Early Breast Morphology Remodeling In Breast Cancer

Part One Chapter One:Delayed-immediate breast reconstruction for breast cancerObjective : To assessed the clinic value by conclusion the operative steps and attentions in delayed-immediate breast reconstruction for early breast cancer and summarized the surgical complications with the related reasons and processing methods.Methods:To retrospective analyzed the 139 patients with early breast cancer and took delayed-immediate reconstruction in Jiangsu province hospital from January2014 to December 2017 and assembled the demographic data and surgical process and statistics the complication during follow-up.Then we analyzed the causes of complications and corresponding treatment.Finally,the subjective satisfaction of patients and the objective evaluation was statistically analyzed.Results : All were performed delayed-immediate breast reconstruction after mastectomy which were implanted the soft tissue expander at the first step and replace the prosthesis at the second step when all treatment completed.There were 93short-term complication cases including 24 cases(17.3%)with mild skin flap ischemia,3 cases(2.2%)with severe flap necrosis,29 cases(31.8%)with partial nipple areola ischemia,8 cases(8.8%)with entire nipple areola necrosis,1case(0.7%)with postoperative infection,28 cases(20.1%)with dilator shift.There was only one long-term complication case which was severe capsular contracture with surgery failure.At the end of the follow-up,138 patients were evaluated with81.9% satisfaction rate and the objective evaluation of superior rate was 92.8%.Conclusion:Delayed-immediate breast reconstruction is widely applied in clinic currently,the first step of the operation method is simple and the second step can provide rooms for adjustment.Besides,the postoperative radiotherapy were not affected.In brief,it can be a part of early breast cancer treatment.Part One Chapter Two:Immediate breast reconstruction for breast cacerObjective:To summarize the related procedures of immediate breast reconstruction in the early stage of breast cancer treatment and the complications of the operation and explore the related causes and related treatment methods,and evaluate the clinical value.Methods:To retrospective analyzed the 20 patients with skin-sparing mastectomy(SSM)or nipple-sparing mastectomy(NSM)and immediate reconstruction with implant combined mesh in Jiangsu province hospital from November 2016 to December 2017 and assembled the demographic data and surgical process and statistics the complication during follow-up.Analyzed the causes of complications and corresponding treatment.Finally,the subjective satisfaction of patients and the objective evaluation was statistically analyzed and evaluate the clinic value.Results : All were performed immediate breast reconstruction after mastectomy which was implant prosthesis combined with Titanium-Coated Polypropylene Mesh(TCPM).The prosthesis was implanted behind the pectoralis major and the TCPM which covered the below.Postoperative treatment was standardized.There were no short-term complications and long-term complications during the follow-up period.At the end of the follow-up,20 patients were evaluated with 100%satisfaction and the objective evaluation of superior rate was 100%.Conclusion:The method which used the TCPM for breast reconstruction is simple operation and low complication rate,and the plastic surgery and mastectomy can be completed at one time.This procedure can be generalized.Part Two Use the latissimus dorsi musculocutaneous flap for breast cancerObjective:To investigate the operative effect of latissimus dorsi musculocutaneous flap(LD flap)in early breast cancer surgery including the mastectomy and breast-conserving surgery and conclusion the indication and contraindication of the operation to assess clinical value.Methods : To retrospective analyzed the 40 patients with latissimus dorsi musculocutaneous flap to repair or reconstruct the breast after the tumor resection or mastectomy in Jiangsu province hospital from January 2013 to December 2017 and assemble the demographic data and surgical process and statistics the complication during follow-up.Analyzed the causes of complications and corresponding treatment.Finally,the subjective satisfaction of patients and the objective evaluation was statistically analyzed and evaluate the clinic value.Results:All patients were used the LD flap to repair or reconstruct the breast.The main complications about the flap were at the donor sites including 9 cases(22.5%)with seroma,7 cases(17.5)with scar.The complications of breast were about the nipple-areola,including 4 cases(10%)with partial nipple areola necrosis,1 cases(2.5%)with entire nipple areola necrosis.There were no long-term complications in this study.At the end of the follow-up,40 patients were evaluated with 95% satisfaction and the objective evaluation of superior rate was 100%.Conclusion : In the case of appropriate indications,breast-conserving surgury combined with the latissimus dorsi musculocutaneous flap to repair the postoperative defect can obtain better clinical results.The LD flap combined with prosthesis can achieve a better breast tenderness and a high degree of satisfaction when we take enough communicate with patients before surgery.