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Jung SM, Kim YJ, Lee KT, Jeon BJ, Mun GH, Pyon JK, Ryu JM. Learning curve for robot-assisted nipple-sparing mastectomy: A single institution experience. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108602. [PMID: 39167863 DOI: 10.1016/j.ejso.2024.108602] [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: 04/20/2024] [Revised: 07/11/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Robot-assisted nipple sparing mastectomy (RANSM) is emerging because it offers hidden incisions and ergonomic movements. In this study, we report the learning curve and feasibility of RANSM. METHODS A retrospective study was conducted among women who underwent RANSM with immediate breast reconstruction from July 2019 to June 2022. All RANSM procedures were performed by a single surgeon. We divided all the cases into two phases: the early phase (cases 1 to 21) and the late phase (cases 22 to 46). The total operation time, breast operation time, docking time, and console time were analyzed, and the cumulative sum (CUSUM) method was used to evaluate the effects of case experience accumulation on the time required for RANSM. Postoperative complications were analyzed according to their Clavien-Dindo grade. RESULTS Overall, 42 women underwent 46 RANSM procedures. In the early and late phases, the mean console times were 78.1 min and 60.1 min (p = 0.011), respectively. In learning curve analysis, 21 RANSM procedures were required to reduce the breast operation time. Two cases of Clavien-Dindo grade III postoperative complications occurred (4.3 %). One case was an implant removal caused by infection, and the other was partial nipple ischemia; both occurred in the early phase, with none in the late phase. CONCLUSIONS The breast operation time improved after the 21st RANSM procedure, and only two cases had Clavien-Dindo grade III or higher postoperative complications. RANSM is thus technically feasible and acceptable, with a short learning curve.
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Affiliation(s)
- Sung Mi Jung
- Division of Breast Surgery, Department of Surgery, Seoul Medical Center, Seoul, South Korea
| | - Yeon Jin Kim
- Breast Division, Department of Surgery, Myongji Hospital, Gyeonggi-do, South Korea
| | - Kyeong-Tae Lee
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung-Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Goo-Hyun Mun
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jai-Kyong Pyon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jai Min Ryu
- Division of Breast Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
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Dai H, Chung K, Liang F, Xie Y, Zhang Q, Qiu M, Yang H, Zhou J, Feng Y, Du Z. Safety and aesthetic outcomes of double purse-string suture nipple reconstruction in early breast cancer patients undergoing nipple resection and endoscopic skin-sparing mastectomy with breast reconstruction. Front Oncol 2024; 14:1462850. [PMID: 39411139 PMCID: PMC11476627 DOI: 10.3389/fonc.2024.1462850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 09/09/2024] [Indexed: 10/19/2024] Open
Abstract
Background The current surgical methods for managing incisions after nipple excision in breast reconstruction patients are limited. However, double purse-string suture (DPS) shows promise in the treatment of nipple excision. This study aimed to investigate the safety and aesthetic outcomes of DPS nipple reconstruction in early breast cancer patients who underwent endoscopic skin-sparing mastectomy (E-SSM) and breast reconstruction. Methods We retrospectively analyzed the clinical data of 87 early breast cancer patients with nipple excision who underwent E-SSM with breast reconstruction. According to the suture methods of nipple incision, all patients were divided into the spindle suture (SS) group, single purse-string suture (SPS) group, and DPS group, with SS and SPS groups combined as the traditional suture (TS) group. Then, we compared the groups' differences in aesthetic outcomes, surgical safety, and oncological safety. Results A total of 87 patients with 88 breasts were enrolled in this study (SS n=17, SPS n=21, DPS n=50). Patients in the DPS group had significantly better nipple reconstruction satisfaction, Harris scale and any complications incidence than the TS group (all p <0.05). For nipple reconstruction satisfaction and any complication, the adjusted OR (95%CI) of the DPS group were 6.314(1.095-36.415) (p=0.039) and 0.124(0.018-0.863) (p=0.035) compared with the SS group. One patient in the SS group had vertebral metastases, and no recurrence, metastasis, or death has been observed in the other two groups during the follow-up period. Conclusions DPS is an effective and safe nipple reconstruction procedure for patients undergoing E-SSM with breast reconstruction, delivering excellent aesthetic outcomes.
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Affiliation(s)
- Hui Dai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Kawun Chung
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxue Qiu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huanzuo Yang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiao Zhou
- Department of Thyroid and Breast Surgery, The First People’s Hospital of Ziyang, Sichuan University, Ziyang, China
| | - Yu Feng
- Department of General Surgery, The Fourth People’s Hospital of Sichuan Province, Chengdu, China
| | - Zhenggui Du
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
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Yang H, Liang F, Feng Y, Qiu M, Chung K, Zhang Q, Du Z. Single Axillary Incision Reverse Sequence Endoscopic Nipple-Sparing Mastectomy in the Management of Gynecomastia: Short-Term Cosmetic Outcomes, Surgical Safety, and Learning Curve of the Preliminary 156 Consecutive Procedures from a Prospective Cohort Study. Aesthetic Plast Surg 2024; 48:3120-3127. [PMID: 37957390 DOI: 10.1007/s00266-023-03727-y] [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: 08/12/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Currently, a standard, optimal surgical procedure is still lacking for gynecomastia. Despite the development of a variety of surgical interventions, these techniques were often limited to patients with Simon I and II. The present study aimed to introduce a novel technique for all types and grades of gynecomastia, and reported the preliminary results. METHODS Patients who received single axillary incision reverse sequence endoscopic nipple-sparing mastectomy (R-E-NSM) from March 2021 to March 2023 were enrolled at a single institution. The data from 3-month follow-up cut-off were collected prospectively and analyzed to determine the short-term esthetic and safety results of this technique, as well as the learning curve. RESULTS A total of 159 single axillary incision reverse sequence endoscopic nipple-sparing mastectomy procedures were performed in 81 gynecomastia patients. Among these 81 patients, 7 patients (8.6%) were classified as Simon grade I, 29 patients (35.8%) as grade IIa, 24 patients (29.6%) as grade IIb, and 21 patients (25.9%) as grade III. In the patient-reported cosmetic results, the overall satisfaction score was 8.4 ± 1.4. A total of 74.1% of patients were highly satisfied, and 25.9% were satisfied. The overall complication rate was 10.1%, and only 1 patient had a major complication. According to the cumulative sum plot analysis, approximately 12 cases were needed for surgeon B and 11 cases for surgeon C to decrease their operation time significantly. CONCLUSIONS R-E-NSM is safe and effective for all Simon grade gynecomastia patients, with excellent cosmetic results and a short learning curve. However, a long-term follow-up assessment is still needed. 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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Affiliation(s)
- Huanzuo Yang
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Faqing Liang
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Yu Feng
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, The Fourth People's Hospital of Sichuan Province, 12 Chengshoudong Street, Jinjiang District, Chengdu, 610016, China
| | - Mengxue Qiu
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Kawun Chung
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Qing Zhang
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
| | - Zhenggui Du
- Breast Centre, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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Qiu M, Liang F, Xie Y, Yang H, Zhang Q, Zhong J, Dai H, Du Z. Clinical Outcomes of Transaxillary Reverse-Sequence Endoscopic Nipple-Sparing Mastectomy and Direct-to-Implant Prepectoral Breast Reconstruction: A Prospective Study of Initial 68 Procedures. Ann Surg Oncol 2024; 31:2777-2785. [PMID: 38334846 DOI: 10.1245/s10434-023-14687-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/12/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND Minimal access breast surgery improves cosmetic outcomes over conventional breast surgery but still faces barriers in becoming standard procedure for breast reconstruction. This report introduces a novel technique of transaxillary reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) followed by direct-to-implant prepectoral breast reconstruction (DTI-PBR) and describes its clinical outcomes. METHODS This prospective study enrolled patients who underwent R-E-NSM and DTI-PBR from March 2021 to December 2021 at a single institution. Perioperative data, surgical complications, oncologic outcomes, and patient- and surgeon-reported cosmetic results were noted. RESULTS The 60 patients in this study who underwent 68 R-E-NSM and DTI-PBR had a mean age was 40.4 ± 10.3 years. The average durations of uni- and bilateral operations were 156.5 ± 48.3 min and 191.3 ± 36.1 min, respectively. The overall surgical complication rate was 13.3%, including 10.0% of patients with minor complications and 3.3% of patients with major complications. The study had one case (1.7%) of implant loss and one case (1.7%) of skin flap necrosis treated by reoperation. During the median follow-up period of 24 months, one patient (1.7%) who discontinued chemotherapy for myelosuppression experienced liver metastases 5 months postoperatively, and one patient experienced new-onset contralateral ductal carcinoma in situ 24 months postoperatively. The preoperative and 18-month postoperative Breast-Q scores for satisfaction with breasts, psychosocial well-being, sexual well-being, and chest well-being did not differ significantly, and the Scar-Q was 81.2 ± 14.5 points. The good-to-excellent rate in surgeon-reported cosmetic results reached 90%. CONCLUSIONS Transaxillary R-E-NSM followed by DTI-PBR is a safe and efficient technique with high cosmetic outcomes and reliable medium-term oncologic results.
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Affiliation(s)
- Mengxue Qiu
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Huanzuo Yang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayuan Zhong
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Dai
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- Breast Centre, West China Hospital, Sichuan University, Chengdu, China.
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Chung K, Xie Y, Liang F, Qiu M, Yang H, Zhang Q, Dai H, Du Z. Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery. Front Oncol 2024; 14:1366877. [PMID: 38511135 PMCID: PMC10951398 DOI: 10.3389/fonc.2024.1366877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
Background Our center proposes a new technique that effectively provides space to broaden the surgical field of view and overcomes the limitations of endoscopy-assisted nipple-sparing mastectomy (E-NSM) by changing the dissection sequence and combining it with air inflation. The purpose of this study was to compare the clinical outcomes of the new technique designated "reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with subpectoral breast reconstruction (SBR)" and the conventional E-NSM (C-E-NSM) with SBR. Method All patients undergoing E-NSM with SBR at our breast center between April 2017 and December 2022 were included in this study. The cohort was divided into the C-E-NSM group and the R-E-NSM group. The operation time, anesthesia time, medical cost, complications, cosmetic outcomes, and oncological safety were compared. Results Twenty-six and seventy-nine consecutive patients were included in the C-E-NSM and R-E-NSM groups, with average ages of 36.9 ± 7.0 years and 39.7 ± 8.4 years (P=0.128). Patients in the R-E-NSM group had significantly shorter operation time (204.6 ± 59.2 vs. 318.9 ± 75.5 minutes, p<0.001) and anesthesia time (279.4 ± 83.9 vs. 408.9 ± 87.4 minutes, p<0.001) and decreased medical costs [5063.4 (4439.6-6532.3) vs. 6404.2 (5152.5-7981.5), USD, p=0.001] and increase SCAR-Q scores (77.2 ± 17.1 vs. 68.8 ± 8.7, P=0.002) compared to the C-E-NSM group. Although trends increased in both the excellent rate of Ueda scores (53.8% vs. 42.3%, P = 0.144), excellent rate of Harris scores (44.0% vs. 63.1%, P=0.102), and decreased surgical complications (7.6% vs. 19.2%, P = 0.135) were observed in the R-E-NSM group, the differences were not significant. There were no significant differences in oncological outcomes between the two groups. Conclusion R-E-NSM improves cosmetic outcomes and efficiency of C-E-NSM, reduces medical costs, and has a trend of lower surgical complications while maintaining the safety of oncology. It is a safe and feasible option for oncological procedures that deserves to be promoted and widely adopted in practice.
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Affiliation(s)
- Kawun Chung
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxue Qiu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huanzuo Yang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Dai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
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Feng Y, Liang F, Wen N, Yang H, Zhou J, Zhang S, Liu X, Qiu M, Xie Y, Du Z. An Innovative and Highly Efficient Single-Port Endoscopic Nipple-/Skin-Sparing Mastectomy and Dual-Plane Direct-to-Implant Breast Reconstruction: A Prospective Study from a Single Institution. Aesthetic Plast Surg 2024; 48:1133-1141. [PMID: 37253841 DOI: 10.1007/s00266-023-03402-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 04/30/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND The difficulty in creating and maintaining a stable workspace of the breast makes endoscopic nipple-/skin-spring mastectomy (E-N/SSM) develop slowly. This study aims to report the preliminary results of a novel endoscopic technique for N/SSM followed by dual-plane direct-to-implant (DP-DTI) breast reconstruction. METHODS A prospectively maintained database was reviewed that included patients who underwent single-axillary-incision E-N/SSM and DP-DTI breast reconstruction from September 2020 to April 2021 at a single institution by three surgeons. The data were collected prospectively and analyzed to determine the efficacy, feasibility, safety, and esthetic results of the operation, as well as quality of life (QoL). RESULTS During the study period, a total of 68 E-N/SSM and DP-DTI reconstruction procedures through a single axillary incision were performed in 63 female patients. Among all the procedures, the majority were performed for grade 1-3 ptotic breasts (n =46, 73.0%). During the median follow-up of 26.5 months, the major and minor surgical complication rates were 1.6% (1/63) and 9.5% (6/63), respectively. The cosmetic complication rate was 14.3%. One patient suffered local recurrence 4 months postoperation. The average scores in patient-reported outcomes at 2 years postoperation of satisfaction with breast (66.57), psychosocial well-being (75.93) and sexual well-being (56.29) were not significantly different compared with the baseline, except for physical well-being: chest (69.85). CONCLUSIONS The proposed procedure for E-N/SSM and DP-DTI breast reconstruction is feasible, time-saving and safe with good outcomes in terms of cosmetic results and QoL and expands the indications of DTI reconstruction to ptotic breasts, making it easier to popularize. 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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Affiliation(s)
- Yu Feng
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Faqing Liang
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Nan Wen
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Huanzuo Yang
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiao Zhou
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Songbo Zhang
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xinran Liu
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Mengxue Qiu
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yanyan Xie
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhenggui Du
- Breast Disease Research Center, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, People's Republic of China.
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Zhou J, Xie Y, Liang F, Feng Y, Yang H, Qiu M, Zhang Q, Chung K, Dai H, Liu Y, Liang P, Du Z. A novel technique of reverse-sequence endoscopic nipple-sparing mastectomy with direct-to-implant breast reconstruction: medium-term oncological safety outcomes and feasibility of 24-hour discharge for breast cancer patients. Int J Surg 2024; 110:01279778-990000000-01048. [PMID: 38348883 PMCID: PMC11020081 DOI: 10.1097/js9.0000000000001134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/24/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Due to the short operation time and no need for special instruments, reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with direct-to-implant breast reconstruction (DIBR) has been rapidly becoming popular in the last three years. However, there has yet to be an evaluation of its oncologic safety or the feasibility of discharging patients within 24 hours. MATERIALS AND METHODS In this single-center retrospective cohort study, individuals diagnosed with stage 0-III breast cancer between May 2020 and April 2022 who underwent traditional open mastectomy or R-E-NSM with DIBR were included. Follow-up started on the date of surgery and ended in December 2023. Data, including demographics, tumor characteristics, medium-term oncological outcomes, and postoperative complications, were collected and analyzed. Propensity score matching (PSM) was performed to minimize selection bias. RESULTS This study included 1679 patients (median [IQR] age, 50 [44-57] years). Of these, 344 patients underwent R-E-NSM with DIBR (RE-R group), and 1335 patients underwent traditional open mastectomy (TOM group). The median [IQR] follow-up time was 30 [24-36] months (29 [23-33] months in the RE-R group and 30 [24-36] months in the TOM group). Regarding before or after PSM, the P value of local recurrence-free survival (LRFS, 0.910 and 0.450), regional recurrence-free survival (RRFS, 0.780 and 0.620), distant metastasis-free survival (DMFS, 0.061 and 0.130), overall survival (OS, 0.260 and 0.620), disease-free survival (DFS, 0.120 and 0.330) were not significantly different between the RE-R group and the TOM group. The 3y-LRFS and 3y-DFS rates were 99.0% and 97.1% for the RE-R group and 99.5% and 95.3% for the TOM group, respectively. The rates of any complications and major complications were not significantly different between the RE-R patients who were discharged within 24 hours and the RE-R patients who were not discharged within 24 hours (P=0.290, P=0.665, respectively) or the TOM patients who were discharged within 24 hours (P =0.133, P=0.136, respectively). CONCLUSIONS R-E-NSM with DIBR is an innovative oncologic surgical procedure that not only improves cosmetic outcomes but also ensures reliable oncologic safety and fewer complications, enabling patients to be safely discharged within 24 hours. A long-term prospective multicenter assessment will be supporting.
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Affiliation(s)
- Jiao Zhou
- Department of General Surgery
- Breast Center
- Department of Thyroid and Breast Surgery, The First People’s Hospital of Ziyang, Sichuan University, Ziyang, China
| | - Yanyan Xie
- Department of General Surgery
- Breast Center
| | | | - Yu Feng
- Department of General Surgery, The Fourth People’s Hospital of Sichuan Province, Chengdu
| | | | | | - Qing Zhang
- Department of General Surgery
- Breast Center
| | | | - Hui Dai
- Department of General Surgery
- Breast Center
| | - Yang Liu
- Day Surgery Center, West China Hospital, Sichuan University
| | - Peng Liang
- Day Surgery Center, West China Hospital, Sichuan University
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Xie Y, Hu X, Du Z, Liang F, Lv Q, Li B. Minimally Invasive and Innovative Management of Prosthesis Infections in Endoscopic-Assisted Breast Reconstruction. Aesthetic Plast Surg 2024; 48:266-272. [PMID: 37605028 DOI: 10.1007/s00266-023-03525-6] [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: 06/22/2023] [Accepted: 07/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Implant infection continues to be the most common complication of breast reconstruction, and it can lead to serious consequences of implant loss. Recently, endoscopic-assisted nipple-sparing mastectomy with direct-to-implant breast reconstruction is being performed more frequently, with similar prosthetic infection incidence compared to conventional techniques. But there is little information published in the literature on the management of periprosthetic infection in endoscopic-assisted breast reconstruction. METHODS A retrospective review was performed of patients who underwent endoscope-assisted breast reconstruction and developed periprosthetic infection between January 2020 and December 2022. Prosthesis infection was defined as any case where antibiotics were given, beyond the surgeon's standard perioperative period, in response to clinical signs such as swelling, pain, erythema, increased temperature, fever, etc. We summarized our clinical approach and treatment protocol for periprosthetic infection patients. Collected data include preoperative basic information, surgical details, postoperative data, and outcomes. RESULTS A total of 580 patients (713 reconstructions) underwent endoscopic-assisted immediate breast reconstruction. There were 58 patients developed periprosthetic infection, 14 of whom had bilateral prosthesis reconstruction with unilateral prosthesis infection. The incidence of infection was 10.0%. Average follow-up was 17.3 ± 8.9 months (range = 2-37 months). Of the 58 patients, 53 (91.4%) patients successful salvaged implant and 5(8.6%) patients removed prosthesis. During follow-up, Baker III capsular contracture occurred in 2 patients (3.8%) who had radiotherapy. CONCLUSION Our management of prosthesis infections in endoscopic-assisted breast reconstruction is easy, minimally invasive, and inexpensive. This method can be repeated if the implant infection does not improve after the first drainage. What's more, our data suggest that our prosthesis salvage of periprosthetic infection is effective. 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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Affiliation(s)
- Yanyan Xie
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoxia Hu
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Lv
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
- Breast Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Bo Li
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, China.
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Zhao J, Chen Z, Wang M, Hai L, Xiao C. Transaxillary Single-Port Endoscopic Nipple-Sparing Mastectomy with Immediate Implant-based Breast Reconstruction in Breast Cancer Patients Receiving Neoadjuvant Chemotherapy or Not: A Comparative Study with Analysis of Surgical Complications and Patient-Reported Outcomes. Aesthetic Plast Surg 2023; 47:2304-2321. [PMID: 37700196 DOI: 10.1007/s00266-023-03644-0] [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: 06/20/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND In most cases, transaxillary single-port endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction (E-NSM-IIBR) is conducted in patients with early-stage breast cancer, ensuring surgical safety while achieving improved breast aesthetics. However, whether E-NSM-IIBR is appropriate in patients undergoing neoadjuvant chemotherapy (NAC) is still unclear. The aim of this study was to report the surgical safety and patient-reported outcomes (PROs) of breast cancer patients who underwent E-NSM-IIBR with NAC in comparison to those who did not receive NAC. METHODS A retrospective cohort study was conducted on patients who underwent E-NSM-IIBR with or without NAC at a single center between January 2021 and July 2022. Patient demographics, postoperative complications, and PROs evaluated using the BREAST-Q version 2.0 questionnaire were compared between the two groups. Factors associated with PROs at 9 months after surgery were assessed with linear regression analysis. RESULTS A total of 92 patients who underwent E-NSM-IIBR were included in the study, with 27 patients receiving NAC and 65 patients not receiving NAC. There was no significant difference in the incidence of postoperative complications between the two groups. The BREAST-Q version 2.0 questionnaire was completed by 24 out of 27 patients (88.9%) in the NAC group and 59 out of 65 patients (90.8%) in the non-NAC group at 9 months after surgery. The patient-reported outcomes in various domains of the BREAST-Q did not show a significant difference between the two cohorts. The results of the multiple linear regression analysis indicated that in the both groups age (β = - 0.985, 95% CI - 1.598 to - 0.371, p = 0.003 in the NAC group; β = - 0.510, - 1.011 to - 0.009, p = 0.046 in the non-NAC group) and rippling (β = - 21.862, - 36.768 to - 6.955, p = 0.006 in the NAC group; β = - 7.787, - 15.151 to - 0.423, p = 0.039 in the non-NAC group) significantly impacted the patients' satisfaction with breasts, and PMRT was negatively associated with patients' physical well-being of chest (β = - 13.813, - 26.962 to - 0.664, p = 0.040 in the NAC group; β = - 18.574, - 30.661 to - 6.487, p = 0.003 in the non-NAC group). Our findings revealed that patients with larger implant volumes had higher scores in psychosocial well-being (β = 0.082, 0.001 to 0.162, p = 0.047), whereas implant displacement (β = - 14.937, - 28.175 to - 1.700, p=0.028) had a negative impact on patients' psychological well-being in the non-NAC group. However, our results did not demonstrate any significant influencing factors on patients' psychosocial well-being within the NAC group. CONCLUSION Our preliminary experiences confirm that E-NSM-IIBR is a safe option for selected patients even after NAC, with favorable patient-reported outcomes comparable with those in the primary surgery setting. The postoperative long-term outcomes of patients who undergo radiation therapy after NAC merit further investigation in the future. LEVEL OF EVIDENCE III 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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Affiliation(s)
- Jingjing Zhao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, China
| | - Zujin Chen
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, China
| | - Mengdie Wang
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, China
| | - Linyue Hai
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, China
| | - Chunhua Xiao
- The First Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Huan-Hu-Xi Road, He-Xi District, Tianjin, China.
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10
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Chia CLK, Sae-Lim C, Lai HW, Chandrachamnong K, Huang HI, Chen DR, Chen ST. Single-port three-dimensional (3D) endoscopic-assisted breast surgery-preliminary results and patient-reported satisfaction in 145 breast cancer and gynecomastia cases. World J Surg Oncol 2023; 21:335. [PMID: 37880770 PMCID: PMC10601236 DOI: 10.1186/s12957-023-03191-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/17/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Minimal-accessed (robotic and endoscopic) breast cancer surgery is increasingly performed due to better cosmetic results and acceptable oncological outcomes. This study aims to demonstrate the clinical safety and patient-reported cosmetic satisfaction of single-port three-dimensional endoscopic-assisted breast surgery (S-P 3D EABS), which is our new endoscopic surgical innovation, in both malignant and benign breast conditions. METHODS Patients who underwent S-P 3D EABS from 1 August 2018 to 31 July 2022 in a single institution were enrolled. Clinical outcomes of this procedure were retrospectively reviewed, and the patient-reported cosmetic satisfaction was evaluated by a questionnaire and reported herein. RESULTS During the study period, 145 patients underwent 164 procedures of S-P 3D EABS. One hundred fifty (91.5%) procedures were endoscopic-assisted nipple-sparing mastectomy (S-P 3D E-NSM; 117 therapeutic procedures for breast cancer, 13 prophylactic mastectomies, 20 procedures for gynecomastia). Fourteen (8.5%) procedures of endoscopic-assisted breast-conserving surgery (S-P 3D E-BCS) were performed (12 S-P 3D E-BCS, 2 S-P 3D E-BCS with 3D videoscope-assisted partial breast reconstruction, which was 1 case of latissimus dorsi flap and 1 case of omental flap). The mean operative time was 245 ± 110 min in S-P 3D E-NSM and 260 ± 142 min in S-P 3D E-BCS. The mean intraoperative blood loss was 49.7 ± 46.9 ml in S-P 3D E-NSM and 32.8 ± 17.5 ml in S-P 3D E-BCS. Subnipple biopsy showed positive malignancy in 3 (2.6%) S-P 3D E-NSM patients. None of the S-P 3D E-BCS patients found margin involvement; however, 3 (2.6%) reported margin involvement in S-P 3D E-NSM patients. Thirty-two complications were found (24.6%): 7 (5.3%) transient nipple-areolar complex (NAC) ischemia, 7 (5.3%) partial NAC necrosis, 1 (0.7%) total NAC necrosis, and 1 (0.7%) implant loss. During the mean follow-up time of 34 months, there were 2 (1.5%) patients with locoregional recurrence, 9 (6.9%) distant metastasis, and 2 (1.5%) mortality. 78.6% (77/98) of patients answering the cosmetic-evaluated questionnaire reported good and excellent overall satisfaction. CONCLUSIONS S-P 3D EABS is a novel surgical innovation, which is able to perform safely in either malignant or benign breast conditions and offer promising cosmetic results.
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Affiliation(s)
- Clement Luck Khng Chia
- Department of Surgery, Breast Surgery Service, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chayanee Sae-Lim
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Hung-Wen Lai
- Department of Surgery, Endoscopic & Oncoplastic Breast Surgery Center, Changhua Christian Hospital, 135 Nanxiao Street, Changhua, 500, Taiwan.
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan.
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan.
- Minimal Invasive Surgery Research Center, Changhua Christian Hospital, Changhua, Taiwan.
- Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin, Taiwan.
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Korawan Chandrachamnong
- Department of Surgery, Division of Breast Surgery, Police General Hospital, Bangkok, Thailand
| | - Hsin-I Huang
- Department of Information Management, National Sun-Yat-Sen University, Kaohsiung, Taiwan
| | - Dar-Ren Chen
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
| | - Shou-Tung Chen
- Department of Surgery, Division of General Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Comprehensive Breast Cancer Center, Changhua Christian Hospital, Changhua, Taiwan
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11
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Yang H, Liang F, Xie Y, Qiu M, Du Z. Single axillary incision reverse-order endoscopic nipple/skin-sparing mastectomy followed by subpectoral implant-based breast reconstruction: Technique, clinical outcomes, and aesthetic results from 88 preliminary procedures. Surgery 2023; 174:464-472. [PMID: 37422354 DOI: 10.1016/j.surg.2023.05.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Single axillary incision reverse-order endoscopic nipple-sparing mastectomy overcomes the limitations of conventional endoscopic nipple-sparing mastectomy application. We introduce this technique and report the preliminary results of this study. METHODS Patients who received single axillary incision reverse-order endoscopic nipple-/skin-sparing mastectomy from May 2020 to May 2022 were enrolled from a single institution. Data were analyzed to evaluate the safety and effectiveness of this technique. Patient-reported and surgeon-reported cosmetic outcomes were collected. RESULTS In total, 68 patients who underwent 88 single axillary incision reverse-order endoscopic nipple-/skin-sparing mastectomy combined with subpectoral implant-based breast reconstruction were enrolled in the current study. The overall complication rate was 10.3%. In total, 2.9% of patients suffered from major complications, and 5 (7.4%) experienced minor complications. Only 1 patient experienced partial nipple-areola complex necrosis. During a median follow-up time of 24 months, the locoregional recurrence and distant metastasis rate was both 1.6%. In the surgeon-reported cosmetic results, 92.1% of patients achieved good or excellent results. The mean SCAR-Q scores were 82.07 ± 8.86, and 85.3% evaluated their breasts as good or excellent. The mean overall cost was 5,670.4 ± 1,351.3 USD. The total mean operation time and maturity-stage mean operation time were 234.3 ± 80.4 and 172.55 ± 41.29 min, respectively. According to cumulative sum plot analysis, approximately 18 cases were needed for surgeons to decrease their operation time significantly and complication rate. CONCLUSION Single axillary incision reverse-order endoscopic nipple-sparing mastectomy is a safe, less expensive, and efficient surgical technique with reliable intermediate-term oncologic safety. For suitable candidates, the technique with subpectoral implant-based breast reconstruction can provide a good cosmetic outcome.
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Affiliation(s)
- Huanzuo Yang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China; Breast Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Faqing Liang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China; Breast Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yanyan Xie
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China; Breast Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxue Qiu
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China; Breast Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenggui Du
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China; Breast Centre, West China Hospital, Sichuan University, Chengdu, China.
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12
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Qiu M, Yang H, Zhou J, Feng Y, Liu X, Zhang Q, Du Z. Short-term safety and cosmetic outcomes of endoscopic direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation for breast cancer: a prospective analysis of 33 patients. World J Surg Oncol 2023; 21:201. [PMID: 37424000 DOI: 10.1186/s12957-023-03089-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND For patients with small breasts, breast-conserving surgery (BCS) and unilateral nipple-/skin-sparing mastectomy (N/SSM) with breast reconstruction may result in visible breast deformities or asymmetry, and contralateral breast augmentation often require a two-staged operation. We propose a novel endoscopic technique, direct-to-implant breast reconstruction and simultaneous contralateral breast augmentation (DTI-BR-SCBA), and report its short-term safety and cosmetic outcomes. METHODS In this prospective study, patients with early breast cancer who underwent endoscopic DTI-BR-SCBA between November 2020 and August 2022 were followed for more than 3 months to analysed short-term postoperative safety (complications and oncological safety) and cosmetic outcomes (doctor-assessed results by Ueda scale and patient-reported results by Breast-Q scale). RESULTS A total of 33 patients, including 30 treated with endoscopic prepectoral DTI-BR-SCBA, 1 with endoscopic dual-plane DTI-BR-SCBA and 2 with endoscopic subpectoral DTI-BR-SCBA, were analysed. The mean age was 39.7 ± 6.7 years. The mean operation time was 165.1 ± 36.1 min. The overall surgical complication rate was 18.2%. All complications were minor, including haemorrhage (3.0%), cured by compression haemostasis, surgical site infection (9.1%), cured by oral antibiotics, and self-healing nipple-areolar complex ischaemia (6.1%). Furthermore, rippling and implant edge visibility occurred in 6.2% of them. The outcome was graded as "Excellent" and "Good" in 87.9% and 12.1% of patients in the doctor cosmetic assessment, respectively, and patient satisfaction with breasts was significantly improved (55.0 ± 9.5 vs. 58.8 ± 7.9, P = 0.046). CONCLUSIONS The novel endoscopic DTI-BR-SCBA method may be an ideal alternative for patients with small breasts because it can improve cosmetic results with a relatively low complications rate, which makes it worthy of clinical promotion.
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Affiliation(s)
- Mengxue Qiu
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Huanzuo Yang
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Jiao Zhou
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Yu Feng
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Xinran Liu
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Qing Zhang
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China
| | - Zhenggui Du
- Department of General Surgery, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China.
- Breast Center, West China Hospital, Sichuan University, 37 Guoxue Street, WuHou District, Chengdu, 610041, China.
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