Application of latissimus dorsi muscle flap for breast conservation in breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Breast conserving surgery (BCS) is one of standard treatment approaches in early breast cancer. Although most defect after BCS can be repaired, the cosmetic outcomes are unsatisfactory in the patients with poor tumor/breast ratio. Oncoplastic surgery (OPS) has emerged as a new approach for providing adequate tumor resection without compromise of aesthetic outcomes in BCS. Our purpose is to explore the cosmetic outcomes of applying latissimus dorsi (LD) muscle flap to reshape severe breast conservation deformities in breast cancer.</p><p><b>METHODS</b>Totally 24 cases of breast cancer were studied. The tumor size was 3.0 - 5.5 cm (median 3.5 cm). All the cases underwent BCS and achieved negative margin by frozen sections examination. Then LD flap reshaping were performed. All the patients received whole breast radiotherapy ± chemotherapy ± endocrine therapy.</p><p><b>RESULTS</b>All the LD flaps were alive without skin necrosis. After a median 23-month follow-up, all the cases were disease-free surviving. The whole breast radiotherapy had no significant effect on the LD flaps. The rate of good cosmetic results was 79.2%. The subjective satisfactory rate of the patients was 96%.</p><p><b>CONCLUSIONS</b>Both satisfactory aesthetic outcome and good treatment effect were obtained using LD flap to reshape severe breast conservation deformity. OPS offers tools for breast conservation in patients otherwise destined for mastectomy or poor aesthetic outcome, such as large tumor/breast ratio, nipple-areola complex tumor, ductal carcinoma in situ, neoadjuvant chemotherapy cases and so on.</p>

Research on the postoperative complications and its risk factors of breast reconstruction with abdominal flaps / 中华外科杂志

<p><b>OBJECTIVE</b>To study the postoperative complications and its risk factors in patients underwent breast reconstruction with abdominal flaps.</p><p><b>METHODS</b>The clinical data of 115 cases underwent breast reconstructions with abdominal flaps from May 2001 to October 2008 was reviewed. The postoperative complications included total flap necrosis, partial flap necrosis, fat necrosis, hernia, bulge, fat liquefaction and infection. The risk factors of complication rates were also evaluated.</p><p><b>RESULTS</b>The total postoperative complications rate was 17.4% (20/115). No severe complications was found, such as total flap necrosis, hernia and bulge. The most common complications of flap was fat necrosis which occurred in 6 cases (5.2%), partial flap necrosis in 5 cases (4.3%) and infection in 1 case (0.9%). The donor-site complications included fat liquefaction which occurred in 8 cases (7.0%) and infection in 3 cases (2.6%). No significant relation was found between patient's age, body mass index (BMI), timing of surgery and the postoperative complication rate. The postoperative complications occurred more frequently in active smokers, patients with radiotherapy history, or reconstructions with pedicled transverse rectus abdominis myocutaneous (TRAM) flaps. But no significant difference was found in those factors.</p><p><b>CONCLUSIONS</b>Fewer complications happens in patients with a reconstruction with deep inferior epigastric perforator (DIEP) flap. Abdominal flap should be performed with more consideration in active smokers or patients with a radiotherapy history. Age and obesity should not be contraindications to breast reconstruction with abdominal flaps.</p>

Application of latissimus dorsi-myocutaneous flap in breast reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the design, procedures and effect of latissimus dorsi-myocutaneous flap (LDMF) for breast reconstruction.</p><p><b>METHODS</b>From May, 2005 to April, 2006, 18 consecutive patients underwent breast reconstruction with LDMF. Combined breast implants were also inserted in 8 of the 18 cases. The procedure duration, complication and aesthetic results were assessed.</p><p><b>RESULTS</b>The mean procedure duration was 147 minutes. There was no flap loss and no severe complications. The reconstructed breast was a little over high in one patient. All the other 17 patients (94.4%) were very satisfied with the aesthetic result.</p><p><b>CONCLUSIONS</b>LDMF or a combination of LDMF with breast implants is a reliable method for breast reconstruction with low complication. The procedure is easily performed with good aesthetic result.</p>

Clinical significance and relationship of expression of matrix metalloproteinase-2 mRNA with breast cancer metastasis / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the clinical significance of matrix metalloproteinase-2 (MMP-2) mRNA and the relationship of MMP-2 mRNA expression with breast cancer metastasis.</p><p><b>METHOD</b>Detect MMP-2 mRNA expression of 30 breast cancer, metastatic lymphnode and 116 clinical breast cancer samples by flurence-quantitative RT-PCR and analysis the relativity of MMP-2 mRNA expression with clinical, pathology factors.</p><p><b>RESULTS</b>MMP-2 mRNA expression in 30 metastatic lymphnode is lower than in primary breast cancer (t = -3.293, P < 0.05). The mRNA expression of MMP-2 in tumor > 2 cm is lower than in tumor </= 2 cm (t = 1.936, P < 0.05). The MMP-2 mRNA expression in stage II, III is lower than in stage I (t = 2.466, P < 0.05). The mRNA expression of MMP-2 in more than 4 lymphnodes positive is lower than in lymphnode 1 - 3 positive (t = 3.202, P < 0.05). The MMP-2 mRNA expression is irrelated with tissue grade, pathologic type, ER, PR and Her-2.</p><p><b>CONCLUSIONS</b>MMP-2 mRNA expression is up-regulated in early clinic stage, lymphnode metastatic early stage, and down regulated with tumor progressing. MMP-2 mRNA expression is related with the metastasis of breast cancer.</p>