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Feng Y, Wen N, Liang F, Zhou J, Qin X, Liu X, Li J, Qiu M, Yang H, Du Z. Endoscopic Nipple- or Skin-Sparing Mastectomy and Immediate Breast Reconstruction with Endoscopic Harvesting of the Latissimus Dorsi Flap: A Preliminary Experience of an Innovative Technique. Breast J 2022; 2022:1373899. [PMID: 36349179 PMCID: PMC9633195 DOI: 10.1155/2022/1373899] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/28/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
Background Endoscopic nipple- or skin-sparing mastectomy (E-N/SSM) and endoscopic latissimus dorsi muscle flap (E-LDMF) harvest have been operational difficulties over decades. The aim of this study was to describe the preliminary outcomes of our novel surgical technique, which allows the performance of E-N/SSM and E-LDMF harvest for immediate breast reconstruction (IBR) through a single cosmetic axillary incision for breast cancer patients. Methods This prospective study included 20 breast cancer patients who underwent E-N/SSM and E-LDMF harvesting through a single axillary incision in our hospital from September 2020 to June 2022. The outcomes were statistically calculated, including patient characteristics, operative data, complication rate, hospital length of stay and costs, and patient-reported outcomes. Results A total of 20 breast cancer patients underwent our sufficiently mature novel endoscopy technique. The mean LD flap harvest time was 96.5 ± 25.3 min, the mean operation time was 262.6 ± 54.4 min, and the average length of LDMF was 26.9 ± 3.1. During the median follow-up time of 7.5 months, 4 patients developed donor-site seroma. One of them was also complicated by hypopigmentation of the nipple areola, and one of them suffered from breast cellulitis. No bleeding or flap necrosis happened. No tumor recurrence or metastasis was found until the last follow-up. In the BREAST-Q evaluation, although they gave a lower score beginning at 1-month post-operation than preoperatively (P > 0.05, except for physical well-being: chest and physical well-being: back and shoulder, P < 0.01), there was an uptrend at 3 months postoperatively. Because of the hidden and short incision, the mean score of the appearance scale of the SCAR-Q at 3 months post-operation was 74.2 ± 8.8. Conclusions The novel endoscopy technique, which was first reported to perform lymph node surgery, N/SSM, and LDMF harvesting in an operation for breast cancer patients through a single axillary incision, is associated with a shorter surgery time, lower complication rates, and better patient-reported outcomes.
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Affiliation(s)
- Yu Feng
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Nan Wen
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Faqing Liang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Jiao Zhou
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Xiangquan Qin
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Xinran Liu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Juan Li
- Department of Breast Surgery, Sichuan Academy of Medical Sciences, Sichuan Province People's Hospital, Chengdu 610072, Sichuan, China
| | - Mengxue Qiu
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Huanzuo Yang
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
| | - Zhenggui Du
- Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichua, China
- Breast Disease Research Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
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Combined Endoscopy-Assisted Muscle-Sparing Latissimus Dorsi Flap Harvesting with Lipofilling Enhancement as a New Volume Replacement Technique in Breast Reconstruction. Breast J 2022; 2022:7740439. [PMID: 35711893 PMCID: PMC9187265 DOI: 10.1155/2022/7740439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022]
Abstract
Introduction This study evaluated the feasibility and patient satisfaction of combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting, with lipofilling enhancement for skin-preserving mastectomy. Methods This is a prospective study that included 21 female patients with small breasts (cup size A-B), subjected to skin-preserving mastectomy as a management of breast cancer. Combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting with lipofilling enhancement was performed for immediate breast reconstruction. Patients were followed up for early and late postoperative complications including recurrence for at least 24 months. Postoperative patient satisfaction was assessed using the Kyungpook National University Hospital breast reconstruction satisfaction questionnaire. Results The study included 21 female patients with a mean age of 42.10 ± 8.46 years. Patients were followed up for 26.67 ± 3.38 months. The procedure was successful in all patients with a mean duration of 172.05 ± 28.22 minutes. Local recurrence was encountered in one patient (4.67%). Eighteen patients declared their satisfaction 6 months after the operation, while two patients were satisfied only after the second session of lipofilling. The overall postoperative patient satisfaction was 95.24%. The majority of the patients (93.3%) who underwent NSM surgery were satisfied, while only two-thirds (66.6%) of the patients who underwent SSM surgery were satisfied. Conclusions Combined endoscopy-assisted muscle-sparing latissimus dorsi flap harvesting with lipofilling enhancement seems to be a feasible and encouraging technique for the volume adjustment of small breasts, especially in nipple-sparing mastectomy. It leaves a minor back scar and has an acceptable rate of postoperative complications. The procedure showed high postoperative patient satisfaction.
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Ma JX, Li B, Xia YC, You WT, Zhang J, Sun YM, Chang X, Lang Y. Latissimus dorsi muscle flap transfer through endoscopic approach combined with the implant after tissue expansion for breast reconstruction of mastectomy patients. BMC Surg 2022; 22:10. [PMID: 34998369 PMCID: PMC8742397 DOI: 10.1186/s12893-021-01464-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implant-based breast reconstruction is easy to be performed but has flaws that an unnatural appearance might be presented when no sufficient coverage existing. While autologous tissue reconstruction also has disadvantages like donor site scar and skin patch effect. There is a demand for a new method to obtain natural and aesthetic appearance while surmounting drawbacks of conventional breast reconstruction surgery. METHODS A retrospective review of thirty-one patients undergoing tissue expander (TE)/implant two-stage breast reconstruction with latissimus dorsi muscle flap (LDMF) transfer through endoscopic approach in Peking University Third Hospital from April 2016 to August 2020 was performed. The LDMF harvest time, drain time, and complications were reviewed. The 3D volume was obtained to assess the volume symmetry of bilateral breasts. The BREAST-Q reconstruction module was used to evaluate the satisfaction. RESULTS The mean endoscopic LDMF harvest time was 90.4 min. In the mean follow-up of 11.2 months, there were no severe capsular contracture happened. The reconstructed side achieved good volume symmetry to the contralateral side (P = 0.256). Based on the evaluation of the BREAST-Q scores, the outcome of Satisfaction with Breasts was excellent or good in 87.1% of the cases. CONCLUSIONS The novel type of two-stage breast reconstruction protocol, which includes tissue expansion followed by implant insertion with endoscopy-assisted LDMF transfer, could effectively reduce visible scars, avoid the patch effect, while require short time for LDMF harvest and present low incidence of complications. It is a promising method for breast reconstruction because it achieves good outcomes in the mastectomy patients.
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Affiliation(s)
- Jian-Xun Ma
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China
| | - Bi Li
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China.
| | - You-Chen Xia
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China
| | - Wei-Tao You
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China
| | - Jie Zhang
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China
| | - Yi-Mou Sun
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China
| | - Xu Chang
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China
| | - Yue Lang
- Department of Plastic Surgery, Peking University Third Hospital, #49, North Garden Road Haidian District, Beijing, 100191, People's Republic of China
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Liang F, Wen N, Xie Y, Wang Y, Zhang S, Lv Q, Du Z. Subversion of Endoscopic Breast Reconstruction Surgery: Nipple-sparing Mastectomy and Immediate Reconstruction with a Latissimus Dorsi Flap/Latissimus Dorsi Flap and Implant Through a Single Axillary Incision. ANNALS OF SURGERY OPEN 2021; 2:e082. [PMID: 37635818 PMCID: PMC10455204 DOI: 10.1097/as9.0000000000000082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/27/2021] [Indexed: 11/25/2022] Open
Abstract
Our team has created a novel endoscopic technique (ET) to solve the problems of the former minimally invasive surgery (Inconvenient operation for ET, high cost for robotic technique, long-operation time for both) for breast cancer patients requiring nipple-sparing mastectomy and immediate breast reconstruction (BR) with a latissimus dorsi flap/latissimus dorsi flap and implant. This easy-to-grasp method will benefit more patients.
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Affiliation(s)
- Faqing Liang
- From the Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Nan Wen
- From the Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- From the Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Wang
- From the Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Songbo Zhang
- From the Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Lv
- From the Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- From the Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China
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Chang HP, Fan KL, Song SY, Lee DW. The traditional versus endoscopic-assisted latissimus dorsi harvest in oncoplastic surgery: A long term comparison of breast volume, aesthetics, and donor site outcomes. Asian J Surg 2020; 43:1165-1171. [DOI: 10.1016/j.asjsur.2020.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/20/2020] [Accepted: 03/04/2020] [Indexed: 11/25/2022] Open
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Robotic-assisted skin sparing mastectomy and immediate reconstruction using latissimus dorsi flap a new effective and safe technique: A comparative study. Surg Oncol 2020; 35:406-411. [PMID: 33035789 DOI: 10.1016/j.suronc.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/19/2020] [Accepted: 09/27/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Breast reconstruction is an essential part of breast cancer treatment. After skin sparing mastectomy, Immediate Breast Reconstruction (IBR) can be achieved using breast implants, autologous flaps (i.e. latissimus dorsi-myo-cutaneous flap (LDF)) or an association of both. Robotic assistance has gained popularity in many surgical fields including breast surgery. This study aims to compare the post-operative results of Robotic Assisted Latissimus Dorsi Flap (RALDF) to Traditional Latissimus Dorsi Flap (TLDF) for IBR after Skin Sparing Mastectomy (SSM) without nipple conservation. MATERIALS AND METHODS Between March 2016 and June 2019, all patients who underwent a SSM and a concurrent IBR with a TLDF were retrospectively compared to patients who underwent SSM and a concurrent IBR with a RALDF. Outcomes compared included operative time, length of hospital stay and complications rate. RESULTS 105 cases of SSM with a LDF based IBR were included in the study. 46 patients underwent RALDF and 59 patients underwent TLDF. Mean operative time was longer in the RALDF group (290.5min versus 259.7min). In binary regression, the concomitant placement of breast implant was the only factor associated with an operative time exceeding 290 min (p = 0.032). Univariate analysis showed no significant difference concerning the rate of complications (p = 0.061). After logistic regression, RALDF was associated with a decreased rate of complications (p = 0.042; OR 0.37; IC 95% (0.142-0.966)). DISCUSSION SSM with IBR using RALDF is an effective and safe technique. This technique is actually associated with a lower complication rate at the expense of a longer operative time.
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Houvenaeghel G, Cohen M, Ribeiro SR, Barrou J, Heinemann M, Frayret C, Lambaudie E, Bannier M. Robotic Nipple-Sparing Mastectomy and Immediate Breast Reconstruction With Robotic Latissimus Dorsi Flap Harvest: Technique and Results. Surg Innov 2020; 27:481-491. [PMID: 32418492 DOI: 10.1177/1553350620917916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. Only few cases of robotic latissimus dorsi flap reconstruction (RLDFR) have been reported in indication of reconstruction for breast cancer (BC). We report our experience of combined robotic nipple-sparing mastectomy (R-NSM) and RLDFR, and analyze technique, indications, and reproducibility. Methods. All patients with R-NSM and RLDFR from November 2016 to August 2, 2018, were analyzed, and technics have been described. Complication rate with Clavien-Dindo grading and postoperative hospitalization length (days) are reported. Results. Thirty-five R-NSM with RLDFR were performed in 22 cases for primitive BC and 13 for local recurrence. In 12 patients, another surgical procedure was performed during the same time (axillary lymph node dissection or contralateral breast surgery). R-NSM was realized through a short axillar incision, with inside-only installation for 12 patients (34.3%): 18 nonautologous and 17 autologous RLDFR associated with implant in 9 patients. In logistic regression, mastectomy weight >330 g was significantly associated with the use of implant (odds ratio [OR] = 17, P = .015), and significant factor of the time of anesthesia ≥380 minutes was 2 installations (OR = 10.4, P = .049). The median duration of hospitalization stay was 4 days. Complications rates were 51.4% (18/35; 9 grade-1, 2 grade-2, and 7 grade-3). In logistic regression, associated other surgical procedure was predictive of grade-3 complications (OR = 6.87, P = .053). Conclusion. We confirmed the reproducibility and safety of R-NSM and RLDFR with a decreased complication rate. NSM was performed in 42.8% of our patients after previous radiotherapy. We observed an increase of grade-3 complications when R-NSM and RLDFR was combined to another surgical procedure.
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Affiliation(s)
- Gilles Houvenaeghel
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Monique Cohen
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Sandrine Rua Ribeiro
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Julien Barrou
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Mellie Heinemann
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Christine Frayret
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Eric Lambaudie
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Marie Bannier
- Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, Marseille, Provence-Alpes-Côte d'Azu, France
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Houvenaeghel G, Bannier M, Rua S, Barrou J, Heinemann M, Knight S, Lambaudie E, Cohen M. Robotic breast and reconstructive surgery: 100 procedures in 2-years for 80 patients. Surg Oncol 2019; 31:38-45. [DOI: 10.1016/j.suronc.2019.09.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 08/05/2019] [Accepted: 09/09/2019] [Indexed: 11/24/2022]
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Houvenaeghel G, Bannier M, Rua S, Barrou J, Heinemann M, Lambaudie E, Cohen M. Skin sparing mastectomy and robotic latissimus dorsi-flap reconstruction through a single incision. World J Surg Oncol 2019; 17:176. [PMID: 31677640 PMCID: PMC6825710 DOI: 10.1186/s12957-019-1711-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/12/2019] [Indexed: 11/21/2022] Open
Abstract
Background Robotic latissimus dorsi-flap reconstruction (RLDFR) after skin-sparing mastectomy (SSM) for breast cancer (BC) has been performed through a single nipple incision. We report results of SSM with RLDFR, mainly with analysis of feasibility, morbidity, indications, and technique standardization. Methods We determined characteristics of patients, previous treatment of BC, and type of reconstruction. Surgical technique, duration of surgery, and complication rate were reported according to three successive periods: P1–3. Results Forty RLDFR, with breast implant for 16 patients, with previous breast radiotherapy in 30% had been performed. In logistic regression, factors significantly associated with duration of surgery ≥ 300 min were P2 (OR 0.024, p = 0.004) and P3 (OR 0.012, p = 0.004) versus P1. The median mastectomy weight was 330 g and 460 g for BMI < and ≥ 23.5 (p = 0.025). Length of hospitalization was 4 days. Total complication rate was 20% (8/40): seven breast complications (four re-operations) and one RLDF complication with re-operation. Periods were significantly predictive of complications (p = 0.045). Conclusion SSM with RLDFR is feasible, safe, and reproducible. We reported a decrease of duration of surgery, length of post-operative hospitalization, and complication rate.
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Affiliation(s)
- Gilles Houvenaeghel
- Department of Surgical Oncology, Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
| | - Marie Bannier
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Sandrine Rua
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Julien Barrou
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
| | - Mellie Heinemann
- Department of Surgical Oncology, Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Paoli Calmettes Institute and CRCM, CNRS, INSERM, Aix Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - Monique Cohen
- Department of Surgical Oncology, Paoli Calmettes Institute, Marseille, France
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Acea-Nebril B, García-Novoa A, Cereijo-Garea C, Builes-Ramirez S, Bouzon-Alejandro A, Mosquera-Oses J. Single-Incision Approach for Breast-Conserving Surgery: Effectiveness, Complications and Quality of Life. Ann Surg Oncol 2019; 26:2466-2474. [PMID: 31102095 DOI: 10.1245/s10434-019-07443-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess the success of tumor resection and its postoperative complications, satisfaction, and quality of life using a single-incision approach for breast-conserving surgery. MATERIALS AND METHODS This was an observational, prospective study conducted between 2015 and 2018. The study group consisted of patients in whom tumor extirpation and lymph node (LN) staging was performed using a single incision, while the control group consisted of patients who underwent a breast-conserving procedure with independent incisions. All patients were given the preoperative and postoperative module of the Breast-Q™ questionnaire. RESULTS Overall, 226 patients met the study's inclusion criteria, 152 of whom successfully underwent breast and LN removal using a single-incision approach (98.7% overall success). There were no significant differences in postoperative complications, although there was a greater tendency towards breast seroma in the study group and axillary neuralgia in the control group. Both groups presented a similar rate of breast and axillary salvage surgery. The postoperative Breast-Q™ questionnaire showed that the study group had greater satisfaction with both the breast and the information provided by the surgeon. CONCLUSION The single-incision approach is as effective as standard surgery, with custom incisions in terms of breast resection, LN staging, and complications. There was greater satisfaction with both the breast and the information provided.
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Liu C, Luan J, Ouyang Y, Zhuang Y, Xu B, Chen L, Li S, Fu S, Xin M. Breast Reconstruction in Poland Syndrome Patients with Latissimus Dorsi Myo Flap and Implant: An Efficient Endoscopic Approach Using Single Transverse Axillary Incision. Aesthetic Plast Surg 2019; 43:1186-1194. [PMID: 30877446 DOI: 10.1007/s00266-019-01346-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 02/24/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Breast hypoplasia or amastia with pectoralis major muscle defect in female Poland syndrome patients always necessitates surgical intervention. This study aims to introduce an efficient endoscopic technique to perform breast reconstruction in Poland syndrome patients with a latissimus dorsi myo flap and an implant using a single transverse axillary incision (ELDM + IMPLANT) and to evaluate its safety and effectiveness. METHODS A prospective study was designed to recruit Poland syndrome candidates for ELDM + IMPLANT breast reconstruction. Only one transaxillary incision was made to harvest the LDM flap and create the anterior chest wall pocket. The LDM flap was transposed to the front to reconstruct the breast with a silicone implant. Patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time and post-operative complications were collected. The BREAST-Q reconstruction module was used to evaluate patient quality of life. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. RESULTS Sixteen eligible patients were recruited and received ELDM + IMPLANT-BR. Mean endoscopic time for LDM flap harvesting was 61.6 min. All of the 16 patients recovered uneventfully without any significant complications. The post-operative scores of satisfaction with breast and psychosocial well-being were significantly higher than the pre-operative ones. The score of DASH was 7.1 pre-operatively and 8.3 post-operatively with no significant difference either. The score of satisfaction with outcome was 80.0. CONCLUSIONS Our proposed ELDM + IMPLANT technique provides a safe and efficient way to reconstruct breasts in Poland syndrome patients with a high satisfaction rate, optimized aesthetic outcome and minimized donor site morbidity. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Houvenaeghel G, Bannier M, Rua S, Barrou J, Heinemann M, Van Troy A, Lambaudie E, Cohen M. Breast cancer robotic nipple sparing mastectomy: evaluation of several surgical procedures and learning curve. World J Surg Oncol 2019; 17:27. [PMID: 30728011 PMCID: PMC6366058 DOI: 10.1186/s12957-019-1567-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies of robotic nipple sparing mastectomy (NSM) were reported. We report feasibility of robotic NSM and determine standard surgical procedure and learning curve threefold. METHODS A cohort of patients with robotic NSM for breast cancer was analyzed. Complications and post-operative hospitalization stay were reported. The same technic was used for all patients except for skin and nipple areolar complex (NAC) dissection. Differences between three surgical procedures of NAC dissection were analyzed: group 1, dissection with robotic scissors using coagulation; group 2, dissection with robotic scissors without coagulation; and group 3, dissection with non-robotic scissors and then robotic dissection. We explored possible effect of learning curve among patients from group 1 with the same surgical procedure. RESULTS Twenty-seven NSM with immediate breast reconstruction for breast cancers, 22 invasive and 5 in situ, were performed, with robotic latissimus dorsi-flap (RLDF) only in 17 cases, RLDF and breast implant in 6 cases, and implant alone in 4 cases. Repartition according to 3 surgical procedure groups was 16, 5, and 6 patients. Mean time of surgery and anesthesia decrease according to groups 1 to 3. Among 16 patients from group 1, time of surgery and anesthesia decreased with learning curve. Post-operative hospitalization decreased from group 1 to 3. We reported a total of 11 complications, with significant difference between groups (10 for group 1). Skin complications were higher for group 1 in comparison with groups 2-3 (p = 0.02). CONCLUSION Robotic NSM can be performed with a brief learning. Standardized technique is proposed with non-robotic scissors superficial dissection and then dissection with robot.
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Affiliation(s)
- G Houvenaeghel
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France.
| | - M Bannier
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - S Rua
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - J Barrou
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - M Heinemann
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - A Van Troy
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - E Lambaudie
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
| | - M Cohen
- Department of Surgical Oncology, Institut Paoli Calmettes and CRCM and Aix-Marseille Université, 232 Bd de Sainte Marguerite, 13009, Marseille, France
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Augustinho LBZ, Sabino M, Veiga DF, Abla LEF, Juliano Y, Ferreira LM. Patient satisfaction with breast reconstructionusing musculocutaneous flap from latissimus dorsiversus from rectus abdominis: a cross-sectional study. SAO PAULO MED J 2018; 136:551-556. [PMID: 30892486 PMCID: PMC9897135 DOI: 10.1590/1516-3180.2018.032916112018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients' quality of life. Our goal here was to compare patients' satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.
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Affiliation(s)
| | - Miguel Sabino
- MD, PhD. Physician, Adjunct Professor and Coordinator of the Postgraduate Program on Translational Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Daniela Francescato Veiga
- MD, PhD. Physician and Professor, Postgraduate Program on Translational Surgery, Universidade Federal de São Paulo (UNİFESP), São Paulo; and Pro-Rector of Postgraduate Studies, Universidade do Vale do Sapucaí (UNIVÁS), Pouso Alegre (MG), Brazil.
| | - Luiz Eduardo Felipe Abla
- MD, PhD. Physician and Director, Discipline of Plastic Surgery, Hospital Pérola Byington, São Paulo (SP), Brazil.
| | - Yara Juliano
- PhD. Business Administrator and Full Professor, Discipline of Collective Health, School of Medicine, Universidade de Santo Amaro (UNISA), São Paulo (SP), Brazil.
| | - Lydia Masako Ferreira
- MD, PhD. Physician and Titular Professor, Discipline of Plastic Surgery, Universidade Federal de São Paulo (UNİFESP), São Paulo (SP), Brazil.
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Chang CJ, Yu DY, Chang SY, Hsiao YC. Comparing the effectiveness of laser vs. conventional endoforehead lifting. J COSMET LASER THER 2018; 20:91-95. [PMID: 29461879 DOI: 10.1080/14764172.2016.1256487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to compare the efficacy and safety of laser versus conventional endoforehead lifting. Over a period of 12 years (January 2000-January 2012), a total of 110 patients with hyperactive muscles over the frontal region have been collected for a retrospective study. The SurgiLase 150XJ CO2 laser system, in conjunction with the flexible FIBERLASE, was used. The endoscope was 4 mm in diameter with an angle of 30°. The primary efficacy measurement was the assessment of the final outcome for using laser vs. conventional methods. Both groups were observed at three weeks, six weeks and six months after surgery. The most common complication in early convalescence (three weeks) was swelling. This was followed by local paraesthesia, ecchymosis, localized hematomas and scar with alopecia. All these problems disappeared completely after the 6-month study period. Based on a chi-square analysis, there were clinically and statistically significant differences favouring the laser endoforehead surgery in the operative time, early and late complications. All patients achieved significant improvement after both laser and conventional endoforehead surgery in the final outcome. However, the early and late complications indicated a greater difference in the laser group.
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Affiliation(s)
- Cheng-Jen Chang
- a Department of Plastic Surgery , Taipei Medical University Hospital , Taipei , Taiwan , Republic of China.,b Graduate institute of biomedical optomechatronics , College of Biomedical Engineering, Taipei Medical University , Taipei , Taiwan , Republic of China.,c Department of Surgery, School of Medicine , College of Medicine, Taipei Medical University , Taipei , Taiwan , Republic of China
| | - De-Yi Yu
- d Department of Plastic Surgery, Chang Gung Memorial Hospital , Chang Gung University , Taoyuan , Taiwan , Republic of China
| | - Shu-Ying Chang
- d Department of Plastic Surgery, Chang Gung Memorial Hospital , Chang Gung University , Taoyuan , Taiwan , Republic of China
| | - Yen-Chang Hsiao
- d Department of Plastic Surgery, Chang Gung Memorial Hospital , Chang Gung University , Taoyuan , Taiwan , Republic of China
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张 普, 王 立, 罗 云, 史 福, 何 琳, 曾 成, 张 宇, 方 驰. [Application of 3D visualization technique in breast cancer surgery with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1131-1135. [PMID: 28801298 PMCID: PMC6765736 DOI: 10.3969/j.issn.1673-4254.2017.08.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the value of 3D visualization technique in breast-preserving surgery for breast cancer with immediate breast reconstruction using laparoscopically harvested pedicled latissimus dorsi muscle flap. METHODS From January, 2015 to May, 2016, 30 patients with breast cancer underwent breast-preserving surgery with immediate breast reconstruction using pedicled latissimus dorsi muscle flap. The CT data of the arterial phase and venous phase were collected preoperatively and imported into the self-developed medical image 3D visualization system for image segmentation and 3D reconstruction. The 3D models were imported into the simulation surgery platform for virtual surgery to prepare for subsequent surgeries. The cosmetic outcomes of the patients were evaluated 6 months after the surgery. Another 18 patients with breast cancer who underwent laparoscopic latissimus dorsi muscle breast reconstruction without using 3D visualization technique from January to December, 2014 served as the control group. The data of the operative time, intraoperative blood loss and postoperative appearance of the breasts were analyzed. RESULTS The reconstructed 3D model clearly displayed the anatomical structures of the breast, armpit, latissimus dorsi muscle and vessels and their anatomical relationship in all the 30 cases. Immediate breast reconstruction was performed successfully in all the cases with median operation time of 226 min (range, 210 to 420 min), a median blood loss of 95 mL (range, 73 to 132 mL). Evaluation of the appearance of the breast showed excellent results in 22 cases, good appearance in 6 cases and acceptable appearance in 2 cases. In the control group, the median operation time was 283 min (range, 256 to 313 min) and the median blood loss was 107 mL (range, 79 to 147 mL) with excellent appearance of the breasts in 10 cases, good appearance in 4 cases and acceptable appearance in 4 cases. CONCLUSION 3D reconstruction technique can clearly display the morphology of the latissimus dorsi and the thoracic dorsal artery, allows calculation of the volume of the breast and the latissimus dorsi, and helps in defining the scope of resection of the latissimus dorsi to avoid injuries of the pedicled vessels. This technique also helps to shorten the operation time, reduce intraoperative bleeding, and improve the appearance of the reconstructed breast using pedicled latissimus dorsi muscle flap.
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Affiliation(s)
- 普生 张
- 南方医科大学珠江医院, 乳腺专科, 广东 广州 510282Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 立坤 王
- 南方医科大学珠江医院, 乳腺专科, 广东 广州 510282Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 云峰 罗
- 南方医科大学珠江医院, 乳腺专科, 广东 广州 510282Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 福军 史
- 南方医科大学珠江医院, 乳腺专科, 广东 广州 510282Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 琳赟 何
- 南方医科大学珠江医院, 乳腺专科, 广东 广州 510282Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 成炳 曾
- 南方医科大学珠江医院, 乳腺专科, 广东 广州 510282Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 宇 张
- 南方医科大学珠江医院, 乳腺专科, 广东 广州 510282Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
| | - 驰华 方
- 南方医科大学珠江医院, 肝胆一科, 广东 广州 510282First Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China
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de Runz A, Boccara D, Bekara F, Chaouat M, Mimoun M. Outcome of 122 delayed breast reconstruction following post-mastectomy radiotherapy: The scarless latissimus dorsi flap with tissue expansion technique. ANN CHIR PLAST ESTH 2017; 62:23-30. [DOI: 10.1016/j.anplas.2016.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
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Mátrai Z, Gulyás G, Kunos C, Sávolt A, Farkas E, Szollár A, Kásler M. [Minimally invasive breast surgery]. Orv Hetil 2014; 155:162-9. [PMID: 24463161 DOI: 10.1556/oh.2014.29783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Due to the development in medical science and industrial technology, minimally invasive procedures have appeared in the surgery of benign and malignant breast diseases. In general , such interventions result in significantly reduced breast and chest wall scars, shorter hospitalization and less pain, but they require specific, expensive devices, longer surgical time compared to open surgery. Furthermore, indications or oncological safety have not been established yet. It is quite likely, that minimally invasive surgical procedures with high-tech devices - similar to other surgical subspecialties -, will gradually become popular and it may form part of routine breast surgery even. Vacuum-assisted core biopsy with a therapeutic indication is suitable for the removal of benign fibroadenomas leaving behind an almost invisible scar, while endoscopically assisted skin-sparing and nipple-sparing mastectomy, axillary staging and reconstruction with latissimus dorsi muscle flap are all feasible through the same short axillary incision. Endoscopic techniques are also suitable for the diagnostics and treatment of intracapsular complications of implant-based breast reconstructions (intracapsular fluid, implant rupture, capsular contracture) and for the biopsy of intracapsular lesions with uncertain pathology. Perception of the role of radiofrequency ablation of breast tumors requires further hands-on experience, but it is likely that it can serve as a replacement of surgical removal in a portion of primary tumors in the future due to the development in functional imaging and anticancer drugs. With the reduction of the price of ductoscopes routine examination of the ductal branch system, guided microdochectomy and targeted surgical removal of terminal ducto-lobular units or a "sick lobe" as an anatomical unit may become feasible. The paper presents the experience of the authors and provides a literature review, for the first time in Hungarian language on the subject. Orv. Hetil., 2014, 155(5), 162-169.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Gusztáv Gulyás
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Csaba Kunos
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Akos Sávolt
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Emil Farkas
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - András Szollár
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
| | - Miklós Kásler
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth György u. 7-9. 1122
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Mátrai Z, Kunos C, Pukancsik D, Sávolt A, Gulyás G, Kásler M. [Modern breast reconstruction with endoscopically assisted latissimus dorsi flap harvesting]. Orv Hetil 2014; 155:106-13. [PMID: 24412949 DOI: 10.1556/oh.2014.29782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Skin- and nipple-sparing mastectomies made immediate breast reconstruction possible on a systemic level within breast cancer surgery. Mass reconstruction needs brought by the most common malignancy in women can only be met by the use of implant-based techniques, providing excellent cosmetic results and high patient satisfaction. For these postmastectomy reconstructions the replacement of the skin is no longer a challenge, but the well vascularized, good quality soft tissue coverage of the implant. Oncoplastic breast surgery today is able to conduct oncologically radical complete removal of the glandular tissue through an incision of 6-10 cm made in the armpit, with the nearly scarless retention of the natural skin envelope of the breast, and in the same time adequate axillary staging (sentinel node biopsy/axillary lymphadenectomy) is performed, then using the same incision, the implementation of one-step or multi-step breast reconstruction is possible. During these complex interventions, the latissimus dorsi flap formed by endoscopic technique (leaving no scar on the back), rotated to the anterior chest wall can be used for total autologous reconstruction of low-volume breasts as complete coverage of implants placed under the spared skin-envelope or for revitalization of thin or radiation damaged breast skin. This paper presents 4 cases of breast reconstruction with endoscopically assisted latissimus dorsi muscle flap, and the authors demonstrate the surgical technique in detail and conduct a literature review, for the first time in Hungarian.
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Affiliation(s)
- Zoltán Mátrai
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1122
| | - Csaba Kunos
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1122
| | - Dávid Pukancsik
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1122
| | - Akos Sávolt
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1122
| | - Gusztáv Gulyás
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1122
| | - Miklós Kásler
- Országos Onkológiai Intézet Emlő- és Lágyrészsebészeti Osztály Budapest Ráth Gy. u. 7-9. 1122
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