Choice of pectoralis fascia resection in breast cancer surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Zhenchao ,  KANG Hua

Center for Thyroid and Breast Surgery, Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, P. R. China;

Corresponding author：

KANG Hua, Email: kanghua@xwh.ccmu.edu.cn

Keywords：

breast cancer; pectoralis fascia; breast-conservation surgery; modified radical mastectomy; breast reconstruction; review

DOI：

10.7507/1007-9424.202004130

Video：

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Objective To investigate the anatomy and function of pectoralis fascia in breast cancer operation, and the choice of resection and preservation of pectoralis fascia in different operation methods.Method We searched the articles related to pectoralis fascia and breast cancer through PubMed, Web of Science, EBSCO, WanFang Medical Network, SinoMed, and other databases, and then selected the Chinese and foreign articles that met the objective of this paper, and made an review after reading the articles.Results In the immediate breast reconstruction of breast prosthesis after breast cancer operation, the preservation of pectoralis fascia was beneficial to the complete coverage of breast prosthesis and improved the cosmetic effect after operation. The purpose of preserving pectoralis fascia adipose tissue in breast-conserving surgery was to reduce the loss of breast volume and to pursue the cosmetic effect after operation. At present, there had been reports on the safety of pectoralis fascia oncology, but there was no final conclusion on the safe distance between tumor and pectoralis fascia, and the current research could not provide sufficient evidence for the preservation of pectoralis fascia.Conclusions The question of whether the pectoralis fascia needs to be removed in breast cancer surgery is still controversial. The preservation of pectoralis fascia is more for better immediate breast reconstruction after operation. However, the current evidence of evidence-based medicine is not sufficient. Clinicians need to conduct multicenter, randomized controlled clinical trials to improve the evidence.

Citation： YU Zhenchao, KANG Hua. Choice of pectoralis fascia resection in breast cancer surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 125-129. doi: 10.7507/1007-9424.202004130 Copy

1.	吴炅, 张琪. 乳腺癌保乳手术的发展与变革. 中国普外基础与临床杂志, 2018, 25(2): 129-133.
2.	Uroskie TW, Colen LB. History of breast reconstruction. Semin Plast Surg, 2004, 18(2): 65-69.
3.	Nahabedian MY. Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. Plast Reconstr Surg, 2012, 130(5 Suppl 2): 44S-53S.
4.	Maxwell GP, Gabriel A. Breast implant design. Gland Surg, 2017, 6(2): 148-153.
5.	Nahabedian MY. Innovations and advancements with prosthetic breast reconstruction. Breast J, 2018, 24(4): 586-591.
6.	Hwang K, Kim DJ. Anatomy of pectoral fascia in relation to subfascial mammary augmentation. Ann Plast Surg, 2005, 55(6): 576-579.
7.	Matousek SA, Corlett RJ, Ashton MW. Understanding the fascial supporting network of the breast: key ligamentous structures in breast augmentation and a proposed system of nomenclature. Plast Reconstr Surg, 2014, 133(2): 273-281.
8.	Lin JD, Song JL, Chen XP, et al. Anatomy and clinical significance of pectoral fascia. Plast Reconstr Surg, 2006, 118(7): 1557-1560.
9.	Würinger E, Mader N, Posch E, et al. Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg, 1998, 101(6): 1486-1493.
10.	曾杰, 王映, 范培芝, 等. 一期假体植入乳房再造中保留胸大肌筋膜的初步研究. 中国现代医学杂志, 2018, 28(9): 94-97.
11.	邹伟伟, 白玉, 王希龙, 等. 胸大肌筋膜在乳腺癌乳房切除后即刻乳房重建中的应用. 中国普通外科杂志, 2017, 26(11): 1447-1452.
12.	Suijker J, Blok YL, de Vries R, et al. Pectoral fascia preservation in oncological mastectomy to reduce complications and improve reconstructions: a systematic review. Plast Reconstr Surg Glob Open, 2020, 8(3): e2700.
13.	张彦收, 刘运江. 乳腺癌手术治疗回顾和进展. 现代肿瘤医学, 2015, 23(5): 719-722.
14.	Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
15.	Veronesi U, Luini A, Galimberti V, et al. Conservation approaches for the management of stage Ⅰ/Ⅱ carcinoma of the breast: Milan Cancer Institute trials. World J Surg, 1994, 18(1): 70-75.
16.	Salvadori B, Veronesi U. Conservative methods for breast cancer of small size: the experience of the National Cancer Institute, Milan (1973–1998). Breast, 1999, 8(6): 311-314.
17.	Veronesi U, Zurrida S. Breast conservation: current results and future perspectives at the European Institute of Oncology. Int J Cancer, 2007, 120(7): 1381-1386.
18.	程琳, 乔新民, 杨德启, 等. 乳腺癌保乳手术治疗 148 例分析. 中国微创外科杂志, 2004, 4(4): 276-278.
19.	Dalberg K, Johansson H, Signomklao T, et al. A randomised study of axillary drainage and pectoral fascia preservation after mastectomy for breast cancer. Eur J Surg Oncol, 2004, 30(6): 602-609.
20.	Dalberg K, Krawiec K, Sandelin K. Eleven-year follow-up of a randomized study of pectoral fascia preservation after mastectomy for early breast cancer. World J Surg, 2010, 34(11): 2539-2544.
21.	Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg, 2009, 124(6): 1772-1780.
22.	Simmons RM, Hollenbeck ST, Latrenta GS. Two-year follow-up of areola-sparing mastectomy with immediate reconstruction. Am J Surg, 2004, 188(4): 403-406.
23.	Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat, 2009, 118(3): 623-633.
24.	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.
25.	Veronesi P, Ballardini B, De Lorenzi F, et al. Immediate breast reconstruction after mastectomy. Breast, 2011, 20(Suppl 3): S104-S107.
26.	李娟娟, 孙圣荣. 乳房即刻重建术中胸肌筋膜组织瓣覆盖假体的应用分析. 临床外科杂志, 2019, 27(1): 51-54.
27.	Sandelin K, Wickman M, Billgren AM. Oncological outcome after immediate breast reconstruction for invasive breast cancer: a long-term study. Breast, 2004, 13(3): 210-218.
28.	Vallejo da Silva A, Rodriguez FR, Loures CM, et al. Mastectomy in the era of implant-based reconstruction: should we be removing the pectoralis fascia? Breast, 2012, 21(6): 779-780.
29.	Katz A, Strom EA, Buchholz TA, et al. The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys, 2001, 50(3): 735-742.
30.	郑新宇. 乳腺癌保乳手术切缘问题. 中国实用外科杂志, 2011, 31(10): 928-931.
31.	张保宁. 早期乳腺癌保乳手术的相关问题. 中国肿瘤, 2007, 16(10): 758-760.
32.	曹旭晨. 乳腺癌改良根治术的手术技巧. 外科理论与实践, 2008, 13(2): 99-102.
33.	姜鹏, 郭慕红, 王汉晋. 乳腺癌保乳手术. 江苏医药, 2008, 34(7): 737-738.
34.	孙轩, 曹旭晨. 乳腺癌手术治疗的研究进展. 天津医药, 2011, 39(1): 90-92.
35.	邵志敏. 乳腺癌保乳手术的进展与评述. 肿瘤防治研究, 2018, 45(5): 269-273.
36.	陈亚, 张强, 刘铁成. 保乳术—乳腺癌外科治疗的发展方向. 安徽医学, 2017, 38(2): 246-249.
37.	Gran MV, Nicholson S, Mahajan AL. Pectoralis fascia grafts in breast reconstruction. J Plast Reconstr Aesthet Surg, 2012, 65(4): e104-e105.

1. 吴炅, 张琪. 乳腺癌保乳手术的发展与变革. 中国普外基础与临床杂志, 2018, 25(2): 129-133.
2. Uroskie TW, Colen LB. History of breast reconstruction. Semin Plast Surg, 2004, 18(2): 65-69.
3. Nahabedian MY. Acellular dermal matrices in primary breast reconstruction: principles, concepts, and indications. Plast Reconstr Surg, 2012, 130(5 Suppl 2): 44S-53S.
4. Maxwell GP, Gabriel A. Breast implant design. Gland Surg, 2017, 6(2): 148-153.
5. Nahabedian MY. Innovations and advancements with prosthetic breast reconstruction. Breast J, 2018, 24(4): 586-591.
6. Hwang K, Kim DJ. Anatomy of pectoral fascia in relation to subfascial mammary augmentation. Ann Plast Surg, 2005, 55(6): 576-579.
7. Matousek SA, Corlett RJ, Ashton MW. Understanding the fascial supporting network of the breast: key ligamentous structures in breast augmentation and a proposed system of nomenclature. Plast Reconstr Surg, 2014, 133(2): 273-281.
8. Lin JD, Song JL, Chen XP, et al. Anatomy and clinical significance of pectoral fascia. Plast Reconstr Surg, 2006, 118(7): 1557-1560.
9. Würinger E, Mader N, Posch E, et al. Nerve and vessel supplying ligamentous suspension of the mammary gland. Plast Reconstr Surg, 1998, 101(6): 1486-1493.
10. 曾杰, 王映, 范培芝, 等. 一期假体植入乳房再造中保留胸大肌筋膜的初步研究. 中国现代医学杂志, 2018, 28(9): 94-97.
11. 邹伟伟, 白玉, 王希龙, 等. 胸大肌筋膜在乳腺癌乳房切除后即刻乳房重建中的应用. 中国普通外科杂志, 2017, 26(11): 1447-1452.
12. Suijker J, Blok YL, de Vries R, et al. Pectoral fascia preservation in oncological mastectomy to reduce complications and improve reconstructions: a systematic review. Plast Reconstr Surg Glob Open, 2020, 8(3): e2700.
13. 张彦收, 刘运江. 乳腺癌手术治疗回顾和进展. 现代肿瘤医学, 2015, 23(5): 719-722.
14. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med, 2002, 347(16): 1233-1241.
15. Veronesi U, Luini A, Galimberti V, et al. Conservation approaches for the management of stage Ⅰ/Ⅱ carcinoma of the breast: Milan Cancer Institute trials. World J Surg, 1994, 18(1): 70-75.
16. Salvadori B, Veronesi U. Conservative methods for breast cancer of small size: the experience of the National Cancer Institute, Milan (1973–1998). Breast, 1999, 8(6): 311-314.
17. Veronesi U, Zurrida S. Breast conservation: current results and future perspectives at the European Institute of Oncology. Int J Cancer, 2007, 120(7): 1381-1386.
18. 程琳, 乔新民, 杨德启, 等. 乳腺癌保乳手术治疗 148 例分析. 中国微创外科杂志, 2004, 4(4): 276-278.
19. Dalberg K, Johansson H, Signomklao T, et al. A randomised study of axillary drainage and pectoral fascia preservation after mastectomy for breast cancer. Eur J Surg Oncol, 2004, 30(6): 602-609.
20. Dalberg K, Krawiec K, Sandelin K. Eleven-year follow-up of a randomized study of pectoral fascia preservation after mastectomy for early breast cancer. World J Surg, 2010, 34(11): 2539-2544.
21. Chen CM, Disa JJ, Sacchini V, et al. Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction. Plast Reconstr Surg, 2009, 124(6): 1772-1780.
22. Simmons RM, Hollenbeck ST, Latrenta GS. Two-year follow-up of areola-sparing mastectomy with immediate reconstruction. Am J Surg, 2004, 188(4): 403-406.
23. Didier F, Radice D, Gandini S, et al. Does nipple preservation in mastectomy improve satisfaction with cosmetic results, psychological adjustment, body image and sexuality? Breast Cancer Res Treat, 2009, 118(3): 623-633.
24. 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.
25. Veronesi P, Ballardini B, De Lorenzi F, et al. Immediate breast reconstruction after mastectomy. Breast, 2011, 20(Suppl 3): S104-S107.
26. 李娟娟, 孙圣荣. 乳房即刻重建术中胸肌筋膜组织瓣覆盖假体的应用分析. 临床外科杂志, 2019, 27(1): 51-54.
27. Sandelin K, Wickman M, Billgren AM. Oncological outcome after immediate breast reconstruction for invasive breast cancer: a long-term study. Breast, 2004, 13(3): 210-218.
28. Vallejo da Silva A, Rodriguez FR, Loures CM, et al. Mastectomy in the era of implant-based reconstruction: should we be removing the pectoralis fascia? Breast, 2012, 21(6): 779-780.
29. Katz A, Strom EA, Buchholz TA, et al. The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys, 2001, 50(3): 735-742.
30. 郑新宇. 乳腺癌保乳手术切缘问题. 中国实用外科杂志, 2011, 31(10): 928-931.
31. 张保宁. 早期乳腺癌保乳手术的相关问题. 中国肿瘤, 2007, 16(10): 758-760.
32. 曹旭晨. 乳腺癌改良根治术的手术技巧. 外科理论与实践, 2008, 13(2): 99-102.
33. 姜鹏, 郭慕红, 王汉晋. 乳腺癌保乳手术. 江苏医药, 2008, 34(7): 737-738.
34. 孙轩, 曹旭晨. 乳腺癌手术治疗的研究进展. 天津医药, 2011, 39(1): 90-92.
35. 邵志敏. 乳腺癌保乳手术的进展与评述. 肿瘤防治研究, 2018, 45(5): 269-273.
36. 陈亚, 张强, 刘铁成. 保乳术—乳腺癌外科治疗的发展方向. 安徽医学, 2017, 38(2): 246-249.
37. Gran MV, Nicholson S, Mahajan AL. Pectoralis fascia grafts in breast reconstruction. J Plast Reconstr Aesthet Surg, 2012, 65(4): e104-e105.

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Choice of pectoralis fascia resection in breast cancer surgery

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