Clinical Study Of Annular Areola Incision In The Treatment Of Benign Breast Lesions

Objective: Through the first study,to observe and analysis the effects of annular areola incision on intraoperative blood loss,length of hospital stay,effectiveness,complications,scar score and breast appearance score in patients with benign breast lesions by retrospectively analyzing the clinical data of patients with benign breast lesions treated by breast surgery in our hospital,and explored the clinical treatment effect of annular areola incision on benign breast lesions.Because Study I is a single-center retrospective study and lacks high-quality evidence-based medical evidence,Study II searched Chinese and English databases and included different studies related to annular areola incision surgery in patients with benign breast lesions,and systematically evaluated the clinical treatment effect of annular areolar incision surgery in patients with benign breast lesions.Methods: The first study: A retrospective analysis was conducted on the clinical data of 1187 patients with benign breast lesions who underwent surgery in the Department of Breast Surgery of our hospital,and divided into annular areolar incision treatment group(ring areola group)and traditional radiation incision treatment group(traditional group)according to different surgical incisions.There were 653 cases in the ring areola group and 534 cases in the traditional group.Intraoperative blood loss,length of hospital stay,effectiveness,complications,scarring score,and breast appearance score were compared between the two groups.The second study: CNKI,Wanfang,VIP and other Chinese databases were searched by using breast,benign,annular areola incision,areola incision approach,benign breast tumor,open and surgical treatment as Chinese search terms.Mammary,Benign mass,Annular areola incision,Areola incision approach,Benign breast tumor,Open,Surgical treatment were used as English search terms,and MEDLINE,EMBASE,CENTRAL,Scopus,Science Direct and Web of Science and other English databases.We searched for all observational studies on the clinical effects of ring areola incision surgery in people with benign breast lesions from January 2017 to December2022.The patients included in the study were divided into two groups,the treatment group performed surgery by annular areola incision to remove benign breast tumors in patients;and the control group was treated with conventional surgery to remove benign breast tumors in patients.Eleven outcomes were selected from the literature,including patient age,mass diameter,duration of surgery,intraoperative blood loss,length of hospital stay,response rate to surgery,postoperative complication rate,normal rate of sensory neurological function in the areola area at 1 days postoperatively,normal sensory neurological function rate in the areola area at six months postoperative,scar score,and cosmetic satisfaction.The literature search was conducted independently by 2 researchers using standardized methods.Rev Man 5.4 software for data analysis;risk of bias assessment using the Newcastle–Ottawa Scale(NOS);Funnel plots were used to analyse publication bias in included studies.Results:The first study: Compared with the traditional group,the incision length,intraoperative blood loss,hospital stay,postoperative complications,and scar scores of the ring areola group were significantly reduced(P<0.05),and the scores of effectiveness and breast appearance were significantly increased(P<0.05),but the operation time was not shortened(P>0.05).The second study:A total of10 articles and 1587 patients were included,with 849 patients in the treatment group and738 cases in the control group,respectively.The results showed that compared with the control group,The hospital stay of patients in the treatment group was significantly shortened(MD=-1.77,95%CI=-2.92 to-0.63,P=0.002);the postoperative complication rate was significantly reduced(RR=0.37,95%CI=0.20 to 0.69,P=0.002);the scar score was also significantly reduced(MD=-5.80,95%CI=-9.97 to-1.64,P=0.006);the surgical response rate was significantly increased(RR=1.29,95%CI=1.14 to 1.47,P < 0.0001);postoperative 1d(RR=2.48,95%CI=1.82 to 3.39,P<0.00001)and half a year(RR=1.38,95%CI=1.21 to 1.57,P< 0.00001)areola area sensory nerve function normal rate was significantly improved,beauty satisfaction was also significantly increased(RR=1.38,95%CI=1.21 to 1.57,P < 0.00001),but could not reduce the patient’s operation time(MD=-3.18,95%CI=-19.15 to 12.79,P=0.70)and intraoperative blood loss(MD=-6.63,95%CI=-16.33 to 3.07,P=0.18).Conclusions: Annular areola incision surgery in patients with benign breast lesions can improve intraoperative indicators,improve the effectiveness of surgery and breast appearance score,and reduce the incidence of postoperative complications and scar score.Meta-analysis of existing clinical studies shows that the use of annular areola incision surgery has significant benefits on hospital stay,postoperative complication rate,surgical response rate,areola sensory nerve function and cosmetic satisfaction in patients with benign breast lesions,but some high-quality RCTs are still needed to study the clinical effect of ring areola incision surgery in patients with benign breast lesions.