ObjectiveTo investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve. MethodsOne hundred and sixty patients with breast cancer were divided into ultrasound knife group and electroscalpe group and then performed modified radical mastectomy with pectoral nerve and intercostobrachial nerve remainning. the pectoralis major thickness and paresthesia of skin of inner upper arm and axillary fossa were detected on the different time after operation. Results①The age, body mass index, and mean opera-tion time had no significant differences between these two groups (P > 0.05).②On 6 months after operation, the thickness of bilateral pectoralis major was not significantly different in the ultrasound knife group (P > 0.05), which of injuried pectoralis major was significantly thinner than that of uninjuried pectoralis major in the electroscalpe group (P < 0.05).③The rates of paresthesia of skin on postoperative 3 months and 6 months in the ultrasound knife group were signifi-cantly lower than those in the electroscalpe group (P < 0.05). ConclusionCompared with monopolar electro diathermy, the use of ultrasonic harmonic scalpel in modified radical mastectomy could better protect pectoral nerve and intercosto-brachial nerve, and thus decrease nerve parafunctional rate.
Objective To investigate effect of optimizing operation procedure (OOP) on surgical outcomes of complete endoscopic subcutaneous mastectomy (CESM) in treatment of gynecomastia. Methods A total of 217 patients with gynecomastia underwent CESM from January 2014 to March 2017 in the Third People’s Hospital of Chengdu were collected according to the criteria for inclusion and exclusion, further, based on a propensity score-matching model, a total of 94 patients were evenly assigned to OOP group (April 2015 later) and non-OOP group (before April 2015). The CESM with or without OOP was performed in the OOP group or the non-OOP group, respectively. The operative time, postoperative length of stay, treatment expenses, and favorable cosmetic effect were compared in these two groups. Results The differences in the general clinical data in both groups were not statistically significant (P>0.05). The operative time (min) was shorter (139.90±37.18versus 175.20±46.99, P=0.002), the postoperative length of stay (d) was shorter too (7.13±1.46 versus 8.47±2.71, P=0.021), and the treatment expenses (yuan) were more less (11 426.80±1 861.19 versus 12 315.75±1 306.64, P=0.036) in the OOP group as compared with the non-OOP group. Meanwhile the favorable cosmetic effect of the self-evaluation score in the OOP group was significantly higher than that in the non-OOP group (7.33±1.16 versus 5.97±1.16, P<0.05). Conclusion This study demonstrates that using optimizing standard CESM could shorten operative time, reduce treatment expenses, and improve satisfaction of patients.
ObjectiveTo investigate the clinical application value of immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy for patients with breast cancer. MethodsA total of 28 patients with breast cancer undergoing immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy from January 2006 to December 2009 were included in this study. The perioperative results, breast appearance evaluation and followup results were analyzed. ResultsAll 28 patients received axillary lymph node dissection and the number of lymph node dissected was 14-32 (median 21). The operation time was 117-140 min (mean 126 min), blood loss was 82-124 ml (mean 98 ml), and the time to drainage tube removal was 3-5 d. No wound infection, skin necrosis, and foreign body reaction occurred in all the patients, especially in 22 patients underwent nippleareola complex-sparing mastectomy, no ischemia or necrosis occurred in nippleareola complex. For evaluation of breast appearance, excellent was in ten cases and good in 18 cases, thus, the excellent and good rate was 100%. All patients were followed up for 12-48 months (median 24 months) after operation, and distant metastasis, local recurrence, upper extremity edema, and dysfunction were not found. No fiber kystis contracture was found and all patients were satisfied with breast appearance and good handfeels. ConclusionsImmediate breast reconstruction using silicon implant after skinsparing modified radical mastectomy has the advantage of minimal invasion, safety, simple operation, and quick postoperative recovery for patients with breast cancer and the appearance of reconstructed breast is excellent, which can be clinically used widely.
ObjectiveTo investigate the effectiveness of axillary single-site laparoscopic subcutaneous mastectomy in treatment of gynecomastia (GYN) and the assessment method of glandular mass before operation. Methods A clinical data of 65 GYN patients admitted between August 2023 and February 2024 and matched the selection criteria was retrospectively analyzed. The patients were (30.8±7.9) years old, with a body mass index (BMI) of 27.3 (24.9, 29.8) kg/m2. According to Simon’s grading criteria, the GYN was classified as gade Ⅰ in 8 cases, grade Ⅱa in 32 cases, grade Ⅱb in 21 cases, and grade Ⅲ in 4 cases. All patients underwent bilateral axillary single-site laparoscopic subcutaneous mastectomy. The operation time, intraoperative blood loss, postoperative bilateral extubation time, total length of hospital stay, and the occurrence of related complications were recorded. The cosmetic outcome score was assessed by questionnaire at 2 months after operation. Preoperative BMI, lying/standing sternal notch to nipple (SN-N), and lying/standing nipple to nipple (N-N) were measured. The differences in SN-N between standing and lying positions (ΔSN-N) and in N-N between lying and standing positions (ΔN-N) were calculated. The intraoperative resected glandular mass was recorded. The glandular mass-related indicators (BMI, ΔSN-N, ΔN-N) were compared between Simon grades. Spearman’s correlation analysis and multiple linear regression analysis of glandular mass with BMI and ΔSN-N, ΔN-N and Simon grading (grades Ⅰ, Ⅱa, Ⅱb, and Ⅲ were assigned values of 1, 2, 3, and 4, respectively) of the corresponding side. ResultsAll operations were successfully completed with the operation time of 75.0 (60.0, 90.0) minutes, the intraoperative blood loss of 12.0 (11.0, 13.0) mL, and the bilateral extubation time of 1.5 (1.5, 1.5) days after operation. The total length of hospital stay was 3.0 (3.0, 3.0) days. Three cases of subcutaneous hematoma in the chest wall and 1 case of nipple areola numbness and discomfort occurred after operation, while the rest of the patients had no complication, such as postoperative haemorrhage, effusion, infection, and nipple areola necrosis. The subjective cosmetic scores were all 15 at 2 months after operation, which was very satisfactory. The differences in ΔSN-N of right side between Simon grade Ⅰ and grades Ⅱa, Ⅱb, Ⅲ and in ΔSN-N of left side between Simon grade Ⅰ and grades Ⅱb, Ⅲ were significant (P<0.05), while the differences between the remaining grades were not significant (P>0.05). The differences in ΔN-N between Simon grade Ⅱa and gradeⅡb and in BMI between Simon grade Ⅱb and grade Ⅲ were not significant (P>0.05), while the differences between the remaining grades were significant (P<0.05). The glandular masses of left and right breasts in 65 patients were 69.0 (52.1, 104.0) g and 73.0 (56.0, 94.0) g, respectively; and the difference between left and right breasts was not significant (Z=−0.622, P=0.534). The data of the right breast was selected for correlation analysis. Correlation analysis showed that the right glandular mass was positive correlated with BMI and Simon grading, ΔSN-N, and ΔN-N (P<0.05). Multiple linear regression analysis showed that Simon grading had a positive predictive effect on glandular mass, and the regression equation was as follows: right glandular mass=5.541+32.115×Simon grading (R2=0.354, P<0.001). ConclusionAxillary single-site laparoscopic subcutaneous mastectomy is an ideal surgical procedure for the treatment of GYN. BMI and Simon grading are closely related to GYN glandular mass, and have certain reference value for preoperative glandular mass assessment.
Objective To analyze the efficacy of breast-conserving surgery with adjuvant radiation therapy (BCS+RT) vs. mastectomy (MAST) for early breast cancer among young Chinese patients. Methods Young female breast cancer patients (≤40 years old) treated at West China Hospital of Sichuan University between January 1st, 2008, and December 31st, 2019 were analyzed for clinical staging, molecular subtypes, surgical techniques, and prognostic assessments using follow-up data. Results Of 974 eligible patients in this study, 211 underwent BCS+RT and 763 underwent MAST. The Kaplan-Meier analyses indicated that there was no significant difference in the 5-year locoregional recurrence-free survival rate (99.1% vs. 99.4%, P=0.299), distant metastasis-free survival rate (97.9% vs. 96.4%, P=0.309), breast cancer-specific survival rate (100.0% vs. 97.0%, P=0.209), or overall survival rate (99.4% vs. 96.8%, P=0.342) between patients who underwent BCS+RT and those who underwent MAST. The multiple Cox proportional hazards regression analyses revealed that the treatment approach (BCS+RT or MAST) did not significantly predict locoregional recurrence-free survival (P=0.427), distant metastasis-free survival (P=0.154), breast cancer-specific survival (P=0.155), or overall survival (P=0.263). Subgroup analyses showed that there was no statistically significant difference in survival outcomes between BCS+RT and MAST in different clinical stages or molecular subtypes. Clinical stage and molecular subtype should also not be regarded as independent factors in deciding the treatment approach. Conclusions Receiving BCS+RT or MAST treatment does not affect the survival outcomes of young early-stage breast cancer patients, showing similar efficacy across various clinical stages and molecular subtypes. Choosing BCS+RT is considered safe for early-stage young female breast cancer patients eligible for breast conservation.
ObjectiveTo investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.MethodWe searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.ResultsIn the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.ConclusionsThe question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.
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 understand the progress of postmastectomy radiotherapy (PMRT) in patients with T1–2N1M0 breast cancer. MethodThe studies and the treatment guidelines relevant to PMRT in the patients with T1–2N1M0 breast cancer in recent years were analyzed and summarized. ResultsThe ability of PMRT to improve the prognosis of patients with T1–2N1M0 breast cancer remained controversial. Owing to the patients with T1–2N1M0 breast cancer were heterogeneous, and the indications for PMRT had not been standardized. With the increasing use of neoadjuvant chemotherapy for early-stage breast cancer, some studies had attempted to formulate decisions about PMRT based on changes in tumor characteristics before and after neoadjuvant chemotherapy, but the findings were currently controversial. ConclusionsWhether PMRT can improve prognosis and decision-making for patients with T1–2N1M0 breast cancer is still controversial. Some ongoing clinical trials may provide some references for the optimal decision-making of PMRT for patients with T1–2N1M0 breast cancer.
Objective To investigate feasibility and preliminary oncological safety of surgical innovations in breast cancer patients who have undergone nipple-skin-sparing mastectomy (NSSM) for nipple discharge or central lesions and tumors that do not involve the nipple-areola skin. MethodsBetween May 2018 and November 2023, patients diagnosed with breast cancer presenting nipple discharge or lesions in the central area underwent NSSM. The imaging assessment revealed no involvement of the nipple-areola-skin by the tumor. We performed a surgical removal of the affected mammary duct and simultaneously made a circular incision measuring 3-4 mm in diameter at the apex of the nipple. The study also involved the collection of clinical data, early complications, oncological outcomes and conducting aesthetic analysis of the nipple using the BREAST-Q scale. Results The surgical procedure was conducted on a cohort of 39 female patients at age of 27-57(39.0±7.6) years. The postoperative pathological stages of breast cancer were distributed as follows: stage 0 in 2 patients (5.1%), stageⅠ in 1 patients (2.6%), ⅡA stage in 15 patients (38.5%), ⅡB stage in 21 patients (53.8%). Tumor type: simple carcinoma in situ in 5 patients (12.8%), invasive carcinoma in 14 patients (35.9%), including invasive carcinoma with carcinoma in situ in 20 patients (51.3%). During the median follow-up period of 15.0 (2-66) months, 3 patients (7.7%) developed decolorization caused by mild nipple ischemia; there was no nipple necrosis; 1 patient (2.6%) failed nipple reconstruction (no milk column, the milk column disappeared due to external dressing compression after operation). There were no incision complications, subcutaneous emphysema or intramammary hematoma in all patients. Two patients (5.1%) underwent prosthesis removal and nipple areola excess skin resection because of prosthesis cavity infection and final exposure caused by debridement, dressing change, redrainage and so on. As of April 2024, no tumor recurrence or metastasis was found during the follow-up period. The satisfaction of patients with nipple was 97.4% according to BREAST-Q score. ConclusionThe satisfaction of breast cancer patients diagnosed with nipple discharge or lesions in the central area, but without involvement of the nipple areola skin, and who underwent subcutaneous mastectomy with immediate reconstruction is significantly enhanced. Furthermore, there is no increased risk of tumor recurrence or metastasis in short-term.
ObjectiveTo investigate the factors of breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy when choosing surgical mode.MethodsA questionnaire survey was conducted on 228 breast cancer patients who met breast-conserving conditions after neoadjuvant chemotherapy. Chi square test, nonparametric rank sum test and binary logistic regression were used to analyze the factors affecting the choice of surgical mode.ResultsUnivariate analysis showed that age, clinical stage, family history of cancer, molecular type, neoadjuvant chemotherapy effect, surgeon’s recommendation, chemotherapy side effects, and surgical complications were the factors affecting patient’s chose for breast-conserving surgery (P<0.05). Multivariate analysis showed that the effect of neoadjuvant chemotherapy [OR=0.312, 95%CI (0.255, 0.662), P<0.001] and the surgeon’s recommendation [OR=53.947, 95%CI (4.570, 6.239), P=0.002] were independent factors that affected the choice of surgery.ConclusionsThe decision of the surgical mode is a process in which doctors and patients participate together. Individualized neoadjuvant chemotherapy improves the remission rate and the progress of the surgeon’s comprehensive treatment strategy can play a role in improving the breast-conserving rate and the rate of breast-conserving success. Doctors should give positive guidance in accordance with the specific situation of the patient to make the best choice.