Factors Influencing Postoperative Aesthetics After Breast-conserving Surgery For Breast Cancer From A Plastic Perspective

Research background:Breast cancer is currently the highest incidence of malignant tumors,a serious threat to women’s health worldwide.According to the different stages of the tumor,different treatment strategies and surgical methods were selected.Modified radical mastectomy is the main traditional method for the treatment of early breast cancer,and the surgical effect is ideal.However,due to the large resection range of this surgery,all the breast tissue of the patient needs to be removed,and the surgical wound surface is large,which has a great impact on the postoperative rehabilitation of the patient,the appearance of the breast shape and the psychological state of the patient.However,a large number of literatures at home and abroad,including a 20-year follow-up study abroad,suggest that combined treatment measures such as follow-up chemotherapy and radiotherapy have no difference in the prognosis of early breast cancer patients compared with modified radical surgery,and the quality of life of patients after breast-conserving surgery is significantly improved.Therefore,breast-conserving surgery is the best surgical method for early stage breast cancer patients.In terms of surgical effect,breast conserving combined with postoperative chemoradiotherapy has the same clinical effect as modified radical surgery.From the perspective of surgical methods,breast conserving surgery is not only relatively improved radical surgery in terms of incision length and breast tissue retention,but also has positive significance for postoperative recovery of patients and maintenance of breast shape.With the development of society and economy,people’s spiritual demand for beauty is growing day by day,so clinical and surgical treatment needs to be considered from more aspects.In order to achieve the purpose of treating lesions and restoring physiological functions while taking into account aesthetics,attention should be paid to the aesthetic appearance of surgical incision and postoperative scar healing of patients.Through different incision design,suture methods,suture materials,and different postoperative incision treatment,the aesthetic impact on patients can be reduced as far as possible.Therefore,this study intends to combine clinical and literature data to evaluate the overall postoperative cosmetic effect,consider factors affecting the postoperative cosmetic effect in various aspects,screen out some meaningless variables,and then focus on the analysis of key influencing factors.To explore the influence of different surgical incisions,suture materials and suture methods on the postoperative aesthetics of patients,so as to provide a theoretical basis for improving the cosmetic effect of breast after breast conserving surgery for patients with early breast cancer.Methods:A total of 41 patients who received breast-conserving surgery in the Department of Breast Surgery,Affiliated Cancer Hospital of Guangzhou Medical University from January 2022 to March 2023 were screened.Clinical data such as gender,age,body mass index,underlying disease,surgical method,tumor location,tumor size,tumor to breast volume ratio,postoperative diagnosis,TNM staging,molecular typing,surgical incision,incision length,skin resection method,suture method,suture material treatment plan were collected.Meanwhile,postoperative imaging data of patients were kept through follow-up.The evaluation model was established to analyze the influence of different treatment factors in perioperative period on postoperative aesthetic effect and wound healing.Results:1.Among the 41 patients with breast cancer who received breast-conserving surgery,16 cases(39.0%)had excellent postoperative cosmetic effects on breast,10 cases(24.4%)were good,6 cases(14.6%)were average,and 9 cases(22.0%)were poor.Among the factors affecting the total cosmetic score of breast,tumor/breast volume ratio(x2/t statistic= 0.748,P value = 0.002),scar score(x2/t statistic =1.915,P = 0.006),tumor location(x2/t statistic = 0.167,P = 0.337),tumor size stage(x2/t statistic = 0.145,P = 0.115),the difference was not statistically significant.2.Based on the above results and literature data,it can be concluded that scar played a significant role in postoperative breast aesthetic score.Among the 41 patients collected,scar score was 0-1 in 5 cases(12.2%),2-3 in 15 cases(36.6%),4-5 in 21 cases(51.2%).According to the analysis of influencing factors of scar score,incision length(x2/t statistic= 1.05,P value = 0.001)and suture method(x2/t statistic = 0.491,P value = 0.003)were statistically significant.Age(x2/t statistic = 2.512,P = 0.995),body mass index(x2/t statistic = 2.907,P = 1),history of diabetes(x2/t statistic = 0.11,P = 0.609),tumor location(x2/t statistic = 0.365,P value = 0.243),incision direction(x2/t statistic = 0.504,P value = 0.296),incision method(x2/t statistic = 0.299,P value = 0.426),suture material(x2/t statistic = 0.232,P value = 0.658),postoperative time(x2/t statistic = 0.352,P =0.274).Conclusion:1.The total cosmetic score of breast after breast conserving surgery is closely related to the ratio of tumor size to breast volume,incision design and scar healing.2.Tumor size and breast volume ratio are often related to breast development and "early detection and treatment" of tumors after disease,and reducing the formation of surgical scars is the top priority in clinical operation.We can design the length and position of the incision during the operation,select a better suture method,and reduce the tension of the skin,so as to provide a good anastomosis for the healing of the operative opening,so as to achieve a better cosmetic effect.