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Smit JM, Plat VD, van Est MLQ, van der Velde S, Daams F, Negenborn VL. Clinical outcomes of breast reconstruction using omental flaps: A systematic review. JPRAS Open 2024; 42:10-21. [PMID: 39279848 PMCID: PMC11399463 DOI: 10.1016/j.jpra.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 09/18/2024] Open
Abstract
Background Breast cancer is the most common cancer in women, and breast reconstruction improves the patient's quality of life. Autologous breast reconstruction provides benefits of natural appearance, feel, and long-term results without implant-associated problems. However, thin patients are not always suitable for standard autologous reconstructions. In these patients, an omental flap could be a useful alternative. The aim of this review was to provide an overview of the literature regarding the clinical outcomes of omental flaps in breast reconstruction. Methods A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Medline and Embase databases up to November 1, 2023. Study outcomes were type of flap, tissue transfer, cosmetic outcomes, and short- and long-term complications. Results Eleven studies covering 985 reconstructions in 969 patients were included. The omentum was mostly laparoscopically harvested (88.6%) and a pedicled reconstruction was mostly performed (91.2%). The most commonly reported short-term complications were wound infections at the donor site (5.8%), partial flap necrosis, and fat necrosis. In the long term, epigastric, umbilical and tunnel hernias, and epigastric bulging were observed. Satisfactory cosmetic results were reported by the patients (88.7%) and professionals (80.0%). Conclusion Breast reconstruction using an omental flap can be performed in unilateral reconstructions with acceptable donor-site morbidity if laparoscopically harvested. In general, satisfactory cosmetic outcomes were reported and it appears to be a suitable alternative for selected patients who prefer autologous, unilateral breast reconstruction. Further research is necessary to determine the ideal candidates for this reconstruction and the long-term effects of an omentectomy in young patients.
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Affiliation(s)
- Jan Maerten Smit
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Victor D Plat
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Marijn L Q van Est
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Susanne van der Velde
- Department of Surgical Oncology, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
| | - Vera L Negenborn
- Department of Plastic, Reconstructive- and Hand surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, The Netherlands
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2
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Liu H, He X, Li L, Wan NB. Laparoscopically harvested omental flap for immediate breast reconstruction: a retrospective single-center study of 300 cases. World J Surg Oncol 2024; 22:97. [PMID: 38622606 PMCID: PMC11020457 DOI: 10.1186/s12957-024-03377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The laparoscopically harvested omental flap (LHOF) has been used in partial or total breast reconstruction, but most studies on LHOF were case reports or small case series. However, the clinical feasibility and oncological safety of LHOF in oncoplastic breast surgery remains controversial. This study reported our experience applying LHOF for immediate breast reconstruction. METHODS Between June 2018 and March 2022, 300 patients underwent oncoplastic breast surgery using LHOF at our institution. Their clinicopathological data, complications, cosmetic outcomes, and oncologic outcomes were evaluated. RESULTS All patients underwent total breast reconstruction using LHOF after nipple-sparing mastectomy. The median operation time was 230 min (ranging from 155 to 375 min). The median operation time for harvesting the omental flap was 55 min (ranging from 40 to 105 min). The success rate of the laparoscopically harvested pedicled omental flap was over 99.0%. Median blood loss was 70 ml, ranging from 40 to 150 ml. The volume of the flap was insufficient in 102 patients (34.0%). The overall complication rate was 12.3%. Subcutaneous fluid in the breast area (7%) was the most common reconstruction-associated complication, but most cases were relieved spontaneously. The incidence rate of omental flap necrosis was 3.3%. LHOF-associated complications occurred in two cases, including one case of incisional hernia and one case of vascular injury. Cosmetic outcomes were satisfactory in 95.1% of patients on a four-point scale by three-panel assessment and 97.2% using the BCCT.core software. Two local and one systemic recurrence were observed during a median follow-up period of 32 months. CONCLUSIONS The LHOF for immediate breast reconstruction is a safe and feasible method that involves minimal donor-site morbidity, satisfactory cosmetic outcomes, and promising oncologic safety.
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Affiliation(s)
- Hao Liu
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China.
| | - Xiao He
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Li Li
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
| | - Neng-Bin Wan
- The Second Department of Breast Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, Hunan, China
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Wang ZH, Gang TR, Wu SS, Lu C, Gao GX, Xu W, Ding GQ, Qu X, Zhang ZT. Single-port endoscopic-sentinel lymph node biopsy combined with indocyanine green and carbon nanoparticles in breast cancer. Surg Endosc 2023; 37:7591-7599. [PMID: 37460818 PMCID: PMC10520094 DOI: 10.1007/s00464-023-10018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/12/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND In order to explore the surgical safety and the reliability of axillary staging of single-port endoscopic-sentinel lymph node biopsy, we combined it with indocyanine green that was excited by near-infrared fluorescence endoscopy and carbon nanoparticles as a tracer and compared this method to conventional open sentinel lymph node biopsy. METHODS This is a retrospective and observational study, there were 20 patients in each group and the total sample size was 60: Group 1, single-port endoscopic-sentinel lymph node biopsy combined with indocyanine green and carbon nanoparticles; Group 2, single-port endoscopic-sentinel lymph node biopsy with carbon nanoparticles only; Group 3, conventional sentinel lymph node biopsy with indocyanine green and carbon nanoparticles. Sentinel lymph node detection and upper extremity function were determined to measure the safety and efficacy of the novel single-port endoscopic-sentinel lymph node biopsy (SPE-SLNB) technique to the standard conventional sentinel lymph node biopsy technique. RESULTS The detection rate of sentinel lymph nodes was 100% in Group 1, 100% in Group 2, and 95% in Group 3. There were no significant differences in upper arm function and pain scores between the three groups. CONCLUSION The novel technique of combining indocyanine green and carbon nanoparticles with single-port endoscopic-sentinel lymph node biopsy achieved a similar detection rate and mean number of sentinel lymph nodes as conventional sentinel lymph node biopsy. Traditional open surgery requires two different incisions for breast surgery and SLNB. While the most important advantage of SPE-SLNB is that two procedures can be effectively performed through a single-port in the axilla Therefore, for patients who meet the indications, single-port endoscopic-sentinel lymph node biopsy is as safe and reliable as conventional sentinel lymph node biopsy but has the aesthetic advantage of only one incision.
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Affiliation(s)
- Zi-Han Wang
- Department of Breast Disease, Peking University People's Hospital, Beijing, 100044, China
| | - Tian-Ran Gang
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Shan-Shan Wu
- Department of Clinical Epidemiology and Evidence-Based Medicine, Beijing Friendship Hospital, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Can Lu
- Department of Breast Surgery, Beijing Daxing District Maternal and Child Health Hospital, Beijing, China
| | - Guo-Xuan Gao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Wei Xu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Guo-Qian Ding
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Xiang Qu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
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Wang B, Ou C, Yu J, Ye J, Luo Y, Wang Y, Zhang P. Three-dimensional visual technique based on CT lymphography data combined with methylene blue in endoscopic sentinel lymph node biopsy for breast cancer. Eur J Med Res 2022; 27:274. [PMID: 36464689 PMCID: PMC9719621 DOI: 10.1186/s40001-022-00909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 11/21/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND The combined application of blue dye and radioisotopes is currently the primary mapping technique used for sentinel lymph node biopsy (SLNB) in breast cancer patients. However, radiocolloid techniques have not been widely adopted, especially in developing countries, given the strict restrictions on radioactive materials. Consequently, we carried out a retrospective study to evaluate the feasibility and accuracy of three-dimensional visualization technique (3DVT) based on computed tomography-lymphography (CT-LG) in endoscopic sentinel lymph node biopsy (ESLNB) for breast cancer. METHODS From September 2018 to June 2020, 389 patients who underwent surgical treatment of breast cancer in our department were included in this study. The CT-LG data of these patients were reconstructed into digital 3D models and imported into Smart Vision Works V1.0 to locate the sentinel lymph node (SLN) and for visual simulation surgery. ESLNB and endoscopic axillary lymph node dissection were carried out based on this new technique; the accuracy and clinical value of 3DVT in ESLNB were analyzed. RESULTS The reconstructed 3D models clearly displayed all the structures of breast and axilla, which favors the intraoperative detection of SLNs. The identification rate of biopsied SLNs was 100% (389/389). The accuracy, sensitivity, and false-negative rate were 93.83% (365/389), 93.43% (128/137), and 6.57% (9/137), respectively. Upper limb lymphedema occurred in one patient 3 months after surgery during the 12-month follow-up period. CONCLUSIONS Our 3DVT based on CT-LG data combined with methylene blue in ESLNB ensures a high identification rate of SLNs with low false-negative rates. It, therefore, has the potential to serve as a new method for SLN biopsy in breast cancer cases.
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Affiliation(s)
- Baiye Wang
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Caifeng Ou
- Present Address: Department of Breast Care Surgery, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080 China
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
| | - Jingang Yu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, Guangdong China
| | - Jianping Ye
- Shenzhen Smart Vision Co. LTD., Shenzhen, Guangdong China
| | - Yunfeng Luo
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
| | - Yu Wang
- Department of Pathology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong China
| | - Pusheng Zhang
- Department of Breast Surgery, Zhujiang Hospital, Southern Medical University, 253, Gongye Dadao Zhong, Haizhu District, Guangzhou, 510282 Guangdong China
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5
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Luo C, Wei C, Guo W, Yang J, Sun Q, Wei W, Wu S, Fang S, Zeng Q, Zhao Z, Meng F, Huang X, Zhang X, Li R, Ma X, Luo C, Yang Y. 17-Year Follow-up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicenter, Randomized Controlled Trial. Adv Ther 2022; 39:2961-2970. [PMID: 35486221 DOI: 10.1007/s12325-022-02152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Longer follow-up was necessary to determine the exact value of mastoscopic axillary lymph node dissection (MALND). METHODS From January 1, 2003, to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection); 996 eligible patients were enrolled. RESULTS The final cohort of 996 patients was followed for an average of 198 months. Events other than death differed significantly between the two cohorts (p = 0.0311; 46.3% in MALND and 53.2% in CALND, respectively). The sum of events other than death and deaths from other causes was much higher in the CALND (59.6%) than MALND (53.4%) group (p = 0.0494). The 17-year disease-free survival DFS rates were 36.7% for the MALND and 33.6% for the CALND group, respectively. There was a significant difference between the groups (p = 0.0306). Overall survival (OS) rates were 53.2% after MALND and 46.0% after CALND (p = 0.0119). MALND patients had much less axillary pain (p = 0.0000), numbness or paresthesia (p = 0.0000), arm mobility (p = 0.0000) and arm swelling on the operated side (p = 0.0000). Aesthetic appearance of the axilla was much better in the MALND than CALND group (p = 0.0000) at an average follow-up of 17 years. CONCLUSIONS The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed. TRIAL REGISTRATION INFORMATION The comparison of long-term outcomes of mastoscopic and conventional axillary lymph node dissection in breast cancer: a multicenter randomized control trial. ChiCTR-TRC-11001477, CHiCTR. First registration 08/14/2011.
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Affiliation(s)
- Chengyu Luo
- Breast Surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Changsheng Wei
- Breast Surgery, Affiliated Beijing Anzhen Hospital, Capital Medical University, No 2, Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Wenbin Guo
- Breast Surgery, Affiliated Da Lian Hospital, Dalian Medical University, Dalian, China
| | - Jie Yang
- Breast Surgery, Affiliated Foshan Hospital, Zhongshan University, Fushan, China
| | - Qiuru Sun
- Breast Surgery, Affiliated Wei Hai Hospital, Medical College of Qingdao University, Qingdao, China
| | - Wei Wei
- Breast Surgery, Shenzhen Hospital, Beijing University, Shenzhen, China
| | - Shuhua Wu
- General Surgery, Heibei Concord Hospital, Hebei Medical University, Tangshan, China
| | - Shubing Fang
- Breast Surgery, Affiliated Hospital, Anhui Medical University, Hefei, China
| | - Qingliang Zeng
- General Surgery, Affiliated Hospital, Zunyi Medical College, Zunyi, China
| | - Zhensheng Zhao
- Breast Surgery, Affiliated Hospital, Capital Medical University Yanjing College, Shijianzhuang, China
| | - Fanjie Meng
- General Surgery, Huabei Petroleum General Hospital, University of Chinese Academy of Sciences, Cangzhou, China
| | - Xuandong Huang
- Breast Surgery, Affiliated Huaian Hospital, Nanjing Medical University, Huaian, China
| | - Xianlan Zhang
- Affiliated Hospital, Guilin Medical University Affiliated Hospital, Guilin, China
| | - Ruihua Li
- General Surgery, Affiliated Shunde Hospital, Guangdong Medical University, Shunde, China
| | - Xiufeng Ma
- Gansu Maternal and Child Care Center, Lanzhou, China
| | - Chaoying Luo
- Affiliated Xinjiang Kelamayi Central Hospital, Xinjiang Medical University, Kelamayi, China
| | - Yun Yang
- Department of Epidemiology and Health Statistics, Capital Medical University, Beijing, China
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6
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Wang ZH, Xin P, Qu X, Zhang ZT. Breast reconstruction using a laparoscopically harvested pedicled omental flap after endoscopic mastectomy for patients with breast cancer: an observational study of a minimally invasive method. Gland Surg 2020; 9:676-688. [PMID: 32775257 PMCID: PMC7347812 DOI: 10.21037/gs.2020.04.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/27/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Breast reconstruction is typically performed using autologous tissue from a laparoscopically harvested omental flap. Because open surgery and another abdominal wall incision for a subcutaneous tunnel cannot be avoided, minimal scars typically cannot be achieved. This study explored a minimally invasive method of pedicled omental flap breast reconstruction in which omentum harvesting, mastectomy, and subcutaneous tunnel establishing were performed laparoscopically and endoscopically, and large incisions on the thoracic and abdominal wall were unnecessary. METHODS Ten patients with breast cancer were enrolled. They underwent endoscopic subcutaneous mastectomy (ESM) and single-stage breast reconstruction using a laparoscopically harvested pedicled omental flap (LHPOF), which was pulled through a subcutaneous tunnel that was created under laparoscopic vision. The incisions made on the abdominal wall were no wider than 12 mm, and the thoracic wall incisions were no wider than 30 mm. Three of the patients had a prosthetic implant placed for reconstruction at the same time because of the large breast volume, and the omental flaps were used to cover the prostheses. RESULTS All patients underwent successful single-stage breast reconstruction surgery, and laparotomy was not required. Eight of the patients (80%) had satisfactory aesthetic results (five had excellent results and three had good results). The incisions at the thoracic wall and in the donor site area were short and hidden. The mean operation time was 367.6 min and the mean time for harvesting the omental flap was 62.9 min, similar to previous studies. The total mean blood loss was 37.0 mL. No serious donor-site complications occurred. CONCLUSIONS LHPOF breast reconstruction combined with ESM is minimally invasive, and satisfactory aesthetic results are achievable. In patients who undergo ESM combined with prosthetic implant reconstruction, the pedicled omental flap can be used to cover the prosthesis instead of using acellular dermal matrix.
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Affiliation(s)
- Zi-Han Wang
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
| | - Pei Xin
- Surgical Oncology Department, Beijing Chuiyangliu Hospital, Beijing 100000, China
| | - Xiang Qu
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
| | - Zhong-Tao Zhang
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, Beijing 100000, China
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Spinelli R, Lanthaler M, Tasch C, Nitto A, Pierer G, Bauer T. Breast reconstruction with the omentum flap: a case report with unsatisfactory outcome and review of the literature. Eur Surg 2019. [DOI: 10.1007/s10353-019-00621-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Summary
Background
Recently, breast reconstruction with the greater omentum flap has gained more attention, although it has been only rarely reported in the literature. An unpleasant case presented by us here prompted us to perform a literature search on breast reconstruction with the omentum flap concerning postoperative results and complication rates.
Case presentation
We here present the case of a 46-year-old woman who presented with severe infection 3 months after omentum flap reconstruction in a distant local hospital. Intraoperative revision showed an inflammatory, completely necrotic flap that had to be removed.
Conclusion
The literature review shows that the omentum flap can be reasonably used only in one-sided reconstructions of very small breasts. Due to the limited indications, unpredictable flap volume, and our negative experience, we recommend that this type of reconstruction be used with restraint.
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Shen G, Yu X. Application value of laparoscopy in radical mastectomy and omental breast reconstruction. Oncol Lett 2019; 18:645-650. [PMID: 31289537 PMCID: PMC6540348 DOI: 10.3892/ol.2019.10339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022] Open
Abstract
Application value of laparoscopy in radical mastectomy and omental breast reconstruction was explored. The medical records of 104 patients undergoing radical mastectomy and omental breast reconstruction from July 2015 to August 2017 in Inner Mongolia Xing'an League People's Hospital were retrospectively analyzed. Fifty-three patients undergoing laparoscopic surgery were the experimental group and 51 patients undergoing open surgery were the control group. The surgery conditions, upper limb function, postoperative complications, volume similarity between unilateral subcutaneous glands and autologous omentum, cosmetic excellent rate and treatment satisfaction were observed. The surgical duration of the patients in the experimental group was significantly longer than that in the control group, but the intraoperative blood loss was less and hospital stay was significantly shorter than that in the control group (P<0.05). The improvement of upper limb function in the experimental group was significantly better than that in the control group (P<0.05). The cosmetic excellent rate in the experimental group was significantly higher than that in the control group (P<0.001). The incidence of postoperative complications in the experimental group was significantly less than that in the control group (P<0.001). The satisfaction degree of patients in the experimental group was significantly higher than that in the control group (P<0.001). Filling the autologous omentum while excising the unilateral mammary gland is an equivalent replacement, which can make the appearance of the breast on the operation side similar to that on the healthy side, thus improving the excellent rate of breast beauty and patient satisfaction.
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Affiliation(s)
- Guangtai Shen
- Department of Breast Surgery, Inner Mongolia Xing'an League People's Hospital, Ulanhot, Inner Mongolia 137400, P.R. China
| | - Xiaoqiang Yu
- Department of Breast Surgery, Inner Mongolia Xing'an League People's Hospital, Ulanhot, Inner Mongolia 137400, P.R. China
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Zhang P, He L, Shi F, Deng J, Fang C, Luo Y. Three-dimensional visualization technique in endoscopic breast-conserving surgery and pedicled omentum for immediate breast reconstruction. Surg Oncol 2019; 28:103-108. [PMID: 30851881 DOI: 10.1016/j.suronc.2018.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the three-dimensional visualization technique (3DVT) in endoscopic breast-conserving surgery (EBCS) and pedicled omentum for immediate breast reconstruction. METHODS Clinical data of 256-slice multi-detector CT scanning from 52 patients (group A) were introduced into self-developed Medical Imaging 3D Visualization Systems (MI-3DVS) for individualized segmentation, 3D reconstruction and volume calculation. The surgical process was designed according to the 3D model. Next, the EBCS and pedicled omentum breast reconstruction were performed according to the preoperative design. Finally, the operating time, blood loss, length of postoperative hospital stay, complications and cosmetic outcomes in group A were compared to 44 patients in group B, who underwent the same operation without 3DVT. RESULTS The 3DVT can be used to analyze the location of the breast tumors and determine the excision extension of the breast precisely. Compared to group B, group A had the advantage of less bleeding, shortened operating time and earlier discharge (p < 0.05). The cosmetic results of group A were more satisfactory than those of group B (p < 0.05). After a postoperative follow-up of 6-30 months, none of the patients in either group showed any signs of recurrence. CONCLUSIONS 3DVT can be used to design the surgical process preoperatively and results in positive therapeutic and cosmetic outcomes in EBCS and pedicled omentum for immediate breast reconstruction.
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Affiliation(s)
- Pusheng Zhang
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Linyun He
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Fujun Shi
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Jianwen Deng
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Yunfeng Luo
- Department of General Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
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Shash H, Al-Halabi B, Aldekhayel S, Dionisopoulos T. Laparoscopic Harvesting of Omental Flaps for Breast Reconstruction-A Review of the Literature and Outcome Analysis. Plast Surg (Oakv) 2018; 26:126-133. [PMID: 29845051 DOI: 10.1177/2292550317731762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Evidence on the use of omental flaps for breast reconstruction in patients with breast cancer is lacking, and no published reviews report an outcome-based assessment of such flap. This review explores available data and evidence for change in complication rates following the shift toward laparoscopic harvesting. Methods We searched the databases Excerpta Medica database, MEDLINE, and PubMed from inception until December 2015 using search terms "omental flaps" and "breast reconstruction." Data extracted were patient characteristics, technique used, and outcome measures reported and were then analyzed based on the technique of harvesting. Results Twenty-two articles reporting 651 patients who underwent mastectomies and breast-conserving surgeries were included in this review. Most flaps, 537 (82.5%), were harvested by laparoscopy, and 626 (96.2%) of the flaps were pedicle flaps. The mean age was 47.7 years (standard deviation: 4.29), and mean follow-up was 38.1 months. There were 88 reported complications among 562 patients in 16 reports. The rate of any complication was calculated to be 15.0%, with a higher rate (29.1%) occurring with the open technique in comparison to laparoscopy (12.6%). The commonest complications were postoperative infection and breast firmness each reported in 2.22%. Most authors reported advantages of malleability and excellent aesthetic outcomes and disadvantages in terms of inability to estimate the volume of the flap and variability in size. Conclusion Omentum use is safe and has advantages in breast reconstruction where other options are limited including a natural feeling and minimal donor site morbidity if harvested laparoscopically.
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Affiliation(s)
- Hani Shash
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QuGill, Canada
- Department of Plastic Surgery, King Faisal University College of Medicine, Eastern Province, Saudi Arabia
- Saudi Arabia Cultural Bureau, Ottawa, Ontario, Canada
| | - Becher Al-Halabi
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QuGill, Canada
| | - Salah Aldekhayel
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QuGill, Canada
| | - Tassos Dionisopoulos
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QuGill, Canada
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11
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Ni C, Zhu Z, Xin Y, Xie Q, Yuan H, Zhong M, Xia W, Zhu X, Lv Z, Song X. Oncoplastic breast reconstruction with omental flap: A retrospective study and systematic review. J Cancer 2018; 9:1782-1790. [PMID: 29805704 PMCID: PMC5968766 DOI: 10.7150/jca.25556] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/05/2018] [Indexed: 11/05/2022] Open
Abstract
The increasing frequency of early breast cancer cases has driven an increasing number of patients to choose immediate reconstruction with an autologous flap. Omentum-flap-based breast reconstruction is a unique strategy that is highly suitable for repairing moderate tissue defects. However, all available evidence comes from individual reports with small numbers of cases, and the overall effectiveness and safety of the procedure have yet to be reported. Here, we reported 7 cases of laparoscopically harvested omental free flap breast reconstruction and performed a systematic review to assess the applicability and safety of this approach. The data were gathered from MEDLINE, Ovid, Google Scholar and the China Knowledge Resource Integrated Database. In total, we combined 15 articles (410 cases) for analysis. The data revealed that almost all patients (87.6%) were reported to have undergone laparoscopy instead of laparotomy; pedicle flaps were used in 90.9% of the cases, while only 5 (37 cases) used free flaps for reconstruction; and 96.6% (396/410) of all reconstruction procedures were immediate. Almost all of these cases had a small tumour burden (T0/Tis/T1 59.8%; T2 36.8%), and the distribution of tumour location was similar among the four quadrants. The cosmetic outcomes were desirable in most cases (83.9%). There were 41 complications identified in the dataset: partial graft necrosis accounted for the largest percentage (41.5%) of all events, followed by skin necrosis (19.5%), haematoma (12.2%) and wound infection (9.8%). During the follow-up period, which had a short median duration, 2 cases of tumour recurrence were reported. Overall, our systematic review found that omentum-flap-based breast reconstruction could achieve a satisfactory aesthetic outcome, especially for small breasts and tissue replacement after breast-conserving surgery, and the safety of the procedure was also acceptable.
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Affiliation(s)
- Chao Ni
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China.,Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province
| | - Ziguan Zhu
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Yin Xin
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Qingping Xie
- Department of Hand Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Hongjun Yuan
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Miaochun Zhong
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Wenjie Xia
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Xiaoyan Zhu
- Department of General Surgery, Haining Central Hospital, Haining, Zhejiang 314408, P.R. China
| | - Zhengye Lv
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. China
| | - Xiangyang Song
- Department of Breast and Thyroid Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang 310014, P.R. 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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Immediate liposuction could shorten the time for endoscopic axillary lymphadenectomy in breast cancer patients. World J Surg Oncol 2017; 15:35. [PMID: 28137289 PMCID: PMC5282818 DOI: 10.1186/s12957-017-1106-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 01/24/2017] [Indexed: 11/30/2022] Open
Abstract
Background Endoscopic axillary lymphadenectomy (EALND) was introduced to clinical work to reduce side effects of conventional axillary lymphadenectomy, while the lipolysis and liposuction of EALND made the process consume more time. The aim of the study was to determine whether immediate liposuction after tumescent solution injection to the axilla could shorten the total time of EALND. Methods Fifty-nine patients were enrolled in the study, 30 of them received EALND with traditional liposuction method (TLM), and the rest 29 patients received EALND with immediate liposuction method (ILM). The operation time, cosmetic result, drainage amount, and hospitalization time of the two groups were compared. Results The median EALND operation time of TLM group and ILM group were 68 and 46 min, respectively, the difference was significant (P < 0.05); the median cosmetic results of the two groups were 6.6 and 6.4, respectively; the median drainage amount of the two groups were 366 and 385 ml, respectively; the hospitalization time of the two groups were 15 and 16 days, respectively. For the last three measures, no significant difference was confirmed (P > 0.05). Conclusions Our work suggests immediate liposuction could shorten the endoscopic axillary lymphadenectomy process, and this method would not compromise the operation results. However, due to the limitations of the research, more work needs to be done to prove the availability and feasibility of immediate liposuction.
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