In pursuit of a flawless aphrodite: paving the way to scarless oncoplastic breast surgery

Zhu, Liling; Li, Shunrong; Tan, Li Kuo; Zhang, Xiaolan; Wu, Jiarui; Su, Fengxi; Chen, Kai; Song, Erwei

doi:10.1186/s40880-019-0422-4

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…Scarring around the breasts is barely noticeable when patients stand erect and hang their arms naturally. From C-E-NSM ( 10 , 26 ), the incision was mainly placed on the lateral upper side of the breast. Because of a gasless technique and retractor, the incision cannot be close to the top of the axilla.…”

Section: Discussionmentioning

confidence: 99%

Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery

Chung,

Xie,

Liang

et al. 2024

Front. Oncol.

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BackgroundOur 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.MethodAll 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.ResultsTwenty-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.ConclusionR-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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Section: Discussionmentioning

confidence: 99%

Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery

Chung,

Xie,

Liang

et al. 2024

Front. Oncol.

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“…No close-suctioned drain was required in S-P 3D E-BCS without reconstruction. For larger defects, volume replacement using 3D videoscope-assisted partial breast reconstruction techniques was considered [ 16 – 18 ], for example, latissimus dorsi myocutaneous (LD) flap (Fig. 3 (3.2)) or omental flap (Fig.…”

Section: Methodsmentioning

confidence: 99%

Single-port three-dimensional (3D) endoscopic-assisted breast surgery—preliminary results and patient-reported satisfaction in 145 breast cancer and gynecomastia cases

Chia,

Sae-lim,

Lai

et al. 2023

World J Surg Onc

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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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“…Ho et al reported that DIEP breast reconstruction could be performed using thoracodorsal recipient vessels and the skin paddles could be placed laterally at the inframammary fold (IMF) [8]. As we previously advocated that surgical treatment of breast cancer has entered a scarless era, efforts were made in forgoing the skin paddles during ms-TRAM/DIEP breast reconstruction, so as to minimize the surgical scar and improve the cosmetic outcome [9]. Levine et al reported that placing an implantable doppler around the site of anastomosis was su cient for post-operative surveillance of the buried DIEP ap and forgoing of the skin paddles was feasible [10].…”

Section: Introductionmentioning

confidence: 99%

The feasibility of nipple-sparing mastectomy in combined with abdominal free flap breast reconstruction without skin paddles for flap monitoring: a single-center experience

Zhu

Chen

et al. 2023

Preprint

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Background Nipple-sparing mastectomy in combination with buried abdominal free flap breast reconstruction without leaving any skin paddles for post-operative monitoring might be associated with better cosmetic outcomes. The feasibility of this approach remains unclear while a detailed and validated protocol of post-operative flap monitoring is lacking. Materials and Methods Eligible patients receiving abdominal free-flap breast reconstruction between 2015 and 2020 in our institution were included. Patients were categorized into the buried-flap cohort and the skin-paddle cohort based on whether a skin paddle remained for direct visual monitoring post-operatively. We reported the learning curve of this surgery and the determinants of operative and/or ischemic time. The oncological outcomes and surgical complications rates were also analyzed. Results This study included 147 eligible patients (buried-flap cohort: N = 18; skin-paddle cohort: N = 129). In early-stage patients with immediate breast reconstruction (N = 104), there were no observed relapse events with a median follow-up time of 18 months. The learning curve analysis showed significant reduction of the surgery time and the ischemic time with accumulation of surgical experience after 30 cases. The surgery time and ischemic time were significantly shorter in the buried flap cohort, when compared to that of the skin-paddle cohort. The take-back surgery rates, flap failure rates, and other complication rates were similar between two cohorts under the intra- and post-operative monitoring protocol. Conclusion This study supported the feasibility of autologous abdominal free-flap breast reconstruction using the buried flap approach, and we validated our intra- and post-operative monitoring protocol. A multicenter and prospective study is needed to validate this approach. Trial registration：NCT05560633

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In pursuit of a flawless aphrodite: paving the way to scarless oncoplastic breast surgery

Cited by 6 publications

References 29 publications

Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery

Reverse-sequence endoscopic nipple-sparing mastectomy with immediate implant-based breast reconstruction: an improvement of conventional minimal access breast surgery

Single-port three-dimensional (3D) endoscopic-assisted breast surgery—preliminary results and patient-reported satisfaction in 145 breast cancer and gynecomastia cases

The feasibility of nipple-sparing mastectomy in combined with abdominal free flap breast reconstruction without skin paddles for flap monitoring: a single-center experience

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