Since February 1987, reconstruction of the brest by transposition of the contralateral half-brest with myocutaneous flap of pectoralis major muscle was used in 4 cases with successful results. The operation was suitable for those patients having radical mastectomy for early carcinoma of brest, and it was particularly feasible in those patients having benign lesions, trauma or other disorders causing absence of brest, and especially for those patients who had a huse brest of the contralateral side.
Objective To describe the role of breast palpation imaging (PI) in breast cancer screening. Method We searched the latest research and previous literatures of PI in the diagnosis of breast cancers, and made an review after reading the articles. Results PI had better diagnostic efficiency than clinical breast examination (CBE) in breast cancer screening. PI combined with mammography (MG) and/or breast ultrasound (BUS) could further improve the diagnostic efficiency. Conclusion PI has important value in breast cancer screening, and is an important supplement to existing breast cancer screening methods.
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.
ObjectiveTo investigate the influencing factors of flap-related complications and the economic benefits of intraoperative indocyanine green (ICG) angiography in the patients undergoing autologous breast reconstruction.MethodsBetween July 2013 and June 2018, the clinical data of 150 patients (152 breasts) who met the selection criteria after autologous breast reconstruction were analyzed retrospectively. Ten factors including age, body mass index, preoperative neoadjuvant chemotherapy (NC), chest radiation history, diabetes, abdominal operation history, chest wall reconstruction, reconstruction timing, flap type, intraoperative ICG angiography were analyzed by univariate analysis. Significant variables found in univariate analysis were used to perform backward multivariate logistic regression of flap related complications and local necrosis. According to the above multi factor analysis results, the patients were divided into 4 groups: ICG+NC group (group A), ICG+non-NC group (group B), non-ICG+NC group (group C), non-ICG+non-NC group (group D). The average extra costs of surgical treatment (including ICG imaging cost+cost of handling flap related complications) of each group was calculated.ResultsAll the 152 flaps survived. There were 33 flap-related complications, including 22 regional necrosis, 9 regional infection, 5 hematoma, 5 simple fat liquefaction, and 2 anasto-motic thrombosis. Univariate analysis showed that preoperative NC, flap type, and intraoperative ICG angiography had significant influence on the incidence of flap-related complications (P<0.05). Multivariate analysis showed that preoperative NC and non-ICG angiography were the risk factors of flap-related complications (P<0.05), and also the risk factors of regional flap necrosis (P<0.05). For patients who had NC, intraoperative ICG angiography could greatly save the average extra costs. The average extra costs in group A was 1 378 yuan less than that in group C. For the patients without NC, intraoperative ICG angiography would increase the average extra costs, which was 747 yuan in group B more than that in group D.ConclusionIn autologous breast reconstruction, ICG angiography can reduce the incidence of flap-related complications, especially the incidence of regional flap necrosis, while NC is the opposite. For patients without NC, ICG angiography is not cost-effective but still can be used if conditions permit. However, for those with NC, ICG angiography is cost-effective and recommended.
From March 1986 through March1989 ,silicon rubber prosthesis had been usedfor mammoplasty in 34 patients ( 55breasts) with 53 success and 2 failures. Theindications of surgical treatment , the time tooperate, the mode of implantatioh of prosthe-sis, the selection of prosthesis and the prophy-lactic measures for complications were dis- cussed.
【Abstract】 Objective To discuss the aesthetic effect and appl ication of refined incisions in breast reconstructionfor breast cancer patients by the transverse rectus abdominis myocutaneous (TRAM) flap. Methods From January 2001 toOctober 2006, 77 cases with breast cancer were treated with TRAM flap to immediate breast recontruction. The patients were all femals, with an average age of 45 years (ranging from 26 years to 53 years). There were 39 cases of left breast and 38 cases of right breast. The disease course was from 1 day to 180 days. There were 11 cases of stage I , 60 cases of stage II and 6 cases of stage III, among which 34 cases were located in the upper outer quadrant, 15 in the lower outer quadrant, 22 in the upper inner quadrant and 6 in the lower inner quadrant. The size of tumors varied from 1 cm to 4 cm. As to the pathologic type, 60 cases were invasive ductal cancers, 12 ductal cancers in situ, 5 invasive lobular cancers; positive lymph node (number: 1-7) happened in 29 cases, while negative lymph node happened in 48 cases. Among the 77 cases, regular shuttle incisions were performed in 35 cases, and refined circle incisions were performed in 42 cases, which were 2 cm away from the breast tumor border. Axillary incision was necessary for the breast tumors located in upper inner, lower inner and upper outer quadrants in order to perform axillary mastectomy. Ten cases were ni pple-areola sparing. The shape, symmetry and incision scar of the reconstructed breast were evaluated and graded. Results There were 6 cases out of 77 cases of breast reconstruction in which partial necrosis happened and the necrosis rate was 7.79%. The time of follow-up was from 13 months to72 months, with an average of 39 months. No recurrence or matastasis happened in 76 cases, and distant metastasis happened only in 1 case. There were 40 cases out of 42 cases with refined incisions which were scored more than 3, and the satisfaction rate was 95.24%. There were 31 cases out of 35 cases with regular incisions which were scored more than 3, and the satisfaction rate was 88.57%. Conclusion The reasonable refined incision based on the location of the tumor is effective to improve the satisfaction rate for the shape of the reconstructed breast.
Objective To introduce the treatment experiences about the skin-sparing mastectomy and immediate breast reconstruction. Methods The skin-sparing mastectomy and immediate breast reconstruction by using transverse rectus abdominis myocutaneous （TRAM） flat were performed in 10 patients with early-stage breast cancer from May 2008 to December 2011 in our hospital. The patients’ data were retrospectively analyzed. Results There were postoperative complications after skin-sparing mastectomy and immediate breast reconstruction， including TRAM flat necrosis in 1 case， papillary necrosis in 1 case and fat necrosis in the reconstructed breast with oxter wound infection in 1 case. There was no incision hernia of abdominal wall or necrosis of all TRAM flat in any case. The patients’ satisfaction that evaluation for the breast shapes of reconstructed breasts was very satisfaction in 5 cases， part satisfaction in 4 cases， and dissatisfaction in 1 case， respectively. Conclusions Because of the minimal access approach and good breast shape， the skin-sparing mastectomy and immediate TRAM flat breast reconstruction is a safe and effective way for treating early-stage breast cancer.
ObjectiveTo understand the current research status of conservative mastectomy with breast reconstruction for breast cancer, so as to provide a reference for surgeons and patients with breast cancer to choose surgical method. MethodThe recently domestic and foreign literature on the research of conservative mastectomy with breast reconstruction for breast cancer was reviewed and summarized. ResultsAt present, conservative mastectomy mainly included nipple sparing mastectomy, skin sparing mastectomy, and skin reduction mastectomy. All three surgical methods were safe and effective in the treatment of breast cancer, and the complications could be controlled. When combined with breast reconstruction, the better cosmetic effect could be obtained, and the postoperative satisfaction and quality of life of patients were markedly improved. ConclusionsAfter comprehensively preoperative evaluation for patients with breast cancer, conservative mastectomy provides a treatment choice for them. After conservative mastectomy, individualized reconstruction scheme is formulated according to size and sagging degree of breast, as well as individual expectations of patients, which can obtain a higher quality of life while treating diseases for patients with breast cancer.