Clinical Research Of Immediate Breast Reconstruction After Skin-sparing Mastectomy For Breast Cancer

BackgroundSince mastectomy remained the primary strategy for treating breast cancer in China,post-mastectomy reconstruction is of great importance in the Chinese population.Breast reconstruction is mainly divided into autologous-based breast reconstruction and implant-based breast reconstruction.The purpose of this study was to evaluate the most widely used tissue expander/implant breast reconstruction and latissimus dorsi flap breast reconstruction in China.The effects of four types of breast reconstruction on patients’ satisfaction were evaluated.MethodsPart Ⅰ Natural history of seroma following the immediate latissimus dorsi flap method of breast reconstructionA retrospective review of 45 consecutive cases of immediate breast reconstruction with latissimus dorsi flap from April 2012 to February 2017 was conducted.The scope of the seroma was demarcated with a marker pen,and cases that remained stable over time(i.e.,the size of the seroma did not increase)were observed without treatment.The measured outcomes included the incidence of seromas,the volume and duration of postoperative wound drainage,and other demographic characteristics.Part Ⅱ The study of seroma dynamics at the operation site after the immediate latissimus dorsi flap method of breast reconstruction.A prospective clinical study was conducted in 21 patients undergoing latissimus dorsi flap breast reconstruction and 30 patients undergoing modified radical mastectomy for breast cancer.The history of seroma,biochemical parameters and cytokine levels were compared between the two groups.Part Ⅲ Management of Common complications after tissue expander/implant breast reconstruction for breast cancer.We retrospectively analyzed the patients undergoing tissue expander/implant breast reconstruction(two-step method).All the patients underwent two steps of operation:tissue expander implantation(the first stage operation)and issue expander removal followed by implant implantation(the second step operation).The acute and delayed complications of the two operations were recorded and their management methods were recorded.Part Ⅳ May the type of breast reconstruction influence patient satisfaction?A custom survey consisting of questions that assessed general and aesthetic satisfaction was sent to patients who had undergone breast reconstruction in the last 5 years.The clinical data and details of the surgery were also collected from the patients who returned the surveys.We compared satisfaction rates across the four breast reconstruction types and analyzed the effects of various factors on overall general and aesthetic satisfaction rates using a binary logistic regression model.ResultPart Ⅰ Natural history of seroma following the immediate latissimus dorsi flap method of breast reconstruction Twenty-four patients(53.3%)developed a seroma at the donor site.Of these,21(87.5%)did not require treatment,and the seroma resolved over time.The mean duration of a sustained seroma was 6.8±1.4 weeks(range:4—9 weeks).Part Ⅱ The study of seroma dynamics at the operation site after the immediate latissimus dorsi flap method of breast reconstruction.Seroma occurred in 9 patients undergoing latissimus dorsi surgery and 6 patients undergoing modified radical operation.The duration of seroma was 7.2±1.1 weeks and 1.6±0.3 weeks,respectively.IL-6 and TNF-a levels of seroma in modified radical operation group were significantly higher than those in latissimus dorsi muscle breast reconstruction group,with statistical differences.Part Ⅲ Management of Common complications after tissue expander/implant breast reconstruction for breast cancer.All of the 50 patients underwent tissue expander/implant breast reconstruction(two-step method),and 2 cases failed in breast reconstruction.The incidence of acute complications and delayed complication in the first and second procedures were 20.8%and 11.3%,11.3%and 5.7%,respectively.The most common delayed complications in the first step of surgery were the upward movement or displacement of tissue expander.Allogeneic acellular dermis(ADM)can be employed in the setting of displacement of tissue expander.Part Ⅳ May the type of breast reconstruction influence patient satisfaction?A total of 207(72%)patients completed the questionnaires.Overall,significant differences in general and aesthetic satisfaction among the four procedures were not observed.A multi-variate analysis revealed that the factor“complications"”(p =0.001)played a significant role in overall general satisfaction and that the factors“>2 years since reconstruction"”(p = 0.043)and“age>35 years"”(p = 0.05)played significant roles in overall aesthetic satisfaction.Conclusion1.This part of study observed the scope and progression of the seromas and found that seromas at the latissimus dorsi donor sites resolved over time without treatment.2.The cytokines of seroma after latissimus dorsi myocutaneous flap surgery were different from those after modified radical operation.3.Tissue expander/implant breast reconstruction could be a simple and safe method.4.The present study demonstrated that the type of breast reconstruction might not influence satisfaction in Chinese patients.