| Objective1.To observe the general conditions and clinical pathological data in the patients who accepted abdominal free dermal fat graft combined with breast-conserving surgery and standard breast-conserving surgery,and analyze the clinical factors that affect the application of abdominal free dermal fat graft combined with breast-conserving surgery.2.To observe the weight and volume for the excision specimens from breast and the free dermal fat graft from abdominal free dermal fat graft combined with breast-conserving surgery,so as to provide experience for clinical promotion.3.To evaluate the postoperative cosmetic outcomes and complications of abdominal free dermal fat graft combined with breast-conserving surgery,analyze patient’s postoperative self-satisfaction of appearance,and assess the clinical feasibility of free dermal fat graftMethods1.9 breast cancer patients who underwent abdominal free dermal fat graft combined with breast-conserving surgery and 18 breast cancer patients who underwent standard breast conserving surgery were collected from the Third Affiliated Hospital of Kunming Medical University from September 2016 to December 2018.The effects of general conditions(age,BMI),tumor maximum diameter,tumor location,the statue of ER,PR,HER-2 and neoadjuvant chemotherapy on the surgical methods were analyzed.2.During the operation,the resected specimens(including the primary tumor and the surrounding tissues of the tumor,and the pectoralis major fascia)were weighed and measured,and the resected specimens of the two groups were collected retrospectively.The weight and volume of the free skin fat flap were collected from the patients with negative resection margin and who received the free skin fat transplantation of the lower abdomen,and the differences in the weight and volume of-the resectable tissue between the two surgical methods were analyzed.3.The patients in the two groups were followed up regularly for 1 week,1 month.3 months and 6 months respectively,and the postoperative complications were evaluated.4.The surgeons assessed the postoperative cosmetic effect and self-satisfaction of appearance respectively between the two groups according to the scale and questionnaire in three months after radiation therapyResults1.Factors influencing the application of abdominal free dermal fat graft combined with breast-conserving surgery in breast cancer:There are 27 female patients in this study,9 of whom underwent abdominal free dermal fat graft combined with breast-conserving surgery,and 18 patients underwent standard breast conserving surgery,aged 30-53 years,with an average age of 44.07±6.78.After the analysis of general situation and clinical pathologic data found that surgical procedure with age,body mass index,tumor location,female progesterone receptors,the expression of HER2 gene amplification situation has nothing to do and whether preoperative neoadjuvant chemotherapy,there was no statistically significant difference(P>0.05),suggest two sets of pathological data comparable.In addition,the choice of surgical method was related to the maximum diameter of the tumor,and the difference was statistically significant(P<0.05).2.The weight and volume of breast resected specimen and free dermal fat graft:the abdominal free dermal fat graft combined with breast-conserving surgery group of resectable group’s mean weight(76.89 g±10.52 g)and the removal mean volume(107.78 cm3±9.70 cm3)were better than those who did standard breast-conserving surgery’s mean weight(63.00 g±7.73 g)and the removal mean volume(96.11 cm3±10.44 cm3),statistically significant difference(P<0.05),and the removal volume of free dermal fat graft is 127.40 cm3±11.03 cm3 on average.3.The distance from tumor to nipple areola complex:The mean linear distance between tumor and NAC in the abdominal free dermal fat graft combined with breast-conserving surgery group was basically the same as that in the standard breast-conserving surgery group(4.66 cm10.90 cm vs 4.60cm±1.00cm).and the difference was not statistically significant(P>0.05).4.The postoperative complications:Patients were followed up 1 week,1 month,3 months and 6 months after surgery.Among the recent postoperative complications,compared with the standard breast conserving surgery group,the incidence of seroma in the lower abdomen free dermal fat graft transplantation group was 11.1%vs 1 1.1%,the incidence of hematoma was 11.1%vs 5.6%,and the incidence of fat liquefaction was 11.1%vs 5.6%,the differences were not statistically significant(.P>0.05).In terms of long-term complications,the incidence of fat necrosis in the lower abdomen free dermal fat graft transplantation combined with breast conserving surgery was 44.4%vs 11.1%,and the incidence of skin retraction was 0%vs 11.1%,respectively,in the standard breast conserving surgery group,and the difference was not statistically significant(P>0.05).5.Evaluation of cosmetic effect and self-satisfaction of appearance after operation:A total of 14(51.9%)of the 27 patients had a score of more than 10 points(good),while 8(88.9%)of the patients in the free dermal fat graft transplantation combined with breast conserving surgery group had a good score.and 6(33.3%)of the patients in the standard breast conserving surgery group had a good score.The difference in excellence rate between the two groups was statistically significant(P<0.05).In the questionnaire survey of breast self-satisfaction,the postoperative satisfaction for patients who received abdominal free dermal fat graft combined with breast-conserving surgery,were generally better than those of the standard breast-conserving surgery,there were no significant difference between the two groups(P>0.05).Conclusions1.Effects of abdominal free dermal fat graft combined with breast-conserving surgery in breast cancer:The age,BMI,location of the tumor,the statue of ER、PR,HER-2 and preoperative neoadjuvant chemotherapy were not correlated with the operation method,and there are no statistical significance between two groups.But the maximum diameter was correlated with the abdominal free dermal fat graft combined with breast-conserving surgery.The difference were statistically significant.It is suggested that abdominal free dermal fat graft combined with breast-conserving surgery is more suitable for patients with larger tumor diameter2.Abdominal free dermal fat graft combined with breast-conserving surgery can increase the amount of resected tissue weight and volume,thereby achieving a safe margin of incision,with the minimum cost of tissue to achieve the best cosmetic results.3.Postoperative cosmetic effect and self-satisfaction for appearence of abdominal free dermal fat graft combined with breast-conserving surgery were superior to standard breast conserving surgery.4.Abdominal dermal fat graft combined with breast conserving surgery can achieve the optimal effect with the minimum tissue cost,which is worthy of further clinical promotion. |
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