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Chen Y, Yang C, Yang S, Chen X, Huang L. Serratus Anterior Fascia for Immediate Implant-Based Breast Reconstruction: A Case Series of 65 Patients With Breast Cancer. Ann Plast Surg 2024; 92:169-173. [PMID: 38157477 DOI: 10.1097/sap.0000000000003769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVE After immediate implant-based breast reconstruction (IIBR) after mastectomy, implant exposure or capsular contracture can occur. This study aimed to evaluate IIBR using serratus anterior fascia in patients with breast cancer. METHODS This retrospective case series study enrolled patients with breast cancer underwent IIBR using the serratus anterior fascia after mastectomy in the Department of Breast Surgery of Fujian Cancer Hospital between January 2021 and December 2022. RESULTS Sixty-five cases with breast cancer underwent IIBR using serratus anterior fascia were enrolled, with a median age of 39 years (range, 24-57 years) and body mass index of 21.32 kg/m 2 (range, 19-25 kg/m 2 ). The aesthetic outcomes of the reconstructed breasts showed good in 53 cases (81.6%), moderate in 11 cases (16.9%), and poor in 1 case (1.5%) due to offset position. Two cases showed poor wound healing, which improved after repeat suturing and 5 cases developed partial ischemic necrosis of the nipple, which scabbed and healed spontaneously. CONCLUSIONS Implant-based breast reconstruction using serratus anterior fascia may provide good aesthetic outcomes with few complications.
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Affiliation(s)
- Ying Chen
- From the Department of Breast Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
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Nijiati A, Cui L, Wang X, Xing Z, Zhang M, Yuan Z, Xie W, Lei K. Gasless endoscopic transaxillary subcutaneous mastectomy and immediate reconstruction with implants (GETSMIRI) for breast cancer: Lei's five-step method. Heliyon 2024; 10:e23446. [PMID: 38163137 PMCID: PMC10755302 DOI: 10.1016/j.heliyon.2023.e23446] [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: 08/31/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
Background Endoscopic nipple-sparing mastectomy (E-NSM) is a promising procedure in the treatment of breast cancer, but the limitations of endoscopic tools and intrinsic technical complexity of the technique hinder its applicability. Here, we introduce a novel surgery, gasless endoscopic transaxillary subcutaneous mastectomy and immediate reconstruction with implants (GETSMIRI), for breast cancer. and early effects. Methods A retrospective analysis of the clinical data of 11 female patients, aged 50 (27-78) years, admitted to our hospital from January to December 2022, who underwent gasless endoscopic transaxillary subcutaneous mastectomy and immediate reconstruction with implants (GETSMIRI), was conducted. This study was designed to assess patient satisfaction before and after breast reconstruction, early complications, and breast function. Results The tumors were all solitary, with a mean maximum diameter of 1.0 (0-2.0) cm and a mean distance of 2.3 (2-4) cm from the nipple, the mean intraoperative bleeding volume was 47.5 mL, and the mean hospital stay was 1.5 d. Postoperatively, 1 patient developed depigmentation of the nipple due to mild ischemia. There were no incisional complications, subcutaneous emphysema, infection, areola necrosis, skin flap necrosis, or removal of the prosthesis and/or patch. No tumor recurrence or metastasis was observed during the follow-up period. The difference between breast satisfaction and psychosocial health scores was not statistically significant (P = 0.680; P = 0.612). Conclusion GETSMIRI, immediate implantable breast reconstruction, is less invasive than other such procedures, and short-term follow-up results show good postoperative satisfaction, making it an alternative surgical method.
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Affiliation(s)
- Aierken Nijiati
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
| | - Lingfei Cui
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
| | - Xidi Wang
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
| | - Zhaomin Xing
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
| | - Mingxia Zhang
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
| | - Zhuolin Yuan
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
- Medical School of Sun Yat-Sen University, 66th Gongchang Road, Shenzhen, Guangdong, 518107, China
| | - Wenyu Xie
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
- Medical School of Sun Yat-Sen University, 66th Gongchang Road, Shenzhen, Guangdong, 518107, China
| | - Kefeng Lei
- Department of General Surgery, The Seventh Affiliated Hospital of Sun Yat-Sen University, 628th Zhenyuan Road, Shenzhen, Guangdong, 518107, China
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Chen AX, Chen X, Yu Y, Wang X, Zhang B, Cao XC. Immediate surgical mesh-free implant-based breast reconstruction with fascial flap in breast cancer patients after mastectomy. Arch Gynecol Obstet 2022; 307:1941-1948. [PMID: 36477273 DOI: 10.1007/s00404-022-06871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Surgical meshes are often used in retro-pectoral implant-based breast reconstruction (IBBR) to improve lower pole expansion. However, using of surgical meshes is associated with increased complications and costs. To solve this problem, we have adopted a modified fascia-based IBBR technique using fasciae of pectoral major, serratus anterior, and external oblique muscles to form a sling covering the lower pole of prosthesis since 2014. METHODS Data of 788 retro-pectoral IBBR cases, including 250 fascia-based IBBR cases (fascial group) and 538 traditional IBBR cases (control group), treated between 2014 and 2019 were retrospectively analyzed. The surgical outcomes of the fascial and control group were compared. The primary endpoint was the rate of post-operative complications requiring interventions. The secondary endpoint was the rate of explantation. The exploratory endpoint was the time from surgery to complication and explantation. RESULTS The fascial group had significantly lower rates of developing major post-operative complications (1.2 vs. 6.1%, p = 0.002) and losing prostheses (1.2 vs. 4.3%, p = 0.025), as compared with the control group. The median time from surgery to complication and explantation were 61 (range, 35-115) days and 92 (range, 77-134) days for the fascial group and 35 (range, 6-239) days and 63 (range, 23-483) days for the control group, respectively. CONCLUSION Fascia-based IBBR technique had low rates of major post-operative complications and explantation. Fascia-based IBBR technique could be considered as an alternative reconstruction method in properly selected patients.
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Dimovska EOF, Chen C, Chou HH, Lin YL, Cheng MH. Outcomes and quality of life in immediate one-stage versus two-stage breast reconstructions without an acellular dermal matrix: 17- years of experience. J Surg Oncol 2021; 124:510-520. [PMID: 34133023 DOI: 10.1002/jso.26568] [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: 05/19/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Advantages of one-stage implant-based reconstructions include expedited surgery and recovery. This study aimed to investigate clinical and patient-reported outcomes in one-stage implant-based breast reconstructions without acellular dermal matrix (ADM). METHODS A prospectively collected database from 2002 to 2018 was retrospectively reviewed. One-stage and two-stage groups were compared for demographics, implant properties, early complications (hematoma, seroma, poor wound healing, implant removal), late complications (skin necrosis, capsular contracture, implant exposure, implant rupture), revision procedures, and Breast-Q questionnaire outcomes. RESULTS A total of 223 patients, 187 one-stage (84%) and 36 two-stage (16%) patients were recruited. At a mean follow-up of 124.9 and 92.5 months, respectively (p < .01), there were no differences in early (p = .85) or late (p = .23) complications or revision procedures (p = .12). Eighty patients (36%) returned the Breast-Q questionnaire (60 one-stage, 20 two-stage patients). There were no statistical differences in patient reported outcomes in breast well-being (p = .07), psychosocial well-being (p = .84), or sexual well-being (p = .78). CONCLUSIONS One-stage implant-based breast reconstruction without an ADM is a viable reconstruction providing comparable outcomes to two-stage procedures, with the benefit of minimal complications, a shorter reconstructive journey, and satisfactory quality of life.
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Affiliation(s)
- Eleonora O F Dimovska
- Division of Plastic & Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.,Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Courtney Chen
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hsu-Huan Chou
- Department of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ling Lin
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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