Clinical observation of areola approach endoscopic thyroidectomy and gasless axillary approach endoscopic thyroidectomy in the treatment of patients with papillary thyroid carcinoma / 中华内分泌外科杂志

Objective:To explore the clinical efficacy of areola approach endoscopic thyroidectomy (AET) and gasless axillary approach endoscopic thyroidectomy (GAET) in the treatment of papillary thyroid carcinoma (PTC) patients.Methods:A total of 96 PTC patients from the Thyroid Surgery Department of Linyi People’s Hospital from May. 2019 to May. 2022 were selected and randomly divided into 48 patients using a random number table method. The areola group received AET, while the armpit group received GAET. The surgical situation, postoperative recovery, relevant biochemical indicators [white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), parathyroid hormone (PTH), blood calcium] before and after surgery, postoperative pain level, discomfort level, neck function, and complications were compared between the two groups.Results:The surgical time and extubation time of the armpit group were (125.71±15.73) minutes and (3.12±0.53) days, respectively, which were shorter than those of the areola group (137.94±20.02) minutes and (3.48±0.46) days. The intraoperative bleeding volume was (14.19±4.16) mL, which was less than that of the areola group (22.65±7.39) mL, and the number of lymph nodes cleaned was 5.06±1.02, which was more than that of the areola group (4.23±1.14) ( P<0.05) ; there was no significant difference in postoperative drainage volume and hospital stay between the two groups ( P>0.05) ; Peripheral blood WBC in the armpit group on the 1st and 3rd day after surgery [ (5.69±0.15) ×10 9/L, (5.52±0.14) ] ×10 9/L, ESR [ (8.21±0.55) mm/h, (7.64±0.60) mm/h], CRP [ (10.06±1.78) ng/L, (8.93±1.33) ng/L] were lower than those in the areola group [ (5.83±0.21) ×10 9/L, (5.70±0.23) ×10 9/L, (8.87±0.74) mm/h, (8.19±0.68) mm/h, (12.45±1.90) ng/L, (10.45±1.50) ng/L] ( P<0.05). There was no significant difference in the levels of the above biochemical indicators 5 days after surgery ( P>0.05). There was no significant difference in peripheral blood PTH and calcium levels between the two groups on the 1st, 3rd, and 5th postoperative days ( P>0.05). The pain level [ (3.25±0.32) scores, (2.53±0.27) scores, (1.82±0.22) scores] and discomfort level [ (6.85±0.71) scores, (5.24±0.66) scores, (3.51±0.57) scores] in the axillary group were lower than those in the areola group [ (3.78±0.40) scores, (2.89±0.34) scores, (2.06±0.26) scores, (7.46±0.84) scores, (6.09±0.73) scores, (4.16±0.60) scores] on the 1st, 3rd, and 5th postoperative days ( P<0.05). The neck flexion, lateral flexion, and extension range of motion in the axillary group on the 3rd day after surgery were (33.16±3.09) °, (27.63±2.57) °, and (30.44 2.73) °, respectively, which were greater than those in the areola group[ (30.08±2.76) °, (25.14±2.30) °, and (27.98±2.54) °], and the swallowing disorder index was (30.16±4.97) points lower than the (34.83±4.13) points in the areola group ( P<0.05). The incidence of complications in the axillary group was 4.17% (2/48), lower than the 16.67% (8/48) in the areola group. Conclusion:GAET treatment for PTC patients can improve the effect of lymph node dissection, reduce the degree of surgical trauma, postoperative pain and discomfort, accelerate early postoperative recovery of neck function, and reduce complications.

Resultados en reconstrucción mamaria inmediata prepectoral con implantes / Result of immediate prepectoral implant-based breast reconstruction

RESUMEN Antecedentes: la reconstrucción mamaria inmediata prepectoral con implantes es la incorporación técnica más reciente al arsenal de reconstrucción mamaria. Esta técnica proporciona un aspecto más natural a la reconstrucción, elimina complicaciones, como la deformidad por animación, y disminuye el dolor posoperatorio. Objetivo: describir los resultados quirúrgicos en una serie de pacientes con reconstrucción mamaria inmediata prepectoral con implantes de silicona. Material y métodos: se realizó un estudio retrospectivo descriptivo; fueron revisadas las historias clínicas y los informes de anatomía patológica de pacientes operadas con la técnica descripta entre marzo de 2018 y diciembre de 2021, por carcinoma invasor, no invasor y sarcoma de mama. Todas fueron evaluadas en el preoperatorio con mamografía digital y presentaban más de 2 cm de cobertura grasa en la mama intervenida. Resultados: se registraron 52 reconstrucciones en 40 pacientes. El promedio de edad fue de 52 años (rango 30-76). En todas se realizó mastectomía con preservación del complejo aréolapezón. Con un promedio de seguimiento de 40 meses, no se registraron complicaciones mayores. No se encontró animación, desplazamiento ni rotación del implante. Se observó contractura capsular grados III y IV después del año de seguimiento en 3 pacientes que realizaron radioterapia posoperatoria. Los resultados estéticos fueron excelentes y buenos en 40 mamas (80,0%), regulares en 8 mamas (12,0%) e insuficientes en 4 mamas (8,0%). Se necesitó revisión quirúrgica posoperatoria inmediata por hematoma en 4 mamas (7,7%). Conclusiones: la reconstrucción inmediata con implantes prepectorales posmastectomía fue una técnica segura y con alto porcentaje de satisfacción.

ABSTRACT Background: Prepectoral implant-based breast reconstruction has recently been added to the armamentarium for breast reconstruction. This technique provides natural-looking breasts, avoids complications, such as animation deformity, and reduces postoperative pain. Objective: The aim of this study was to describe the surgical outcomes in a series of patients undergoing immediate prepectoral breast reconstruction with silicone implants. Material and methods: A descriptive and retrospective study was carried out with review of the medical records and pathology reports of patients who underwent surgery using the described technique for invasive carcinoma, non-invasive carcinoma, and sarcoma of the breast from March 2018 to December 2021. All the patients were evaluated preoperatively with digital mammography and had fat coverage thickness in the operated breast > 2 cm. Results: A total of 52 reconstructions were performed on 40 patients. Mean age was 52 age (range 30- 76). The nipple sparing mastectomy was undertaken in all the cases. There were no major complications during the 40-month average follow-up. None of the patients experienced animation deformity, implant displacement, or rotation. After one year of follow-up, three patients who underwent postmastectomy radiotherapy showed grades III and IV capsular contracture. The aesthetic results were excellent and good in 40 breasts (80.0%), fair in 8 breasts (12.0%) and insufficient in 4 breasts (8.0%). Four breasts (7.7%) required surgical revision in the immediate postoperative period. Conclusions: Immediate prepectoral implant-based breast reconstruction is a feasible technique with enduring results and high level of satisfaction.

Current strategies for the reconstruction of the nipple-areola complex: a review

The reconstruction of the nipple-areola complex after a mastectomy is essential for the bio-psycho-social recovery of the patient, it is generally performed 4 to 6 months after surgery and there are multiple surgical reconstruction techniques depending on the experience of the surgeon and of the individual characteristics of the patients. The most widely used for its safety and for having shown the best results is the local flap technique combined with the use of autologous, alloplastic and allograft grafts. However, currently there is still no technique that shows long-term lasting results. For this reason, in this article we describe the five categories of reconstruction techniques for the nipple-areola complex that currently exist, their advantages and disadvantages, as well as the lines of research in tissue engineering in which the world is working to find a therapeutic strategy that can reproduce a nipple-areola complex with the characteristics of the biologic.

A retrospective cohort study of total areolar endoscopic approach versus open thyroidectomy for the treatment of papillary thyroid carcinoma / 国际外科学杂志

Objective:To compare the effectiveness of areola approach endoscopic thyroidectomy (AET) and conventional open thyroidectomy (OT) in treating papillary thyroid carcinoma.Methods:Four hundred and twenty-eight female patients with papillary thyroid carcinoma who were treated at the Department of General Surgery, Beijing Friendship Hospital between January 2017 and January 2020 were included according to the inclusion and exclusion criteria, of whom 183 underwent AET (AET group) and 245 underwent OT (OT group). Direct comparison and subsequent propensity score matching methodology were utilized to compare the differences between the two operation methods in terms of surgical time, intraoperative parathyroid transplantation rate, intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. Data analysis was performed by using SPSS 25.0 software. The metric data of normal distribution was represented by mean ± standard deviation ( ± s), and the t-test was used for between-group comparison. The Chi-test was used for between-group comparison of count data. Results:The AET group had an age of (38.89±9.08) years, weight of (62.10±10.45) kg, and height of (161.97±5.31) cm; the OT group had an age of (45.88±12.47) years, weight of (65.11±12.72) kg, and height of (161.62±5.24) cm. The differences in age, weight, and body mass index between the two groups were statistically significant ( P<0.05). The surgical time in the AET group was (183.00±137.22) min, which was significantly longer than (87.94±28.25) min of the OT group ( t=16.67, P<0.001). The parathyroid transplantation rate in the OT group was significantly higher than that in the AET group (49.39% vs 34.97%, χ2=8.87, P=0.003). There were no statistically significant differences between the two groups in terms of intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. After propensity score matching based on differences in age, weight, body mass index, and soon, 183 cases of AET (AET-PS group) and OT (OT-PS group) were obtained for statistical analysis. The surgical time in the AET-PS group was (137.22±32.77) min, which was significantly longer than (90.26±29.35) min of the OT-PS group ( t=14.44, P<0.001). The parathyroid transplantation rate in the OT-PS group was significantly higher than that in the AET-PS group (53.01% vs. 34.97%, χ2=12.08, P=0.001). There were no statistically significant differences between the two groups in terms of intraoperative nerve injury, postoperative complications, reoperation rate, number of lymph node dissections, postoperative lymph node metastasis at 2 years, and route tumor implantation. Conclusions:AET and OT are equally safe and effective in treating papillary thyroid carcinoma. AET surgery can be performed safely and feasibly under strict adherence to surgical principles.

Enfermedad de Paget pigmentada de la mama simuladora de melanoma cutáneo / Pigmented mammary Paget's disease mimicking cutaneous melanoma

Resumen ANTECEDENTES: La enfermedad de Paget pigmentada de la mama es una variante poco frecuente de este padecimiento cutáneo, una dermatosis que afecta al complejo areola-pezón de manera típicamente unilateral. La importancia del reconocimiento de esta dermatosis pigmentada inespecífica es que forma parte del diagnóstico diferencial del melanoma cutáneo, por manifestarse como una mácula pigmentada irregular, cuyo estudio histopatológico muestra una proliferación de melanocitos en los estratos suprabasales de la epidermis, fagocitosis de melanina y melanófagos en dermis, hallazgos muy similares al melanoma cutáneo, además de la coexistencia de células claras malignas, características de la enfermedad de Paget. La inmunohistoquímica es una técnica auxiliar en la dermatopatología, que forma parte del proceso diagnóstico de los pacientes para lograr el diagnóstico certero que, al correlacionar la clínica y el estudio histopatológico, le permite al dermatólogo tratar a los pacientes con enfermedad de Paget pigmentada de la mama junto con un equipo multidisciplinario para la búsqueda, diagnóstico y, en su caso, tratamiento quirúrgico de las neoplasias subyacentes que suelen relacionarse con esta variante pigmentada. CASO CLÍNICO: Paciente de 35 años con una lesión pigmentada que afectaba el complejo areola-pezón derecho. Con la correlación histopatológica e inmunohistoquímica se estableció el diagnóstico de enfermedad de Paget pigmentada de la mama y posterior al procedimiento ginecológico, se asoció esta dermatosis con un adenocarcinoma microinvasor triple negativo. CONCLUSIONES: La enfermedad de Paget pigmentada de la mama es un diagnóstico complejo que requiere correlación clínico-patológica y estudios de extensión para valorar su asociación con neoplasias subyacentes.

Abstract BACKGROUND: Pigmented Mammary Paget's Disease is a rare variant of this skin condition, an unilateral dermatosis that typically affects the areola-nipple complex. The importance of recognizing this nonspecific pigmented dermatosis resides in its differential diagnosis of cutaneous melanoma, as it presents as an irregular pigmented macula. The histopathological study shows proliferation of melanocytes in the suprabasal layers of epidermis, phagocytosis of melanin and melanophages in dermis. These findings are very similar to cutaneous melanoma, in addition to the presence of malignant clear epitelial cells that are characteristic of Paget's disease. Immunohistochemistry is part of the approach of patients with lesions that shows proliferating melanocytes to rule out other neoplasms. Making an accurate diagnosis by correlating the clinical, histopathological study and immunohistochemistry allows the dermatologist to approach patients with mammary pigmented mammary Paget's disease with a multidisciplinary team for the diagnosis and surgical treatment of the underlying neoplasms that are usually related to this pigmented variant. CASE REPORT: We report the case of a 35 years old woman with a pigmented lesion that affected the right areola-nipple complex. With the histopathological and immunohistochemical correlation, the diagnosis of pigmented mammary Paget's disease was made and after the gynecological approach, this dermatosis was associated with a triple negative microinvasive adenocarcinoma. CONCLUSION: Pigmented mammary Paget's disease is a complicated diagnosis that requires clinicopathological correlation and extension studies to assess its association to underlying neoplasms.

Anatomy and preservation of the nipple-areola complex / 国际外科学杂志

Preserving nipple-areola complex (NAC) in breast-conserving surgery and nipple-areola complex-sparing mastectomy (NSM) can achieve good tumor safety and breast aesthetics under the premise of appropriate case selection. However, there are still many doubts about the local anatomy of the nipple and NAC and how to preserve the NAC and reshape the shape of the nipple on the basis of selecting cases to achieve individualized treatment and complete tumor resection. In this paper, the NAC, internal nipple and posterior nipple anatomy are described in detail; Combined with the operation of NAC during NSM operation, the treatment of breast duct bundle inside the nipple and behind the nipple were introduced with author′s experience and pictures. The pathologic evaluation of preserving NAC, NAC conservation in breast cancer patients with nipple discharge and radiotherapy after NAC conservation were discussed. In fact, the current situation in our country is that too many patients may be suitable for immediate breast reconstruction or delayed breast reconstruction after NSM. It is very important to be familiar with the local anatomical characteristics of nipples and NAC for standardized breast conserving surgery and NSM. Therefore, more patients with breast cancer can safely retain NAC and breast, and breast reconstruction can be further accomplished on the basis of preserving NAC.

Analysis of risk factors related to distant metastasis in patients with early breast cancer undergoing endoscopic nipple-areola-sparing subcutaneous gland resection / 国际外科学杂志

Objective:To analyze the risk factors related to distant metastasis in patients with early breast cancer who undergoing endoscopic nipple-areola-sparing subcutaneous gland resection.Methods:A retrospective analysis was used to select 402 patients with early breast cancer from January 2012 to January 2016. According to the breast cancer metastasis within 5 years after surgery, the patients were divided into the metastasis group ( n=37) and the control group ( n=365). Metastasis group refers to patients with breast cancer metastasis within 5 years after surgery, and control group refers to patients without breast cancer metastasis within 5 years after surgery. The age, family history of breast cancer, breast cancer stage, location of lesion, number of lesions, diameter of tumor, histopathological type, histological grade, molecular classification, lymph node metastasis, distant metastasis site, number of distant metastasis, operation time, intraoperative blood loss, axillary operation, carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 153 (CA153), cancer antigen 199 (CA199), postoperative extubation time, drainage amount, postoperative subcutaneous effusion, flap necrosis, incision infection, poor incision healing, dyskinesia of affected limbs, length of hospital stay were compared between the two groups. Measurement data were expressed as mean ± standard deviation ( ± s), and t-test was used for comparison between groups; Chi-square test was used for comparison of enumeration data between groups. Multivariate logistic regression analysis was used to analyze the independent risk factors of distant metastasis undergoing endoscopic nipple-areola-sparing subcutaneous gland resection in patients with early breast cancer. Using SPSS decision tree model to predict the intensity and hierarchical nodes of each risk factor. Receiver operating characteristic curve (ROC) were drawn using R 4.0.2 software, and the area under the ROC curve (AUC) was used to validate stratified nodes for continuous variables. Results:Multivariate Logisitic regression analysis showed that age < 40 years ( OR=2.715, 95% CI: 2.349-3.168, P=0.002), lymph node metastasis ( OR=2.604, 95% CI: 2.413-2.825, P=0.009), histological grade G3 ( OR=2.473, 95% CI: 2.331-2.701, P=0.007), CEA ≥ 4.10 ng/mL ( OR=2.481, 95% CI: 2.357-2.616, P=0.003) and CA153 ≥ 18.90 U/mL ( OR=2.467, 95% CI: 2.344-2.620, P=0.002) were independent risk factors for distant metastasis after endoscopic nipple-areola-sparing subcutaneous gland resection in patients with early breast cancer. The decision tree model showed that age < 40 years ( χ2=16.18, P<0.001), lymph node metastasis ( χ2=9.53, P=0.002), histological grade G3 ( χ2=11.73, P<0.001), CEA ≥ 4.10 ng/mL ( χ2=13.62, P=0.001) and CA153 ≥ 18.90 U/mL ( χ2=7.39, P=0.010) could predict distant metastasis after endoscopic nipple-areola-sparing subcutaneous gland resection in patients with early breast cancer.The AUC values of ROC curves of each node were 0.814, 0.789, 0.761, 0.696 and 0.745 respectively, the sensitivity were 84.35%, 74.96%, 79.35%, 71.59% and 73.10% respectively, and the specificity were 80.16%, 77.55%, 76.54%, 70.32% and 76.83%, respectively. The prediction performance of the model was good. Conclusion:Age < 40 years, lymph node metastasis, histological grade G3, CEA ≥ 4.10 ng/mL and CA153 ≥ 18.90 U/mL are independent risk factors for distant metastasis after endoscopic nipple-areola-sparing subcutaneous gland resection in early breast cancer patients.

Surgical management of nipple areola complex in central breast cancer / 中华肿瘤杂志

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

Innovation and practice of endoscope-assisted nipple-sparing mastectomy combined with immediate subpectoral implant breast reconstruction without gas and mesh through small skin incisions / 中华内分泌外科杂志

Objective:To examine the feasibility and safety of endoscopic subcutaneous mastectomy and immediate reconstruction via a small skin incision approach without gas and mesh for early breast carcinomas.Methods:We analyzed 7 patients diagnosed with breast cancer who underwent an endoscopic subcutaneous mastectomy and immediate reconstruction from Jun. to Nov. 2021 using a gasless and meshless small skin incision approach at the Department of Thyroid and Breast Surgery, the First Affiliated Hospital of USTC. Mean age was 44.9 (29-63) years. Clinical stage, postoperative complications and other data of patients were collected. Patients were required to fill in BREAST-Q scale anonymously before and during postoperative follow-up. The difference was considered significant for P < 0.05. Results:The tumors were all unilateral and solitary lesions, with a mean diameter of 1.74 (0-5) cm. The average distance of mass from the nipple on imaging was 2.11cm (range 0 to 4) . Postoperative pathological clinical stage,1 patient was in Tis, 3 patients were in stage I, 2 patients were in stage II and a pathological complete response was achieved in one patient (ypT0pN0cM0 CR) . The mean operative time was 245.3 (195-316) min, the mean intraoperative bleeding volume was 37.1ml, the mean postoperative hospital stay was 5.1 d, and the median follow-up time was 8.8 (6-11.2) months. All the 7 patients had incision healing at the first stage, and no complications such as infection, incision complications, capsular contracture, nipple-areola complex or skin flap necrosis, removal or displacement of breast implant occurred. No local recurrence or metastasis was detected during the follow-up period. Compared with preoperative, the scores of postoperative psychosocial status, chest wall status were lower ( P<0.05) , but still ideal, while breast satisfaction and sexual satisfaction scores were not significantly different from preoperative baseline ( P>0.05) . Conclusion:This study indicates that endoscope-assisted breast reconstruction with gasless and meshless is a safe and feasible surgical intervention method for early breast cancer, with good cosmetic effects, and can be promoted as a new type of breast reconstruction.

Análise retrospectiva dos efeitos da radioterapia sobre as aréolas reconstruídas com enxerto de pele total / Retrospective analysis of the effects of radiotherapy on the areolas reconstructed with a total skin graft

RESUMO Introdução: O câncer de mama aumentou progressivamente nos últimos anos e com isso a necessidade de diagnóstico e tratamento mais precoce também aumentaram. Atualmente, no Brasil, o câncer de mama corresponde há 29,7% dos casos de câncer nas mulheres. A reconstrução do complexo areolopapilar (CAP) tem sido foco de maior atenção devido à busca pela simetria e naturalidade, sendo a etapa final de todo esse processo. O objetivo é avaliar a manutenção do tamanho, contorno, coloração, simetria e mudança de formato do CAP reconstruído após mastectomias associadas à radioterapia. Métodos: Foi realizado um estudo retrospectivo analisando a evolução das aréolas reconstruídas, após mastectomia total associada ao tratamento adjuvante com radioterapia. Dois grupos foram selecionados: grupo 1 (reconstrução unilateral) e grupo 2 (reconstrução bilateral). Foram realizadas comparações entre aréola do CAP reconstruído, grupo 1, com a do CAP contralateral e no grupo 2, entre as duas aréolas reconstruídas. Resultados: Após inclusão de 56 paciente no estudo, foi totalizando 71 complexos areolares reconstruídos. A simetria foi classificada como boa em 77,46% de todos os casos (p=0,706). 25 reconstruções realizadas em áreas sob efeito da radioterapia e apenas 9 casos apresentaram diminuição do tamanho da aréola (p=0,050), evoluindo com uma assimetria em 8 casos, sendo 4 em região de radioterapia (p=0,706). O contorno areolar apresentou uma similaridade entre casos tratados com radioterapia e não tratados (p=0,918). Conclusão: A radioterapia adjuvante se mostrou como um fator predisponente para as alterações que possam surgir no transcorrer do pós-operatório de reconstrução do complexo areolopapilar, conforme a análise estatística.

ABSTRACT Introduction: Breast cancer has increased progressively in recent years, and with this, the need for diagnosis and earlier treatment has also increased. Currently, in Brazil, breast cancer accounts for 29.7% of cancer cases in women. The reconstruction of the nipple-areolar complex (NAC) has focused on greater attention due to the search for symmetry and naturalness, which is the final stage of this whole process. The objective is to evaluate the maintenance of the size, contour, color, symmetry and shape change of reconstructed NAC after mastectomies associated with radiotherapy. Methods: A retrospective study was conducted analyzing the evolution of reconstructed areolas after total mastectomy associated with adjuvant treatment with radiotherapy. Two groups were selected: group 1 (unilateral reconstruction) and group 2 (bilateral reconstruction). Comparisons were made between the reconstructed NAC areola, group 1, with that of the contralateral NAC and in group 2, between the two reconstructed areolas Results: After the inclusion of 56 patients in the study, 71 reconstructed areolar complexes were included. Symmetry was classified as good in 77.46% of all cases (p=0.706). Twenty-five reconstructions were performed in areas under the effect of radiotherapy, and only 9 cases showed decreased areola size (p=0.050), evolving with an asymmetry in 8 cases, 4 in the radiotherapy region (p=0.706). The areolar contour showed a similarity between cases treated with radiotherapy and untreated (p=0.918). Conclusion: Adjuvant radiotherapy was a predisposing factor for changes that may arise during the postoperative period of reconstruction of the nipple-areolar complex, according to statistical analysis.

Application of two-stage implant-based breast reconstruction after breast cancer surgery / 国际外科学杂志

Objective:To investigate the efficacy and clinical value of two-stage implant-based breast reconstruction after total mastectomy for breast cancer patients.Methods:Thirty-two patients with breast cancer, who underwent nipple-sparing mastectomy or skin-sparing mastectomy, primary skin expander implantation, and permanent implant replacement after radiotherapy from January 2018 to December 2020 in the Breast Center, Beijing Tongren Hospital, Capital Medical University were analyzed retrospectively. Record the operation time of the patient, the interval between replacement surgery and radiotherapy, prosthesis volume, the difference between the volume of 0.9% sodium chloride solution in the dilator and the volume of the prosthesis, the retention time of the postoperative drainage tube, the satisfaction of the breast shape and the complications after the replacement.Results:The average operation time was (67.81±19.71) min; the average time interval between replacement surgery and radiotherapy was (9.88±2.00) months; the average volume of 0.9% sodium chloride solution in the dilator was (225.47±56.83) mL, and the average prosthesis volume was (259.06±70.88) mL, the average difference between the volume of the prosthesis and the volume of 0.9% sodium chloride solution in the dilator was (33.59±14.88) mL; the volume of the prosthesis is increased by an average of (13.65±5.19)% compared with the dilator; the average time of drainage tube retained after the operation was (9.03±1.40) d; satisfaction with breast shape after replacement: excellent in 23 cases (71.9%), general in 8 cases (25.0%), poor in 1 case (3.1%); postoperative complications: incision fat liquefaction 1 case of dehiscence (3.1%), 2 cases of seroma (6.3%), no serious complications such as external exposure and removal of the prosthesis.Conclusions:For patients with breast cancer, who need breast reconstruction after mastectomy, the two-stage implant-based breast reconstruction in which the replacement operation will be carried out more than 6 months after radiotherapy is safe. Moreover, achieve better symmetry and aesthetic effect by releasing the capsule, reconstructing the inframammary fold, and necessary plastic surgery of the contralateral breast.

Post-thyroidectomy syndrome following endoscopic thyroidectomy via areola approach vs open operation: a retrospective cohort study / 中华内分泌外科杂志

Objective:To estimate and analyze the occurrence of post-thyroidectomy syndrome (PTS) following endoscopic thyroidectomy via areola approach (ETAA) vs open thyroidectomy (OT) .Methods:Data of 903 consecutive cases, aged from 20 to 66 with 231 males and 672 females, in Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, from Jan. 2016 to Dec. 2017 were analyzed retrospectively. They were enrolled according to the same criteria. Based on different procedures, the cases were divided into ETAA group (n=162) and OT group (n=741) . Intraoperative procedure was according to unified principle. Drainage tube was removed if 24-hour drainage volume was less than 20 ml. Following-up was implemented by telephone or outpatient clinic. Data of 2 groups of 5 PTS items during 1 m, 3 m, 6 m and 1 y postoperatively and the scores of the medical outcomes study short form 36-item health survey (SF-36) V2 were analyzed by independent sample t test and repeated measures analysis of variance. Results:The patients of 2 groups were all followed up for more than 1 y with 43 cases censored (4.8%) . Demographic data of the rest of 2 groups were not different statistically ( P>0.05) . Median of every phase scores of the 5 items of PTS were 0 to 1. Scores of the 5 items were decreased gradually in accordance with time factor ( P=0.000) . The scores of peculiar feeling at the surgical site and discomfort in neck were different statistically during 1 m and 3 m postoperatively ( P=0.000) . Incidence of peculiar feeling at the surgical site in 1 m and 3 m postoperatively in ETAA group (54, 38.8% and 8, 5.8%) was higher than that in OT group (153, 21.2% and 20, 2.8%) . However, incidence of discomfort in neck in ETAA group (14, 10.1% and 0) was lower than in OT group (194, 26.9% and 53, 7.4%) . The other 3 items at all phases were not different statistically ( P>0.05) . The SF-36 V2 scores at 1 y postoperatively of 2 groups were not different statistically ( P=0.458) . Conclusions:PTS is a common symptom after OT or ETAA. It is frequent within early phase after thyroidectomy and is decreased significantly within 6 m. Peculiar feeling at the surgical site occurs less in OT than in ETAA in early postoperative phase and discomfort in neck occurs more, conversely.

Effect of modified cervicothoracic compression band on physical condition of patients with endoscopic radical thyroidectomy via breast areola approach / 中国实用护理杂志

Objective:To investigate the effect of modified cervicothoracic compression band on successful hemostasis and postoperative complications of patients with endoscopic radical thyroidectomy via breast areola approach and to provide reference for postoperative nursing of thyroid cancer.Methods:A total of 128 patients with endoscopic radical thyroidectomy via breast areola approach from October 2018 to October 2019 in the Second Affiliated Hospital of Zhejiang University School of Medicine were selected and divided into experimental group(64 cases) and control group (64 cases) by random digits table method. Patients in the control group were fixed with wide adhesive tape for hemostasis, while patients in the experimental group wore modified cervicothoracic compression band. The postoperative complications between two groups were recorded, in addition, the physical condition and comfort of patients was assessed by Edmonton Symptom Assessment System (ESAS) and Kolcaba General Comfort Questionnaire (GCQ), respectively.Results:There was no sigrificance in the score of ESAS, GCQ on the 1st day before the operation between the two groups ( P>0.05). The median score of happiness in ESAS was 6.0 points in the experimental group on the 3rd day after the operation, significantly higher than 4.0 points in the control gorup, the difference was statistically significant ( Z value was 2.919, P<0.01). The physiological, psychological, social, cultural and environmental comfort, total GCQ scores were (10.73±2.35), (24.41±4.99), (23.09±2.11), (20.17±2.32), (78.41±6.49) points in the experimental group and (8.41±2.23), (22.42±4.79), (21.22±2.73), (19.20±2.97), (71.25±6.92) points in the control group, the differences were statistically significant ( t values were 2.058-6.031, P<0.05 or 0.01). The incidence of contact dermatitis, pressure purpura and tension blister were 0, 3.1% (2/64), 0 in the experimental group and 6.3% (4/64), 12.5% (8/64), 7.8% (5/64) in the control group, the differences were statistically significant ( χ2 values were 4.129, 3.095, 5.203, P<0.05). Conclusions:Modified cervicothoracic compression band can significantly alleviate the symptoms of postoperative patients with endoscopic radical thyroidectomy, reduce postoperative complications and improve patient comfort.

Paget’s disease of the breast: a case series

Paget’s disease of the nipple is a rare disease with a rather bizarre presentation which makes the diagnosis easily missed. Three cases are presented here with different modes of presentation and histological findings. A biopsy provided the definitive diagnosis in the three patients and the treatments offered was based on the histological findings - modified radical mastectomy and simple mastectomy for invasive carcinoma and carcinoma in-situ respectively.

Bilateral idiopathic granulomatous mastitis a rare benign inflammatory disease of breast: case report

Idiopathic Granulomatous Mastitis (IGM) is an uncommon benign inflammatory disorder of breast. Peri-ductal mastitis is thought to be the initial inflicting factor for its development. IGM usually presents as painful swelling, abscess or sinus/fistula in breast. There are no specific findings on ultrasound or mammographic imaging, and moreover it looks BIRADS-IV on mammography. Histopathology provides the final diagnosis. Here authors report a case of bilateral IGM which was successfully treated with surgery.

Crusted nipple and areola: A new aetiology of secondary hyperkeratosis of the nipple and areola

Hyperkeratosis of the nipple and areola is a rare condition first described by Tauber in 1923. Less than 100 cases have been reported in the literature. Hyperkeratosis of the nipple and areola presents as hyperkeratotic, hyperpigmented plaques on the nipple and areola. It is more common in females. An 18-year-old female patient presented with hyperkeratotic, plaque-like, hard crusts on both nipples and areolas. The examining physician could successfully remove this crust using his finger. The crust had accumulated as a result of the patient's reluctance to touch or clean the breast area due to psychological issues. A crusted nipple and areola may occur as a secondary condition due to a patient's reluctance to touch or clean their breasts.

Research progress in breast blood supply and breast reduction / 中国修复重建外科杂志

Objective: To review the research on distribution of the nerve and blood supply of breast, and the development of breast reduction in recent years. Methods: The related literatures about the distribution of the nerve and blood supply of breast, the development of breast reduction, and postoperative lactation function in recent years were reviewed extensively. The above aspects were analyzed and summarized in combination with the author's experiences. Results: With the anatomical study of mammary gland, nipple areola complex nerve distribution and blood supply, breast reduction has been developed rapidly, and a variety of surgical methods have been formed. But each has its own advantages and disadvantages, and its indications are different. Through the application and improvement of the auxiliary examination technique, severe complications such as nipple areola complex necrosis reduce obviously after operation. Through the selection of position of the incision and pedicle, the degree of retaining the pedicle glands, the application of auxiliary liposuction technique, and the improvement of suture technique, the scar of incision reduces, the sensation of nipple areola is preserved more, and a more satisfactory breast shape is obtained. Some of the patients who gave birth after breast reduction have lactation function. Conclusion: There are some shortcomings in various surgical methods at present, individualized surgical methods should be adopted according to the characteristics of the patients. Further research is needed on how to preserve more sensation of nipple areola, obtain a good and lasting breast shape, and preserve lactation function of women after operation.

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.

Safety of oncology after immediate breast reconstruction for breast cancer patient / 中国实用外科杂志

Immediate breast reconstruction can reduce the psychological trauma of breast loss while preventing patients from undergoing secondary surgery.However,oncologists must ensure tumor safety when choosing immediate breast reconstruction.Careful preoperative evaluation and adequate intraoperative glandectomy are the prerequisites to ensure oncologic safety.The National Comprehensive Cancer Network(NCCN) guidelines clearly states that inflammatory breast cancer is a contraindication to immediate breast reconstruction.In addition,for patients who plan to receive postoperative radiotherapy,immediate breast reconstruction should be carefully selected.Despite the lack of high-level evidence-based evidence,available data show that immediate breast reconstruction does not affect postoperative adjuvant chemotherapy.It is safe and reliable for some patients to choose the subcutaneous gland resection that retains nipples and areola.Lymphoma after prosthesis implantation has been reported,but the incidence is low.Therefore,breast reconstruction immediately after mastectomy is a safe and reliable surgical procedure in suitable patients with breast cancer.

Effect of para areola incision on the cosmetic surgery of multiple benign breast lumps / 中国基层医药

Objective To investigate the effect of para areola incision on the appearance of breast after excision of multiple benign breast lumps.Methods From February 2010 to November 2017,60 females of multiple benign breast tumor underwent surgical resection in the Fifth Peoples Hospital of Datong were selected and randomly divided into study group (n =30) and control group (n =30),respectively received periareolar incision and traditional incision surgery.The operation time and operation effect were compared between the two groups.VSS was used to compare the postoperative scar score between the two groups.The satisfaction for breast shape was also compared between the two groups.Results The operation time of the study group [(25.36 ± 7.69) min] had no statistically significant difference compared with that of the control group (t =0.264,P ＞ 0.05).The incision length and the amount of bleeding in the study group were (5.86 ± 2.49) mm,(9.69 ±e 5.68) mL,respectively,which were significantly lower than those of the control group (t =8.621,P ＜ 0.05;t =2.549,P ＜ 0.05).The obvious effective rate (53.33％ vs.43.33％),effective rate (40.00％ vs.33.33％) and total effective rate (93.33％ vs.76.67％) between the study group and control group had statistically significant differences (x2 =5.264,7.127,13.267,all P ＜ 0.05).The scar and breast shape scores of the study group were better than those of the control group[VSS:(4.35 ± 1.67)points vs.(7.92 ± 2.51) points,breast appearance:(1.38 ± 0.61) points vs.(4.92 ± 1.67) points,t =7.264,6.621,all P ＜ 0.05].Conclusion The resection of breast muhiple benign masses by parareone incision has less trauma,high resection rate,concealed incision and good cosmetic effect after operation,which meets the needs of the patients.