Clinical analysis of 382 immediately breast reconstruction after mastectomy in Beijing City, Tianjin City and Hebei Province from 2012 to 2016 / 中华外科杂志

To summarize the status of immediate breast reconstruction (IBR) after mastectomy in Beijing City, Tianjin City and Hebei Province. A retrospective analysis was made on the data of 382 cases with breast cancer who were treated and followed up successfully with immediate breast reconstruction after mastectomy from January 2012 to December 2016 in Beijing City, Tianjin City and Hebei Province. Clinic data of the followed-up 382 cases (all female, age (38.5±4.2) years (range: 24 to 70 years)), including general information, tumor information, sugery methods, and treatments after surgery were collected. The survival status, metastasis,complications and prognosis were followed up. Cosmetic effcet was evalated by Harris method, and life quality by Functional Assessment of Cancer Therapy-Breast scale (FACT-B). χ(2) test was used to compare the difference between year 2012 and year 2013 to 2016. Bonferroni method was used to correct the inspection level, which was 0.05/10=0.005. The trend of IBR rate (ratio of IBR to modified radical mastectomy) from 2013 to 2016 was analyzed by trend χ(2) test. There was 46 cases in stage 0, 152 cases in stage Ⅰ, 165 cases in stage Ⅱ, 19 cases in stage Ⅲ. Twenty-five cases was treated by neoadjuvant chemotherapy, 231 by chemotherapy and 35 by radiotherapy. The proportion of implant reconstruction was 48.7% (186/382), more than expanded of 21.5% (82/382), with latissimus dorsi of 12.0% (46/382), TRAM of 8.9% (34/382), DIEP of 2.1% (8/382), and latissimus plus implant of 6.8% (26/382). According to the Harris standard, the excellent and good rate of the cosmetic effect of the reconstructed breast was 93.7%. The score of FACT-B was 108.20±16.9 (range: 67 to 144) 1 year postoperatively. Compared with 2012, the IBR rate was significant increased, till 2015, the IBR rate was 153/10 000 cases (χ(2)=47.028, 0.000). There is a significant increase on IBR rate in Beijing City, Tianjin City and Hebei province by year. Most of cases received IBR is stage Ⅰ to Ⅱ. Implant reconstruction is the main reconstructive method. Postoperative cosmetic effects and quality of life are both meet patients' demon.

Protection and technical key points of nipple-areola complex in breast reconstruction / 中国实用外科杂志

Traditional mastectomy requires the removal of nipple-areola complex(NAC),no matter whether the subsequent reconstruction or not,it can't meet the aesthetic needs of patients.With the development of breast reconstruction technology,immediate breast reconstruction with preservation of nipple-areola complex has superior aesthetic effect.More and more breast cancer patients can maintain the integrity and beauty of their body after operation.How to better protect the nipple-areola complex in breast reconstruction surgery has become one of the focuses of breast surgeons.The operator should have a strong sense of NAC protection,carefully grasp the characteristics of the posterior mammary duct and blood supply of NAC,reasonably design the surgical incision,and reduce the occurrence of postoperative nipple ischemia,necrosis and other complications as far as possible.

Comparison of therapeutic effects of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy on breast cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer.</p><p><b>METHODS</b>This study retrospectively analyzed 530 female patients with early breast cancer operated in the department of General Surgery, Beijing Chaoyang Hospital, from Jan. 2004 to Dec. 2008, including 91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction and 439 patients with modified radical mastectomy. The follow up ended in Mar. 2010. By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency.</p><p><b>RESULTS</b>In the group of immediate implanting reconstruction, 84 patients completed follow up with the median follow-up time of 35 months (14 - 72 months) while the local recurring rate was 2.4%, distant metastasis rate was 8.3% and mortality rate was 6.0%. In the group of modified radical mastectomy, 398 patients completed follow up with the median follow-up time of 36 months (12 - 74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9.5% and mortality rate was 6.5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P > 0.05). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance.</p><p><b>CONCLUSION</b>For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.</p>

A selection of methods for immediate and delayed breast reconstruction / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the surgical methods, indications and effects of postmastectomy breast reconstruction in 67 consecutive patients.</p><p><b>METHODS</b>From July 2002 to October 2005, 67 patients received postmastectomy breast reconstructions. Immediate breast reconstructions were performed using full-size implants in 38 cases, Becker expandable implants in 16 cases, unilateral pedicled transverse rectus of abdominis musculocutaneous (TRAM) in 2 cases. Delayed breast reconstruction were carried out in 6 cases with unilateral pedicled TRAM flaps, 4 cases with extended latissimus dorsi musculocutaneous flap (ELDF), one case with Becker expandable implant.</p><p><b>RESULTS</b>Of the patients, more than 90% were satisfied with the results. Minor complications were recorded in 5 patients, including small local skin necrosis, partial necrosis of nipple-areola complex preserved and seroma formation.</p><p><b>CONCLUSIONS</b>Full-size implant breast reconstruction is ideal for slender, small-breast women undergoing immediate breast reconstruction after skin-sparing mastectomy, but not suitable for delayed breast reconstruction. Expandable implants can be used for immediate breast reconstruction in patients with large breast or those who received modified mastectomy and also can be used for delayed breast reconstruction in patients with well-preserved skin and muscle. TRAM or ELDF flap for breast reconstruction is a useful procedure with advantages of autologous tissue and excellent results, both are suitable for immediate and delayed breast reconstruction.</p>

Expandable implants in immediate breast reconstruction / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the indications, surgical methods and esthetic results in patients undergoing immediate breast reconstruction with expandable implants.</p><p><b>METHODS</b>From January 2002 to March 2006, immediate breast reconstructions were carried out with expandable implants following mastectomy in 30 breast cancer patients. Nipple-areola were preserved in 5 patients.</p><p><b>RESULTS</b>Very satisfactory results were achieved. Minor complications were recorded in 3 patients, two with local skin necrosis, and another with partial necrosis of nipple-areola complex.</p><p><b>CONCLUSIONS</b>The techniques provide better results for the patient who is not a candidate for simple implant reconstruction. These techniques also eliminate the need for a second major surgery to replace a temporary expander with a permanent implant in those patients needing soft tissue expansion. It is a simple procedure with advantages of no additional scarring, short time for convalescence.</p>

Classification and clinical study of plasma cell mastitis under breast duct endoscope / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the clinical significance of breast duct endoscope for plasma cell mastitis.</p><p><b>METHODS</b>Breast duct endoscope was performed on 250 patients with nipple discharge. The characters of 95 cases of plasma cell mastitis under the breast duct endoscope were analyzed and studied.</p><p><b>RESULTS</b>Among the 95 cases with plasma cell mastitis, 21 were in type I, 43 in type II, 18 in type III and 13 in type IV. Eighty-three cases were treated with no-operation treatment, and 45 completely released, 38 partly released. There were 5 cases with middle to serious atypical hyperplasia in 12 cases treated with operation, that were all confirmed by pathological examination.</p><p><b>CONCLUSION</b>In patients with plasma cell mastitis, clear diagnosis can be made through breast duct endoscope, and the breast duct with lesions could be positioned. It is a necessary assistant method for patients to avoid biopsy or decrease the biopsy range.</p>