| Objective To retrospectively analyze the clinical effects of the circular areola incision(AI)and radial incision(RI)on benign breast tumors(BBTs),aiming to provide clinical guidance for the selection of surgical incisions for benign breast tumors.Method A retrospective analysis was performed on 904 patients with benign disease who had been treated in the hospital and outpatient departments between January 2011 and May 2015 in the Breast Department of the Tianjin Municipal Obstetrics and Gynecology Hospital.Among them,510 cases had a circular areola incision and 394 radial incisions.At the same time,the preoperative data including the age,size of the tumor,location of the tumor,and distance from the nipple were observed and recorded.The intraoperative data included incision length and intraoperative blood loss;postoperative data included Postoperative pathology,scar length,scar width,whether the scar highlights the skin surface,pigmentation,postoperative complications(notch infection,scar itch,scar pain,recurrence in situ),postoperative lactation function,and patient satisfaction.The outpatient review and telephone follow-up were conducted,and relevant data were statistically analyzed.Result 1.Areola incision group:(1)preoperative results: 510 patients,the oldest 67 years old,the minimum 10 years old,the average age(36.46 ± 11.14)years;tumor maximum diameter of 0.2 ~ 8.5cm,average diameter(1.88 ± 1.41)cm Tumors were located in the areola below the 71 cases(13.92%),distance areola≤1cm95 cases(18.62%),distance isola>1cm and ≤3cm169 cases(33.13%),distance isola>3cm175 cases(34.31%).Among them,29(5.69%)were located in the nipple,124(24.35%)in the upper inner quadrant,50(9.81%)in the lower inner quadrant,220(43.28%)in the upper outer quadrant,and 81(17.05%)in the lower outer quadrant.(2)Intraoperative results: intraoperative incision 1 ~ 13 cm,the average length(2.97 ± 0.99)cm;intraoperative blood loss 2 ~ 50 ml,the average amount of bleeding(9.38 ± 5.42)ml;(3)Postoperative results: Among the 528 patients with pathological findings,416 cases(78.8%)had breast fibroids,50(9.5%)had intraductal papillomas,17(3.2%)had adenopathy,and 12 had cysts(2.3%),catheter dilatation in 7 cases(1.3%),phyllodes tumor in 5(0.9%),fat necrosis 2(0.4%),mastitis in 1(0.2%);postoperative scar length 1~13cm,average length(2.27±0.987)cm.Postoperative scar width 0.1 to 2cm,average width(0.26 ± 0.17)cm.Postoperative wound infection in 32 cases.Among the postoperative complications,there were 71 patients with itching,47 with pain(excluding other diseases such as breast pain),15 with in situ recurrence,and 32 with pruritus.There were 43 cases of postoperative fertility,31 cases(72.1%)of breast-feeding,11 cases of mastitis(35.5%),and 14 cases(45.2%)of breast milk relative to the contralateral side;breast-feeding time of 0.23 to 18 months,average(4.58±3.71))Month;Satisfaction 1-3 points 22 people(4.6%),4-6 points 34 people(7.1%),7-10 minutes 423 people(88.3%).2.Radial incision group:(1)Preoperative results: Radial incision in 394 patients,the oldest 81 years old,the minimum age of 14 years,mean age(35.70 ± 11.21)years;tumor maximum diameter of 0.1 ~ 7.5cm,average diameter(1.79 ± 1.17)(c)The tumors were located in 123 cases(31.2%)below the areola,93 cases(23.6%)away from areola≤1cm,105 cases(26.6%)away from the areola>1cm and ≤3cm,and>3cm73(18.5%)from the areola.Eighty-three cases(21%)were located under the nipple,48 cases(12.2%)in the upper inner quadrant,22 cases(5.6%)in the lower inner quadrant,147 cases(37.3%)in the upper outer quadrant,and 94 cases(23.9%)in the lower outer quadrant.(2)Intraoperative results: Intraoperative blood loss was 2 to 50 ml,and the average blood loss was(10.72±6.00)ml.(3)Postoperative results: The length of postoperative scar was 1~7.5cm and the average length was(3.37±1.02)cm.The postoperative scar width was 0.1~3cm and the average width was(0.38±0.23)cm.The scar was higher than the surrounding skin in 26 cases,pigmentation(dark red or purple)in 42 cases;postoperative complications occurred in 18 cases of incision infection,76 cases of incision and itching patients,and 47 cases of pain(excluding other diseases such as breast hyperplasia).There were 4 cases of recurrence in situ,20 cases of pruritus,39 cases of postoperative fertility,35 cases of breast-feeding,19 cases of mastitis(54.3%),and 8 cases(22.8%)of breast milk relative to the contralateral side.The time of breastfeeding was 0.32~14 months,with an average of(7.58±5.93)months;satisfaction was 1-3 points,40(11.0%),4-6 points,45(12.4%),and 7-10,278(76.6%).3.Preoperative data: There were no statistical differences(P>0.05)between the general data of the two groups of patients,such as age,maximum diameter of tumor,and location of tumor,and there was a statistically significant difference between the distance from the areola between the two groups(P < 0.05).Table 1-3;4.Intraoperative data: There was no statistical difference in incision length and blood loss between the two groups(P > 0.05).Table 4.5.Postoperative data: Postoperative scar length and width were statistically significant(P<0.05),as shown in Table 8.Postoperative complications Postoperative wound infection,scar pain,pruritus,postoperative scars highlight skin surface and There was no significant difference in pigmentation(P>0.05).Postoperative scar pruritus and in situ recurrence were significantly different(P<0.05).See Table 9-10.The number of breast-feeding cases in postoperative lactation was not statistically significant(P>0.05).There was a statistically significant difference in relative milk deficiency and mastitis(P<0.05).Table 11-12.Patient satisfaction was statistically significant between the two groups(P<0.05).Table 13.Conclusion:1.The circular areola incision is ideal for the treatment of benign breast tumors.The mean width and length of postoperative scars and the incidence of pruritus are better than those of radial incisions;2.The indication of circular areola incision should be appropriately relaxed and should not be limited by age.For larger tumors,incisions should be selected according to the actual situation and clinical experience;3.The ring areola incision and radial incision will affect the patient’s postoperative breastfeeding,and the difference between the two is that the annular areola incision is prone to relatively lack of milk in the contralateral side,and the occurrence of radial incision is more likely to occur mastitis;4.The principle of treatment of benign tumors for women during pregnancy is more prone to conservative treatment,observation-based,does not affect the maternity plan. |
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