Objective To study the cause of the low rate of breast conservation and reconstruction by investigating the approval degree of breast conserving therapy and breast reconstruction of women with breast diseases, to help the breast surgeons make better communication with the patients and make more pertinent choices of therapeutic methods. Methods The age, occupation, educational background, the attitudes towards breast conserving therapy and breast reconstruction， and the choice of operative method of breast reconstruction of 139 patients with breast cancer and 224 patients with benign breast disease were investigated by questionnaire. Results In breast cancer group, 23.9% （28/117） of patients chose breast conserving therapy and 35.9%（42/117） of patients chose breast reconstruction, while the rates of breast conservation and reconstruction were 53.3% （106/199） and 63.8% （127/199） in benign breast disease group. In both groups, the higher rates of breast conservation and reconstruction were associated with better educational background (in breast cancer group: P=0.029， P=0.296; in benign breast disease group: P=0.081, P=0.019） and lower age (all Plt;0.05). Patients engaged in commerce showed higher rates of breast conservation and reconstruction （in breast cancer group: P=0.013, P=0.042； in benign breast disease group: P=0.032, P=0.044）. Age, occupation or educational background was not related with the choice of operative method of breast reconstruction （Pgt;0.05). Conclusions Patients with lower age, better educational background, and better job condition have ber desire of breast conservation and reconstruction. Breast surgeons should enhance communication with those patients about relevant information of breast conservation and reconstruction to make the more pertinent choice of therapeutic methods.
Objective To review the latest progress in the major biological properties of adipose-derived stem cells (ADSCs) and ADSCs assisted autologous lipotransfer in breast repair and reconstruction. Methods Recent literature about ADSCs assisted autologous lipotransfer in breast repair and reconstruction was reviewed. Results ADSCs have multipotential differentiation capacity, and they could promote angiogenesis and regulate immune reactions. ADSCs assisted autologous lipotransfer can obtain satisfactory effectiveness in breast repair and reconstruction with few complications, but more studies are needed to confirm the long-term safety. Conclusion ADSCs assisted autologous lipotransfer has good effectiveness in breast repaired and reconstruction. But further clinical trials are needed to confirm the long-term safety.
Objective To evaluate the feasibility, oncological safety, and aesthetic result of skin-spring mastectomy (SSM) or nipple-spring mastectomy (NSM) in breast reconstruction of implant (permanent gel or expander) for breast cancer patients who were not fit for the breast conserving surgery (BCS). Methods Between October 2005 and July 2011, 89 women with breast caner underwent SSM or NSM, with an average age of 42.4 years (range, 19-55 years) and an average disease duration of 5.7 months (range, 1-24 months). The pathological examination revealed invasive ductal carcinoma in 55 cases, ductal carcinoma in situ (DCIS) in 15 cases, invasive ductal carcinoma + DCIS in 8 cases, DCIS with infiltration in 10 cases, and occult breast cancer in 1 case. According to tumor staging criterion of American Joint Committee on Cancer (AJCC), 15 cases were rated as stage 0, 51 cases as stage I, 22 cases as stage II, and 1 case as unclear. Finally, 33 patients underwent SSM and 56 patients underwent NSM according to the location and diameter of tumor and the infiltration of tumor to nipple. Secondary breast reconstruction was performed with permanent gel replacement after axillary lymph node dissection in 9 patients with positive sentinel lymph node and 1 patient with occult breast cancer; immediate breast reconstruction was performed with permanent gel in the other patients. All the patients received the chemotherapy or/and radiotherapy according to the National Comprehensive Cancer Network (NCCN) guideline. Results Complications occurred in 5 patients undergoing breast reconstruction of permanent gel after NSM, including 1 case of haemorrhage, 2 cases of infection, and 2 cases of local skin necrosis. Primary healing of incision was obtained in the others. No nipple necrosis was observed in patients undergoing NSM. All the patients were followed up 14-88 months (median, 40 months). At 10 months after operation, the aesthetic results were excellent in 40 cases, good in 33 cases, fair in 14 cases, and poor in 2 cases, with an excellent and good rate of 82%. No recurrence or metastasis was found during follow-up. Conclusion The SSM or NSM is feasible and oncological safe for patients who are not fit for BCS, with satisfactory aesthetic result.
ObjectiveTo review the registration and technical data for breast implants. MethodsRecent literature concerning registration for breast implants was reviewed and analyzed. ResultsThe aspects on registration for breast implants are complicated. The major aspects include providing technical data, establishing develop standard, progress type test, and developing the registration specification. ConclusionThe manufacturers need to be well aware of the risk of this kind of product and have the full ability to conduct the researching and developing. Only the strict risk controlling can ensure the safety and effectiveness of the product.
【Abstract】 Objective To discuss the aesthetic effect and appl ication of refined incisions in breast reconstructionfor breast cancer patients by the transverse rectus abdominis myocutaneous (TRAM) flap. Methods From January 2001 toOctober 2006, 77 cases with breast cancer were treated with TRAM flap to immediate breast recontruction. The patients were all femals, with an average age of 45 years (ranging from 26 years to 53 years). There were 39 cases of left breast and 38 cases of right breast. The disease course was from 1 day to 180 days. There were 11 cases of stage I , 60 cases of stage II and 6 cases of stage III, among which 34 cases were located in the upper outer quadrant, 15 in the lower outer quadrant, 22 in the upper inner quadrant and 6 in the lower inner quadrant. The size of tumors varied from 1 cm to 4 cm. As to the pathologic type, 60 cases were invasive ductal cancers, 12 ductal cancers in situ, 5 invasive lobular cancers; positive lymph node (number: 1-7) happened in 29 cases, while negative lymph node happened in 48 cases. Among the 77 cases, regular shuttle incisions were performed in 35 cases, and refined circle incisions were performed in 42 cases, which were 2 cm away from the breast tumor border. Axillary incision was necessary for the breast tumors located in upper inner, lower inner and upper outer quadrants in order to perform axillary mastectomy. Ten cases were ni pple-areola sparing. The shape, symmetry and incision scar of the reconstructed breast were evaluated and graded. Results There were 6 cases out of 77 cases of breast reconstruction in which partial necrosis happened and the necrosis rate was 7.79%. The time of follow-up was from 13 months to72 months, with an average of 39 months. No recurrence or matastasis happened in 76 cases, and distant metastasis happened only in 1 case. There were 40 cases out of 42 cases with refined incisions which were scored more than 3, and the satisfaction rate was 95.24%. There were 31 cases out of 35 cases with regular incisions which were scored more than 3, and the satisfaction rate was 88.57%. Conclusion The reasonable refined incision based on the location of the tumor is effective to improve the satisfaction rate for the shape of the reconstructed breast.