Series Of Studies On Breast Reconstruction By Prosthesis Implantation And Autologous Latissimus Dorsi Flap

Background:Breast reconstruction by prosthesis implantation and latissimus dorsi flap/latissimus dorsi flap in combination with an implant(LD/LD+I)is the most common breast cancer reconstruction procedures for Asian women with small or medium-sized breasts.This study aimed to conduct a clinical analysis of relevant surgical indicators,complications and postoperative effects for evaluation of the safety and benefits of both procedures.Meanwhile,previous studies were collected,and Meta analysis was further used to explore the risks and benefits of the two breast reconstruction methods.Therefore,a conclusion with high credibility was drawn to provide authentic reference information for patients faced with preoperative selection before breast cancer surgery.Moreover,in order to maintain a good shape of the breast after reconstruction,this study conducted a preliminary discussion on the ER-mediated immune inflammatory response to provide new ideas for reducing the rate of postoperative prosthetic capsular contracture.Methods:1.A retrospective clinical study was conducted on 110 breast cancer patients undergoing one-stage breast reconstruction with prosthetic implants or latissimus dorsi flap.The collected indicators included:(1)operation-related observation indicators,such as bleeding volume,operation time,postoperative drainage volume,postoperative extubation time,and postoperative pain time;(2)postoperative breast cosmetic effect and quality of life;and(3)postoperative complications,such as contracture deformity,seroma,hematoma,nipple and areola necrosis,surgical area infection,and local skin flap necrosis.2.A total of 36 patients with capsular contracture after implantation of mammary prosthesis were selected,with 20 mild cases in the observation group and 16 severe cases in the control group.The levels of IL-6,TNF-α and ER-βwere measured by immunohistochemistry.The differences in the expression levels of IL-6,TNF-α and ER-β,and the correlation between ER-β and inflammatory factors IL-6 and TNF-α were analyzed.3.The public database was systematically searched for the research literature on the comparison of breast reconstruction by breast tissue expander-prosthesis and LD/LD+I after breast cancer surgery.Specific inclusion criteria were used to screen relevant literature,and standardized analysis methods were used to extract data from relevant literature.Results:1.The risk of postoperative infection and contracture deformity in the prosthesis group was higher than that in the latissimus dorsi group,and the risk of postoperative seroma in the latissimus dorsi group was higher than that in the prosthesis group.Both were statistically significant.The operation time,bleeding volume,postoperative drainage,extubation time,and postoperative pain time of the reconstruction by latissimus dorsi flap were all distinctly higher than those of the prosthesis implant reconstruction,which were statistically significant.Latissimus dorsi group had a better excellent rate in cosmetic effect of breast reconstruction than the prosthesis group with a statistically significant difference.There was no significant difference in the quality of life scores of postoperative patients in both groups.2.The levels of IL-6,TNF-α and ER-β in the observation group were obviously higher than those in the control group with statistically significant differences.Pearson correlation analysis showed that ER-β was positively correlated with both IL-6 and TNF-α.3.Patients with LD/LD+I reconstruction had a lower risk of infection and capsule contracture at the surgical site,and there was little possibility of reconstruction failure and reoperation after reconstruction.Aesthetically speaking,patients undergoing LD/LD+I breast reconstruction tended to have better cosmetic results than those undergoing expander-prosthesis breast reconstruction.Judging from patient satisfaction,there was no significant difference between the two procedures.Conclusions:1.The probability of postoperative infection and deformity contracture is higher in the prosthesis reconstruction group,and the rate of seroma is higher in the latissimus dorsi flap reconstruction group.The prosthesis reconstruction has the advantages of short operation time,less trauma,and fast recovery after surgery,while the cosmetic effect of latissimus dorsi flap reconstruction is better.Both are worthy of further promotion for suitable patients.2.For patients with indications for both procedures,LD/LD+I breast reconstruction is considered as a good compromise between complication risk and good cosmetic effect.3.ER-β is positively correlated with IL-6 and TNF-αin the capsular tissue of prosthetic contracture,on which basis the prevention plan of reducing the capsular contracture of breast prosthesis can be further explored.