| Part 1Nipple-sparing mastectomy by surround-mammary areola incision combined with delayed immediate breast reconstruction for early breast cancerObjective:To summarize the technical process of nipple-sparing mastectomy by surround-mammary areola incision combined with delayed immediate breast reconstruction for early breast cancer, analyze the causes and measures of complications.Methods:57 patients with early breast cancer and took nipple-sparing mastectomy by surround-mammary areola incision combined with delayed immediate breast reconstruction in Peking Union Medical College Hospital from January 2010 to June 2015 were included. Collect all patients’ epidemiologic features, fulfill the operations according to the uniform procedure, and record all details of every operation.Then summerize all complications after surgery, analyze causes and propose improvements. What’s more, we evaluate the operative effect by the follow-up survey on patients’ subjective and objective satisfication.Results:All the 57 patients with early breast cancer have finished the standard surgery procedure. The average follow-up period is twenty-six months. All the complications occurred after the nipple-sparing mastectomy by surround-mammary areola incision. The main short-term complications are that 22 patients with the disorder of blood supplying in the nipple-areola complex (NAC) including 21 patients(36.8%) with partial NAC necrosis,1 patient(1.8%)with total NAC necrosis and took another surgery to resect the NAC,3 patients with poor wound healing,1 patient with infection, and 3 patients with seroma formation. The main long-term complications are mostly associated with the implantation of expandors, including 1 patient with exposure of expandor,1 patiet with failure of expanding, and 6 patients with displacement of expandors. The postoperative subjective satisfication is 66.7% with good or moderate degree, and the objective satisfication is 71.9%.Conclusion:As for the early breast cancer patients with desire to conserve breast but not suitable for the breast conserving surgery (BCS), the nipple-sparing mastectomy by surround-mammary areola incision combined with delayed immediate breast reconstruction could achive good aesthetic effect, as well as high subjective and objective satisfication. The main complications are the partial NAC necrosis and problems associated with expandors. We could prevent the complications by improving operative procedures and postoperative management. Through the close cooperation betweent the departmento of breast surgery and plastic surgery, we could optimize this operative method as the important part of surgery for Chinese patients with early breast cancer.Part 2Analysis of life quality and correlating factors in patients post radical mastectomy and delayed-immediate breast reconstructionObjective:To investigate the quality of life (QOL) of breast cancer patients who underwent delayed-immediate breast reconstruction (DIBR), and explore its correlating factors.Methods:Fifty-seven breast cancer patients with DIBR in Peking Union Medical College Hospital were enrolled in this study from January 2016 to March 2016. The FACT-B Questionnaire (Chinese version 4.0) was used to assess QOL. Correlation analysis was conducted to evaluate the impact of correlating factors.Results:The patients post DIBR had good QOL.The total score of FACT-G and FACT-B were 89.82±11.11 and 119.37 ± 11.79, respectively. For correlation analysis, older age and menopause were in negative correlation with QOL (r<0＜ p <0.05); factors such as being married, nulliparity, without endocrinological therapy and prolonged post operation time presented a positive correlation (r> 0, p <0.05)Conclusion:DIBR could serve as an ideal breast reconstruction method for the breast cancer patients in terms of good QOL. It could be helpful to personalize surgical treatment basing on the above impact factors to improve the QOL of such patients.Part 3Control Study of the QOL of Breast Cancer Patients with Breast Conserving Surgery and Delayed Immediate Breast ReconstructionObjective:To evaluate the influence of different surgery methods on breast cancer patients’ quality of life (QOL).Methods:64 patients with breast cancer and took operations in Peking Union Medical College Hospital from March 2010 to June 2015 were included.30 patients took the breast conserving surgery (BCS), and 34 patients took the delayed immediate breast reconstruction (DIBR), which means delayed breast reconstruction with immediate implantation of subpectoral expander. QOL was evaluated on all cases by using FACT-B Questionnaire, Chinese version 4.0. The t Test was used to analyze the statistical data.Results:Compared with BCS group, DIBR group shows no difference in thephysical well-being, social/family well-being, emotional well-being, functional well-being, FACT-G and FACT-B (P>0.05), while it has better additional concerns, which is breast cancer specific part (29.37±2.72 vs 26.41 ±4.64, P＜0.05).Conclusion:Patients with breast cancer who are treated with BCS and DIBR have the same QOL. |
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