Direct-to-implant breast reconstruction after bilateral mastectomy: A comparison between endoscopic and conventional open surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Juan ^1,2 , TANG Qing ¹ , FENG Yu ¹ , QIU Mengxue ¹ , ZHOU Jiao ¹ , QIN Xiangquan ¹ , LIU Xinran ¹ , YANG Huanzuo ¹ ,  DU Zhenggui ^1,3

1. Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Breast Surgery, Sichuan Academy of Medical Sciences · Sichuan Province People's Hospital, Chengdu, 610072, P. R. China;
3. Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

DU Zhenggui, Email: docduzg@163.com

Keywords：

Breast tumor; bilateral reconstruction; endoscopic surgery; traditional open surgery

DOI：

10.7507/1007-4848.202201055

Video：

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Objective To compare the differences of clinical effects between the bilateral endoscopic breast reconstruction and the open breast reconstruction. Methods The clinical data of 28 female patients who underwent bilateral breast graft reconstruction in the Department of Breast Surgery of West China Hospital from January 2017 to January 2021 were analyzed retrospectively. The patients were divided into two groups: an endoscopic group (n=12, aged 41.3±8.9 years) and an open group (n=16, aged 41.6±8.8 years). The clinical data of the two groups of patients were compared. Results There was no significant difference in demographic and oncological data between the two groups (P>0.05). There was a significant difference in the implants between the two groups (P=0.008). The operation time (298.2±108.6 min vs. 326.5±95.8 min, P=0.480) and anesthesia time (373.4±91.2 min vs. 400.3±97.1 min, P=0.463) were not significantly different. The total complications (P=0.035) and major complications (P=0.024) in the open group were more than those in the endoscopic group. For the comparison of breast satisfaction, psychosocial well-being and sexual well-being, the scores at six months and one year after surgery were higher in the endoscopic group than those in the open group (P<0.05). Conclusion The endoscopic reconstruction is safe and effective, with high satisfaction rates regarding breast reconstruction and quality of life, and is superior to conventional open surgery.

Citation： LI Juan, TANG Qing, FENG Yu, QIU Mengxue, ZHOU Jiao, QIN Xiangquan, LIU Xinran, YANG Huanzuo, DU Zhenggui. Direct-to-implant breast reconstruction after bilateral mastectomy: A comparison between endoscopic and conventional open surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(1): 32-38. doi: 10.7507/1007-4848.202201055 Copy

1.	Smith ML, Clarke-Pearson EM, Vornovitsky M, et al. The efficacy of simultaneous breast reconstruction and contralateral balancing procedures in reducing the need for second stage operations. Arch Plast Surg, 2014, 41(5): 535-541.
2.	Chang EI, Lamaris G, Chang DW. Simultaneous contralateral reduction mammoplasty or mastopexy during unilateral free flap breast reconstruction. Ann Plast Surg, 2013, 71(2): 144-148.
3.	Fanakidou I, Zyga S, Alikari V, et al. Mental health, loneliness, and illness perception outcomes in quality of life among young breast cancer patients after mastectomy: The role of breast reconstruction. Qual Life Res, 2018, 27(2): 539-543.
4.	Yueh JH, Slavin SA, Adesiyun T, et al. Patient satisfaction in postmastectomy breast reconstruction: A comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg, 2010, 125(6): 1585-1595.
5.	Liu C, Zhuang Y, Momeni A, et al. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: A critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q. Breast Cancer Res Treat, 2014, 146(1): 117-126.
6.	Taylor EM, Wilkins EG, Pusic AL, et al. Impact of unilateral versus bilateral breast reconstruction on procedure choices and outcomes. Plast Reconstr Surg, 2019, 143(6): 1159e-1168e.
7.	中国抗癌协会乳腺癌专业委员会(CBCS), 中国医师协会外科医师分会乳腺外科医师专委会(CSBS), 吴炅, 等. 乳腺肿瘤整形与乳房重建专家共识(2018年版). 中国癌症杂志, 2018, 28(6): 439-480.
8.	Salgarello M, Visconti G, Barone-Adesi L. Nipple-sparing mastectomy with immediate implant reconstruction: Cosmetic outcomes and technical refinements. Plast Reconstr Surg, 2010, 126(5): 1460-1471.
9.	Galimberti V, Vicini E, Corso G, et al. Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications. Breast, 2017, 34 Suppl 1(Suppl 1): S82-S84.
10.	Franceschini G, Visconti G, Garganese G, et al. Nipple-sparing mastectomy combined with endoscopic immediate reconstruction via axillary incision for breast cancer: A preliminary experience of an innovative technique. Breast J, 2020, 26(2): 206-210.
11.	Lai HW, Chen ST, Mok CW, et al. Single-port three-dimensional (3D) videoscope-assisted endoscopic nipple-sparing mastectomy in the management of breast cancer: Technique, clinical outcomes, medical cost, learning curve, and patient-reported aesthetic results from 80 preliminary procedures. Ann Surg Oncol, 2021, 28(12): 7331-7344.
12.	Zhou J, Liu X, Feng Y, et al. Breakthrough in breast reconstruction in the context of COVID-19: Safety and efficiency of endoscopic breast reconstruction at a day surgery center. Gland Surg, 2021, 10(8): 2477-2489.
13.	Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
14.	Wormer BA, Valmadrid AC, Ganesh Kumar N, et al. Reducing expansion visits in immediate implant-based breast reconstruction: A comparative study of prepectoral and subpectoral expander placement. Plast Reconstr Surg, 2019, 144(2): 276-286.
15.	Berlin NL, Tandon VJ, Qi J, et al. Hospital variations in clinical complications and patient-reported outcomes at 2 years after immediate breast reconstruction. Ann Surg, 2019, 269(5): 959-965.
16.	Bennett KG, Qi J, Kim HM, et al. Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction. JAMA Surg, 2018, 153(10): 901-908.
17.	Lai HW, Lin SL, Chen ST, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant. Plast Reconstr Surg Glob Open, 2018, 6(6): e1828.
18.	Hung CS, Chang SW, Liao LM, et al. The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study. PLoS One, 2017, 12(6): e0178251.
19.	Cordeiro PG, McCarthy CM. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: PartⅡ. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction. Plast Reconstr Surg, 2006, 118(4): 832-839.
20.	Mak JC, Kwong A. Complications in post-mastectomy immediate breast reconstruction: A ten-year analysis of outcomes. Clin Breast Cancer, 2020, 20(5): 402-407.
21.	张晔, 钟玲, 刘静, 等. 腔镜与开放的保留乳头乳晕乳腺癌根治切除加一期假体植入乳房重建的对比研究. 中华外科杂志, 2019, 57(10): 770-775.
22.	Gao GX, Wang ZH, Liu WH, et al. Clinical application of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation. Zhonghua Wai Ke Za Zhi, 2021, 59(2): 121-126.
23.	Zhang S, Xie Y, Liang F, et al. Endoscopic-assisted nipple-sparing mastectomy with direct-to-implant subpectoral breast reconstruction in the management of breast cancer. Plast Reconstr Surg Glob Open, 2021, 9(12): e3978.
24.	Simhan J, Smaldone MC, Egleston BL, et al. Nephron-sparing management vs. radical nephroureterectomy for low- or moderate-grade, low-stage upper tract urothelial carcinoma. BJU Int, 2014, 114(2): 216-220.
25.	Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
26.	Nelson JA, Allen RJ, Polanco T, et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: An 8-year examination of 3268 patients. Ann Surg, 2019, 270(3): 473-483.
27.	Yao X, Guo Y, Tu Y, et al. Simple prosthesis versus prosthesis plus titanium-coated polypropylene mesh for implant-based immediate breast reconstruction after total mastectomy for breast cancer. Gland Surg, 2019, 8(6): 773-783.

1. Smith ML, Clarke-Pearson EM, Vornovitsky M, et al. The efficacy of simultaneous breast reconstruction and contralateral balancing procedures in reducing the need for second stage operations. Arch Plast Surg, 2014, 41(5): 535-541.
2. Chang EI, Lamaris G, Chang DW. Simultaneous contralateral reduction mammoplasty or mastopexy during unilateral free flap breast reconstruction. Ann Plast Surg, 2013, 71(2): 144-148.
3. Fanakidou I, Zyga S, Alikari V, et al. Mental health, loneliness, and illness perception outcomes in quality of life among young breast cancer patients after mastectomy: The role of breast reconstruction. Qual Life Res, 2018, 27(2): 539-543.
4. Yueh JH, Slavin SA, Adesiyun T, et al. Patient satisfaction in postmastectomy breast reconstruction: A comparative evaluation of DIEP, TRAM, latissimus flap, and implant techniques. Plast Reconstr Surg, 2010, 125(6): 1585-1595.
5. Liu C, Zhuang Y, Momeni A, et al. Quality of life and patient satisfaction after microsurgical abdominal flap versus staged expander/implant breast reconstruction: A critical study of unilateral immediate breast reconstruction using patient-reported outcomes instrument BREAST-Q. Breast Cancer Res Treat, 2014, 146(1): 117-126.
6. Taylor EM, Wilkins EG, Pusic AL, et al. Impact of unilateral versus bilateral breast reconstruction on procedure choices and outcomes. Plast Reconstr Surg, 2019, 143(6): 1159e-1168e.
7. 中国抗癌协会乳腺癌专业委员会(CBCS), 中国医师协会外科医师分会乳腺外科医师专委会(CSBS), 吴炅, 等. 乳腺肿瘤整形与乳房重建专家共识(2018年版). 中国癌症杂志, 2018, 28(6): 439-480.
8. Salgarello M, Visconti G, Barone-Adesi L. Nipple-sparing mastectomy with immediate implant reconstruction: Cosmetic outcomes and technical refinements. Plast Reconstr Surg, 2010, 126(5): 1460-1471.
9. Galimberti V, Vicini E, Corso G, et al. Nipple-sparing and skin-sparing mastectomy: Review of aims, oncological safety and contraindications. Breast, 2017, 34 Suppl 1(Suppl 1): S82-S84.
10. Franceschini G, Visconti G, Garganese G, et al. Nipple-sparing mastectomy combined with endoscopic immediate reconstruction via axillary incision for breast cancer: A preliminary experience of an innovative technique. Breast J, 2020, 26(2): 206-210.
11. Lai HW, Chen ST, Mok CW, et al. Single-port three-dimensional (3D) videoscope-assisted endoscopic nipple-sparing mastectomy in the management of breast cancer: Technique, clinical outcomes, medical cost, learning curve, and patient-reported aesthetic results from 80 preliminary procedures. Ann Surg Oncol, 2021, 28(12): 7331-7344.
12. Zhou J, Liu X, Feng Y, et al. Breakthrough in breast reconstruction in the context of COVID-19: Safety and efficiency of endoscopic breast reconstruction at a day surgery center. Gland Surg, 2021, 10(8): 2477-2489.
13. Zhang S, Xie Y, Liang F, et al. Video-assisted transaxillary nipple-sparing mastectomy and immediate implant-based breast reconstruction: A novel and promising method. Aesthetic Plast Surg, 2022, 46(1): 91-98.
14. Wormer BA, Valmadrid AC, Ganesh Kumar N, et al. Reducing expansion visits in immediate implant-based breast reconstruction: A comparative study of prepectoral and subpectoral expander placement. Plast Reconstr Surg, 2019, 144(2): 276-286.
15. Berlin NL, Tandon VJ, Qi J, et al. Hospital variations in clinical complications and patient-reported outcomes at 2 years after immediate breast reconstruction. Ann Surg, 2019, 269(5): 959-965.
16. Bennett KG, Qi J, Kim HM, et al. Comparison of 2-year complication rates among common techniques for postmastectomy breast reconstruction. JAMA Surg, 2018, 153(10): 901-908.
17. Lai HW, Lin SL, Chen ST, et al. Robotic nipple-sparing mastectomy and immediate breast reconstruction with gel implant. Plast Reconstr Surg Glob Open, 2018, 6(6): e1828.
18. Hung CS, Chang SW, Liao LM, et al. The learning curve of endoscopic total mastectomy in Taiwan: A multi-center study. PLoS One, 2017, 12(6): e0178251.
19. Cordeiro PG, McCarthy CM. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: PartⅡ. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction. Plast Reconstr Surg, 2006, 118(4): 832-839.
20. Mak JC, Kwong A. Complications in post-mastectomy immediate breast reconstruction: A ten-year analysis of outcomes. Clin Breast Cancer, 2020, 20(5): 402-407.
21. 张晔, 钟玲, 刘静, 等. 腔镜与开放的保留乳头乳晕乳腺癌根治切除加一期假体植入乳房重建的对比研究. 中华外科杂志, 2019, 57(10): 770-775.
22. Gao GX, Wang ZH, Liu WH, et al. Clinical application of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation. Zhonghua Wai Ke Za Zhi, 2021, 59(2): 121-126.
23. Zhang S, Xie Y, Liang F, et al. Endoscopic-assisted nipple-sparing mastectomy with direct-to-implant subpectoral breast reconstruction in the management of breast cancer. Plast Reconstr Surg Glob Open, 2021, 9(12): e3978.
24. Simhan J, Smaldone MC, Egleston BL, et al. Nephron-sparing management vs. radical nephroureterectomy for low- or moderate-grade, low-stage upper tract urothelial carcinoma. BJU Int, 2014, 114(2): 216-220.
25. Pusic AL, Klassen AF, Scott AM, et al. Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q. Plast Reconstr Surg, 2009, 124(2): 345-353.
26. Nelson JA, Allen RJ, Polanco T, et al. Long-term patient-reported outcomes following postmastectomy breast reconstruction: An 8-year examination of 3268 patients. Ann Surg, 2019, 270(3): 473-483.
27. Yao X, Guo Y, Tu Y, et al. Simple prosthesis versus prosthesis plus titanium-coated polypropylene mesh for implant-based immediate breast reconstruction after total mastectomy for breast cancer. Gland Surg, 2019, 8(6): 773-783.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Direct-to-implant breast reconstruction after bilateral mastectomy: A comparison between endoscopic and conventional open surgery

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