Breakthrough in breast reconstruction in the context of COVID-19: safety and efficiency of endoscopic breast reconstruction at a day surgery center

Abstract

Background: In recently years, breast endoscopic reconstruction surgery is becoming increasingly popular.And we have explored a series of endoscopic breast reconstruction procedures and applied it to our day surgery under the epidemic control of the novel coronavirus.Methods: The present study was a retrospective analysis. Patients who underwent unilateral breast endoscopic reconstruction surgery in the West China Hospital from April 2017 to February 2021 were included in the study. Patients were divided into the following three groups: ward exploration period (WEP), ward maturation period (WMP), and day surgery period (DSP), respectively. We compared the results of postoperative complications, hospitalization costs, operation time, and BREAST-Q (a patient-reported outcome instrument measuring health-related quality-of-life and patient satisfaction in breast surgery) scale scores among the three groups of patients.Results: A total of 66 patients were included (WEP n=30, WMP n=14, DSP n=22). Four people refused to complete the BREAST-Q scale, and five patients missed complication record sheets. Patients in the DSP and WMP groups had slightly higher postoperative satisfaction with their breasts than WEP, but there was no statistically significant difference (3 months postoperatively: WEP vs. WMP =0.515, WEP vs. DSP =0.418, WMP vs. DSP =0.982). On the postoperative BREAST-Q scale scores of psychosocial, sexual life and chest well-being, patients with DSP scored slightly higher than those with WEP versus WMP, but there was no statistically significant difference. The incidence of postoperative complications was generally higher in the WEP group than in the WMP and DSP groups, but there was no statistically significant incidence of either major or minor complications (P=1.000). With the use of prostheses and mesh, patients in the DSP group had lower hospitalization costs than other two groups. In terms of operative time, patients in the WMP and DSP groups had shorter operative times compared with the WEP group, and the results were statistically significant (WEP vs. WMP =0.000, WEP vs. DSP =0.000, WMP vs. DSP =0.243). Conclusions:We believe that performing our newly developed endoscopic breast reconstructive surgery at a day surgery center is safe and reliable.

Novel technique for endoscopic-assisted nipple-sparing mastectomy and immediate breast reconstruction with endoscopic-assisted latissimus dorsi muscle flap harvest through a single axillary incision: a retrospective cohort study of comparing endoscopic and open surgery

“…The surgical technique for NSM and the concept of the “HUAXI hole 1” has been described previously ( 20 , 21 ). The retro-areolar tissue should be carefully dissected by surgical scissors to protect the blood supply and prevent nipple ischemia.…”

“…Next, NSM was performed in the order of the subpectoral space (if an implant was placed in the subpectoral position, by a coagulation hook), retromammary space (by a coagulation hook with the assistance of forceps), and the subcutaneous layer of breast, which was dissected using the PMOD to retro-areolar tissue under direct vision, and the rest of the layer was then performed using the PMOD inserted through the "HUAXI hole 1" (located next to the areola in the upper-outer quadrant) (see Figure 2C). The surgical technique for NSM and the concept of the "HUAXI hole 1" has been described previously (20,21). The retro-areolar tissue should be carefully dissected by surgical scissors to protect the blood supply and prevent nipple ischemia.…”

Single-axillary-incision Endoscopic Nipple/Skin-sparing Mastectomy With Immediate Implant-based Breast Reconstruction of Day Surgery: Preliminary Results, Complications and Patient-reported Outcome From Preliminary 68 Procedures

“…Anesthetic was administered using a total intravenous anesthesia protocol or intravenous and inhalational combined anesthesia. The surgery process of total subpectoral breast reconstruction can be obtained in our other studies [21,22] . As we continue to evolve surgical techniques, we found that pre-pectoral implant placement can shorten the operation time, reduce postoperative pain and improve breast satisfaction of patients compared to subpectoral technique.…”

“…The progress of technology (especially the applications of robot/endoscopy nipple/skin-sparing mastectomy(R/E-N/SSM), three dimensional videoscope) greatly reduces the trauma and complications associated with breast reconstruction [17][18][19][20] , however, existing studies on day surgery of breast reconstruction predominantly focus on conventional, open breast reconstruction. West China Hospital pioneered E-N/SSM with breast reconstruction using the original endoscopic technique with reversed dissection order, "HUAXI Hole 1" and "pulling threads method of mesh" in the day surgery department, which can significantly improve the aesthetic of breast, shorten the operation time and minimize the resources [21] . However there were small number patients in our prior study [21] , here we aim to report the preliminary results, complications and patient-reported outcome from preliminary 68 procedures of single-axillary-incision E-N/SSM with immediate IBBR of day surgery to assess its safety and effectiveness convincingly.…”

“…West China Hospital pioneered E-N/SSM with breast reconstruction using the original endoscopic technique with reversed dissection order, "HUAXI Hole 1" and "pulling threads method of mesh" in the day surgery department, which can significantly improve the aesthetic of breast, shorten the operation time and minimize the resources [21] . However there were small number patients in our prior study [21] , here we aim to report the preliminary results, complications and patient-reported outcome from preliminary 68 procedures of single-axillary-incision E-N/SSM with immediate IBBR of day surgery to assess its safety and effectiveness convincingly.…”