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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 612-618. doi: 10.19723/j.issn.1671-167X.2023.04.007

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Choice of immediate breast reconstructive methods after modified radical mastectomy

Jian-xun MA1,You-chen XIA1,Bi LI1,*(),Hong-mei ZHAO2,Yu-tao LEI2,Xi BU1   

  1. 1. Department of Plastic Surgery, Peking University Third Hospital, Beijing 100191, China
    2. Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-12-04 Online:2023-08-18 Published:2023-08-03
  • Contact: Bi LI E-mail:libi0377@sina.com

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Abstract:

Objective: To investigate the choice of immediate breast reconstructive methods and asso-ciated outcomes after modified radical mastectomy. Methods: Retrospective analysis of patients undergoing immediate breast reconstruction after modified radical mastectomy in Peking University Third Hospital from January 2009 to May 2019. The reconstructive methods were summarized, and the clinical outcomes and the safety of immediate breast reconstruction were evaluated. Results: One hundred and twenty-three patients were enrolled in this study. Different reconstructive methods were applied according to the clinical stage, the amount of skin removal, the size of contralateral breasts, the physical condition and the preference of the patients. Seventy-nine cases were performed with tissue expander/implant two-stage reconstruction, twenty-three cases received direct breast implant insertion, seven cases were applied for latissimus dorsi (LD) myocutaneous flap transfer combined with implant insertion, five cases were provided transverse rectus abdominis myocutaneous (TRAM) flap transfer, six cases underwent tissue expander/implant combined with endoscopic LD muscle flap transfer, and three cases chose tissue expander/deep inferior epigastric artery perforator (DIEP) flap transfer. The average follow-up time was (12.3±9.0) months (3.5-41.0 months). One patient with direct implant insertion had partial blood supply distur-bance of the mastectomy flap. One case had necrosis of distal end of TRAM zone Ⅳ. One patient with expander/DIEP reconstruction had partial fat liquefaction. And two cases had expander leakage at the end of the expansion period. The tumor local recurrence occurred in one patient, and the implant was finally removed. The outcomes were evaluated by Harris method, and 90.2% patients were good or above in shape evaluation. Among the patients with implant based reconstruction, there was no obvious capsular contracture, and most of the implants had good or fair mobility. Conclusion: It is safe and feasible of immediate breast reconstruction after modified radical mastectomy for appropriate cases. The reconstructive methods can be individualized according to the individual's different conditions. The appropriate reconstructive methods could achieve satisfactory results.

Key words: Breast neoplasms, Mastectomy, modified radical, Reconstructive surgical procedures

CLC Number: 

  • R655.8

Figure 1

Process of expander/implant breast reconstruction in patients receiving radiation Tissue expander is inserted immediately post-mastectomy, and chemothe-rapy is not affected by tissue expansion. Tissue expansion is completed when radiation is coming. In order to avoid affecting the effect of radiotherapy and minimize the retraction of expanded tissue, the volume of expander should be reduced to 300 mL. Stage Ⅱ surgery could be performed six months after radiation."

Table 1

Relevant information on immediate breast reconstruction of 123 patients"

Items n(%)
Methods of immediate breast reconstruction (n=123)
  Tissue expander / implant 79 (64.2)
  Implant 23 (18.7)
  LDMCF + implant 7 (5.7)
  Tissue expander / LDMF + implant 6 (4.9)
  TRAM 5 (4.1)
  Tissue expander / DIEP flap 3 (2.4)
Implant (n=115)
  Anatomical 108 (93.9)
  Round 7 (6.1)
Surgery on the contralateral breast (n=123)
  Breast augmentation with implant 4 (3.3)
  Breast augmentation with autologous fat 4 (3.3)
  Mastopexy 6 (4.9)
  Breast reduction 1 (0.8)
  None 108 (87.7)
Complication
  Leakage of expander 2 (2/88, 2.3)
  Blood supply disorder of chest wall skin 1 (1/123, 0.8)
  Fat necrosis of DIEP flap 1 (1/3, 33.3)
  Necrosis of distal end of TRAM zone Ⅳ 1 (1/5, 20.0)
Harris evaluation[7] (n=122)
  Perfect 16 (13.1)
  Good 94 (77.1)
  Fine 12 (9.8)
  Poor 0
Capsular contraction (n=114)
  Baker grade Ⅰ 8 (7.0)
  Baker grade Ⅱ 94 (82.5)
  Baker grade Ⅲ 12 (10.5)
  Baker grade Ⅳ 0
Prosthesis mobility (n=114)
  Excessive 0
  Good 18 (15.8)
  Fair 68 (59.6)
  Fixed 28 (24.6)

Figure 2

Immediate tissue expander/implant two-stage breast reconstruction after left mastectomy A, a 41-year-old woman, left breast cancer, preoperative view; B, immediate expander insertion was applied post-mastectomy; C, expansion was finished when the volume reached 430 mL; D, on the second stage, while the expander would change to the permanent implant, the right mastopexy would also be applied; E, nine months after the reconstruction."

Figure 3

Immediate breast reconstruction using transverse rectus abdominis myocutaneous flap after right mastectomy A, a 30-year-old woman, right breast cancer, preoperative view; B, transverse rectus abdominis myocutaneous (TRAM) flap was harvest immediately post-mastectomy; C, six months after the reconstruction."

Figure 4

Immediate breast reconstruction using latissimus dorsi myocutaneous flap with implant after left mastectomy A, a 35-year-old woman, left breast cancer, preoperative view; B, the design of left latissimus dorsi myocutaneous flap (LDMCF) during the operation; C, LDMCF transfer combined with implant insertion for immediate breast reconstruction post-mastectomy; D, twelve months after the reconstruction."

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