases, grade Ⅱb in 21 cases, and grade Ⅲ in 4 cases. All patients underwent bilateral axillary single-site laparoscopic subcutaneous mastectomy. The operation time, intraoperative blood loss, postoperative bilateral extubation time, total length of hospital stay, and the occurrence of related complications were recorded. The cosmetic outcome score was assessed by questionnaire at 2 months after operation. Preoperative BMI, lying/standing sternal notch to nipple (SN-N), and lying/standing nipple to nipple (N-N) were measured. The differences in SN-N between standing and lying positions (ΔSN-N) and in N-N between lying and standing positions (ΔN-N) were calculated. The intraoperative resected glandular mass was recorded. The glandular mass-related indicators (BMI, ΔSN-N, ΔN-N) were compared between Simon grades. Spearman’s correlation analysis and multiple linear regression analysis of glandular mass with BMI and ΔSN-N, ΔN-N and Simon grading (grades Ⅰ, Ⅱa, Ⅱb, and Ⅲ were assigned values of 1, 2, 3, and 4, respectively) of the corresponding side. ResultsAll operations were successfully completed with the operation time of 75.0 (60.0, 90.0) minutes, the intraoperative blood loss of 12.0 (11.0, 13.0) mL, and the bilateral extubation time of 1.5 (1.5, 1.5) days after operation. The total length of hospital stay was 3.0 (3.0, 3.0) days. Three cases of subcutaneous hematoma in the chest wall and 1 case of nipple areola numbness and discomfort occurred after operation, while the rest of the patients had no complication, such as postoperative haemorrhage, effusion, infection, and nipple areola necrosis. The subjective cosmetic scores were all 15 at 2 months after operation, which was very satisfactory. The differences in ΔSN-N of right side between Simon grade Ⅰ and grades Ⅱa, Ⅱb, Ⅲ and in ΔSN-N of left side between Simon grade Ⅰ and grades Ⅱb, Ⅲ were significant (P<0.05), while the differences between the remaining grades were not significant (P>0.05). The differences in ΔN-N between Simon grade Ⅱa and gradeⅡb and in BMI between Simon grade Ⅱb and grade Ⅲ were not significant (P>0.05), while the differences between the remaining grades were significant (P<0.05). The glandular masses of left and right breasts in 65 patients were 69.0 (52.1, 104.0) g and 73.0 (56.0, 94.0) g, respectively; and the difference between left and right breasts was not significant (Z=?0.622, P=0.534). The data of the right breast was selected for correlation analysis. Correlation analysis showed that the right glandular mass was positive correlated with BMI and Simon grading, ΔSN-N, and ΔN-N (P<0.05). Multiple linear regression analysis showed that Simon grading had a positive predictive effect on glandular mass, and the regression equation was as follows: right glandular mass=5.541+32.115×Simon grading (R2=0.354, P<0.001). ConclusionAxillary single-site laparoscopic subcutaneous mastectomy is an ideal surgical procedure for the treatment of GYN. BMI and Simon grading are closely related to GYN glandular mass, and have certain reference value for preoperative glandular mass assessment.
Objective To evaluate the value of extended latissimus dorsi flap (ELDF) in immediate breast reconstruction in patients with breast cancer after modified radical mastectomy. Methods Thirty-six patients with breast cancer who accepted modified radical mastectomy and 12 patients with breast cancer who accepted immediate breast reconstruction after modified radical mastectomy from January 2008 to June 2009 were included. The complications, cosmetical results and quality of life of these patients were compared. The shape of breast reconstruction was also evaluated. Results All of 12 patients succeeded in proceeding immediate breast reconstruction with ELDF. The evaluation of shape of breast reconstruction was good in 6 cases, secondary in 4 cases, and bad in 2 cases, which was beyond that in patients of radical operation group (Plt;0.001). There was no statistical difference in operation complications as hydrops, necrosis, affecting limb shoulder joint motion, drainage time, hospital stay, and starting time for adjuvant therapy between two groups (Pgt;0.05). The patients in breast reconstruction group had a better quality of life compared with the patients in radical operation group (Plt;0.001). In breast reconstruction group, 10 patients received adjuvant chemoradiotherapy and no necrosis was showed in local flap grafting. After the follow-up of 2-17 months (median 8 months), no local recurrence and metastasis was demonstrated in two groups patients. Conclusions There are good cosmetic results after immediate breast reconstruction with ELDF, and it is easy to operate. It is a safe and feasible therapeutics method for early breast cancer.
ObjectiveTo compare the satisfaction and safety of patients undergoing prepectoral breast reconstruction (PBR) versus subpectoral dual-plane breast reconstruction (SBR) with implants combined with mesh after open total mastectomy for breast cancer. MethodsA prospective cohort study on clinical data of breast cancer patients who underwent open total mastectomy and received either PBR or SBR with implants and mesh for immediate breast reconstruction from June 2021 to October 2022 at West China Hospital of Sichuan University were performed. The pain scores on postoperative days 1, 3, 7, and 14, the postoperative use of analgesics within 14 days, and the incidence of postoperative complications, breast satisfaction, and quality of life during follow-up periods were compared between the two groups. ResultsA total of 62 female patients were included, with 35 in the PBR group, having an average age of (39.6±6.5) years, and 27 in the SBR group, having an average age of (41.5±9.9) years. The pain scores of the SBR group on postoperative days 3 (P=0.032), 7 (P＜0.001), and 14 (P＜0.001) were significantly higher than those of the PBR group, and a higher proportion of patients in the SBR group used analgesics within postopeartive 14 days (P=0.001). The median follow-up time was 28.4 months for the PBR group and 34.9 months for the SBR group. There was no statistical difference in the overall (P=0.583), major (P=0.526), or minor (P=0.532) complication rates between the two groups during follow-up. One (2.9%) patient in the PBR group and 2 (7.4%) patients in the SBR group lost their implants (P=0.575). There were 4 patients of movement deformities and 4 patients of chest muscle pain in the SBR group, whereas no patients in the PBR group had these complications (P=0.031). Encapsular contracture occurred in 5 (14.3%) patients in the PBR group and 11 (40.7%) patients in the SBR group (P=0.023). The incidences of ripple sign (25.7% vs. 3.7%, P=0.047) and implant contour visibility (40.0% vs. 11.1%, P=0.020) were significantly higher in the PBR group than those in the SBR group. At 24 months post-surgery, breast satisfaction scores [(67.9±13.1) points vs. (52.6±16.9) points, P=0.025] and chest function satisfaction [(70.7±13.4) points vs. (58.7±14.3) points, P=0.035] were higher in the PBR group. No local recurrence, distant metastasis, or deaths occurred in the PBR group during the follow-up period, while 1 patient of local recurrence and distant metastasis occurred in the SBR group, with no deaths. ConclusionCompared to SBR, PBR is more in line with the physiological and anatomical levels of the breast, effectively avoiding postoperative movement deformities and chest muscle pain, with a lower incidence of capsular contracture, and higher postoperative breast satisfaction and chest function satisfaction. It is a safe and feasible reconstruction method. For some specific patients, especially those with higher physical activity demands, it is a better reconstruction choice.