| Objective:Immediate subpectoral prosthesis breast reconstruction is widely used at present.Enough soft tissue to cover the prosthesis is necessary in operation.Therefore,we propose a new technique of breast reconstruction with lateral fascia confluence and pectoralis major muscle to cover the prosthesis(dual-plane)in patients with early breast cancer.To evaluate the clinical feasibility of dual-plane technique,we sought to compare the differences in surgical operation,postoperative safety and patients’ satisfaction between two cohorts.Methods:A retrospective study was performed in early breast cancer patients respectively undergoing dual-plane(dual-plane group)or partial latissimus dorsi immediate prosthesis breast reconstruction(latissimus dorsi group)after nipple-areola complex or skin sparing mastectomy in Tianjin Medical University Cancer Institute and Hospital between January 2014 and October 2019.Statistical analyses were performed by SPSS.23.T-test was used for continuous variables,and the results were expressed by mean±standard deviation.Categorical variables were assessed by the chi-square test or Fisher’s exact test when applicable.p-value<0.05 was considered statistically significant.Results:Three hundred and twenty-nine patients with early breast cancer were recruited into the study.Three hundred and forty-three immediate subpectoral prosthesis breast reconstructions were performed: 48.7% were dual-plane coverage(n=167)and 51.3%were partial latissimus dorsi coverage(n=176).The follow-up time was 2-71 months,and the median follow-up time was 32 months.There was no significant difference in age,BMI,menopausal status,tumor location,tumor stage and immunohistochemical expression characteristics between the two groups.The operation time,blood loss,operative area drainage and hospitalization time in the dual-plane group were superior to those in the latissimus dorsi group(p < 0.001).During the follow-up period,the overall complications incidence of immediate breast reconstruction was 17.5%.Compared with latissimus dorsi group,the dual-plane group had a significantly lower incidence of complications(7.2% vs 27.3%;p<0.001).In the dual-plane group,there were 7 cases of secondary operation and the loss rate of prosthesis was 3.6%.In the latissimus dorsi group,there were 10 cases of secondary operation and the loss rate of prosthesis was 2.8%.Compared with the latissimus dorsi group,the incidence of secondary operation was lower and the loss rate of prosthesis was higher in the dual-plane group,with no significant statistical difference(p=0.525 and p=0.693).The patients’ satisfaction of the dual-plane group was higher than that of the latissimus dorsi group(90.6% vs 81.2%),and the difference was statistically significant(p=0.015).In terms of prognosis,the local recurrence rate was 3.1% in the dual-plane group and 0.6% in the latissimus dorsi group,with no significant difference(p = 0.083).The distant metastasis rate was 2.5% in the dual-plane group and 4.7% in the latissimus dorsi group,with no significant difference between the two groups(p = 0.290).In terms of mortality,there was no death in the dual-plane group and only 1 case in the latissimus dorsi group during the follow-up period.Conclusions:The combined lateral fascial confluence with pectoralis major muscle covering prosthesis,as a new surgical technique from plastic breast augmentation to reconstruction after mastectomy,has the advantages of simple operation,less injury,less complications and rapid recovery.In addition,the retained fascia not only makes the breast more natural and patients more satisfied,but also does not increase oncological safety,compared with the latissimus dorsi group.In a word,the technique of lateral fascial confluence and pectoralis major muscle to cover prosthesis in some patients with early breast cancer is clinically feasible and is an ideal method of reconstruction. |
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