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@#The traditional view is that breast reconstruction is not an option for day surgery center. As a result, few hospitals in the world conduct this operation in day surgery center. Endoscopic breast reconstruction with liposuction and robot-assisted breast reconstruction are minimally invasive surgeries for breast cancer patients, but they cannot be carried out in the day surgery center due to long operation time. The novel endoscopic-assisted immediate implant-based breast reconstruction after nipple sparing mastectomy through a single axillary incision for breast cancer patients has been successfully conducted in the day surgery center in our hospital due to short operation time and small trauma. Standardized management of the complete process from the patient selection to follow-up after discharge brings rapid recovery and few complications. At the same time, the development of endoscopic surgery makes the breast almost scarless and improves aesthetic results. Therefore, the mode of endoscopic-assisted reconstruction in the day surgery center of our hospital is expected to be popularized in the whole country.
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Objective To study the application of pectoralis majoris fascia combined with serratus anterior fatty fascia flap in immediate breast reconstruction (IBR).Methods 40 patients with early breast cancer were divided into three groups according to indications and their own requirements.11 cases got implants combined with the pectoralis majoris fascia and the serratus anterior fatty fascia flap as a biological membrance,5 patients got latissimus dorsi myocutaneous flap reconstruction,and 24 cases underwent simple mastectomy.The three groups underwent routine sentinel lymph node biopsy.The operation time,subcutaneous drainage volume,drainage time,discharge time,postoperative pain score,infection of incision and patients' satisfaction were compared between the three groups.Results The reconstruction that used implants with pectoralis majoris fascia and serratus anterior fatty fascia flap as a biological membrance had the shortest recovery time,and the least subcutaneous fluid,and the differences were statistically significant(P＜0.05).The difference of incision infection had no statistical significance (P＞0.05).The difference of postoperative pain score and satisfaction had no statistical significance between fascia group and altissimo doris group (P＞0.05).Conclusion The technique of the prosthetic reconstruction of the pectoralis majoris fascia combined with the serratus anterior fatty fascia flap as a biological membrance is simple and safe,with small trauma,quick recovery and high patients' satisfaction,and can be widely used in clinical practice.
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Objective To compare the effects of mammaplasty, non mammaplasty and prosthesis reconstruction in the treatment of quadrant or massive mastectomy. Methods One hundred and twenty patients with segmental or quadrant mastectomy in the First People′s Hospital of Huizhou from February 2015 to December 2016 were selected for the study. The patients were divided into three groups:the mammaplasty group (48 cases),the non mammaplasty group (40 cases),and the prosthesis reconstruction group (32 cases). The patients in the mammaplasty group were treated with quadrant or massive mastectomy, patients in the non mammaplasty group were treated with chest wall fat fascia flap and the prosthesis reconstruction group was treated with the application of the skin flap of the lateral chest wall. The general operation situation of the three groups were recorded,including operation time,indwelling time of drainage tube,hospitalization time and postoperative hospitalization time. The satisfaction and complications of breast reconstruction were compared among the three groups. Results The operation time of the mammaplasty group, non mammaplasty group and prosthesis reconstruction group were (71. 5±18. 4) min,(55. 9±14. 3) min and (89. 7±21. 3) min respectively,there was significant difference among the three groups (F=31.32,P<0.01).The operation time of the mammaplasty group was longer than that of the non mammaplasty group, but less than that of the prosthetic reconstruction group, the difference was statistically significant ( P< 0. 05 ) . The hospitalization time and postoperative hospitalization time in the prosthesis reconstruction group were ( 13. 7 ± 3. 4 ) d and ( 10. 9 ± 2. 6 ) d, mammaplasty group (11. 4±2. 2) d and (8. 6±1. 9) d respectively,non mammaplasty group (11. 3±2) d and (8±1. 8) d respectively. The differences among the 3 groups were statistically significant (F=10. 20,18. 88,P <0. 01) . The postoperative hospitalization time of the prosthesis group was significantly longer than those in the other two groups ( P<0. 05) . The indwelling time of the drainage tube was close in the 3 groups. The overall satisfaction of breast reconstruction in the mammaplasty group, non mammaplasty group and the prosthesis reconstruction group were respectively ( 9. 2 ± 0. 8 ) points, ( 9. 1 ± 0. 6 ) points, ( 7. 9 ± 1. 3 ) points, and the difference was statistically significant ( F=23. 22,P<0. 01) . The satisfaction degrees of breast reconstruction in the mammaplasty group and the prosthesis reconstruction group were equal, higher than that in the non mammaplasty group,the differences were statistically significant ( P<0. 05) . The incidence of wound infection in the mammaplasty group, non mammaplasty group and prosthesis reconstruction group were 10. 4% ( 5/48 ) , 10. 0% (4/40) and 6. 3% (2/32),respectively,the difference was not statistically significant (χ2=1. 29,P=0. 08) . Conclusion In quadrant or massive mastectomy,lateral chest wall fat fascia flap has simple operation and high safety,and the restoration effect is good,which can be widely used in clinical practice.