Immediate Breast Reconstruction After Nipple-areola Complex Sparing Modified Radical Mastectomy

ObjectiveTo assess the various ways of surgery and the safety,feasibility, oncology radically and the cosmetology of immediate breast reconstruction after nipple-areola complex sparing modified radical mastectomy of breast cancer.MethodsFrom February 2002 to January 2011 46 patients of early breast cancer underwent immediate breast reconstruction after nipple-areola complex sparing modified radical mastectomy of breast cancer. Ordinary operation (40 patients) or small cut operation with mastoscopy (6 patients) were chosen for immediate breast reconstruction. The materials could be latissimus dorsi musculocutaneous flap(25 patients), prosthesis(13 patients) or both(8 patients). We observed the time of operation, the volume of bleeding, the number of lymph nodes, the drainage volume, complications, survival rate, recurrence rate and distant metastasis rate. The effect of reconstruction was evaluated by objective criterion and subjective criterion.ResultAll 46 cases succeeded. The mean time of operation was 96.09±14.30 min. The volume of bleeding was 93.37±13.91ml .The mean number of lymph nodes dissected were 16.59±1.88.The average drainage volume was 282.07±34.41ml .The volume of bleeding of the small cut operation with mastoscopy was fewer than ordinary operation(P<0.05).But the time of operation of small cut operation with mastoscopy was longer than ordinary operation(P<0.05). There was no difference between the two ways of operation in the number of lymph nodes dissected and the drainage volume (P>0.05). Five cases(12.5%) had complications of ALND in ordinary operation. Oedema of the arm occurred in two cases. Feeling defect of the arm occurred in two cases. Movement defect of the arm occurred in one case. No complication of ALND was found in the group of small cut operation with mastoscopy. Two cases were found necrosis of nipple. Two cases were found liquid aggregating in the dorsum. Prosthesis disruption occurred in one case. Prosthesis infected occurred in one case. Objective evaluation were classify to good, common, poor and the rate was 86.96%,8.70%,4.34% respectively. 95.65% of subjective evaluation was good and 4.34% was poor. The mean follow up was 86.5 months(Range,2 to 109 months). No local recurrence or distant metastasis occurred. The five years survival rate was 100% .ConclusionImmediate breast reconstruction after nipple-areola complex sparing modified radical mastectomy of breast cancer is safety, feasibility. It has good cosmetology impression. It could satisfy both the tumor therapy and cosmetology. It could improve the quality of life and had no influence in the following therapies of the breast cancer. As a safe and effective operation, we suggest generalization clinically.