| Objective:The purpose of this retrospective study was to compare the clinical value of breast-conserving surgery combined with autologous tissue flap-based phase I breast morphogenesis via areola incision with that of conventional breast-conserving surgery in the treatment of early breast cancer.Methods:From September 2005 to December 2015,85 women with early breast cancer were assigned to undergo breast-conserving surgery combined with autologous tissue flap-based phase I breast morphogenesis via areola incision(50 patients,research group)or breast-conserving surgery via tumor surface incision without breast morphogenesis(35 patients,control group).Based on the analysis of patients' age,the location of tumor,the distance of tumor to nipple,tumor size,the stage of tumor and the number of lymph node metastasis,we evaluated cancer treatment of the surgery.The effects on postoperative breast cosmetic results were comprehensively assessed from the following two aspects:? the shape of breast,including symmetry,nipple position,the degree of surface roughness and breast compliance;? the effects of skin,including scars,color,texture and elasticity.Finally,a questionnaire survey regarding postoperative life quality of two groups was carried out in these patients by using the body self-image scale(BIS)and WHOQOL-BREF as quality of life measurement scale belong to WHO.Results:Patients in research group were females aged from 30 to 61 years(44.52 ±5.06 years)with the tumor diameter ranging from 0.5 to 4.0cm(1.82 ±0.62 cm),including 22 cases of left tumor and 28 cases of right tumor.The distance of tumor to the nipple was 2.0?7.0 cm(3.82± 1.09cm).All patients underwent areola incision with the incision length of 3.0-6.0 cm(3.94 ±0.30cm).After removal of the tumor,Phase I breast morphogenesis was performed using autologous tissue flap for breast defects.The postoperative follow-up lasted 6?114 months with the average of 35 months.Except one case of fat liquefaction,no necrosis of established autologous tissue flap,wound infection and flap necrosis were reported postoperatively.A case of breast cancer bone metastasis was reported at 24 months after surgery;neither local recurrence of regional lymph node and tumor nor deaths were observed.And patients in control group were females aged from 32 to 60 years(43.42 ±4.16 years)with the tumor diameter ranging from 0.6 to 2.9cm(1.77± 0.59 cm),including 16 cases of left tumor and 19 cases of right tumor.The distance of tumor to the nipple was 2.3-6.0 cm(3.82±1.09cm).All patients underwent via tumor surface incision with the incision length of 4.0-6.5 cm(5.56 ± 1.31cm),without breast morphogenesis.The postoperative follow-up lasted 6?117 months with the average of 34 monte.One patient with incision bleeding in the second day after surgery and one patient with mild upper limb lymphedema after ALND were observed.In the multi-factor assessment of two groups of breast cosmetic effect,total scores rated as "good" were significantly higher in research group than in control group(98%vs.58.06%,P<0.05).The postoperative BIS showed that the cosmetic results of research group were negatively correlated with BIS scores.The field of Psychology and the environment in quality of the WHOQOL-BREF were both a negative correlation with the scars(scar)dissatisfied in BIS scores,the correlation coefficient were-0.407,P = 0.006 and-0.331,P = 0.028,respectively.Conclusion:Breast-conserving surgery combined with autologous tissue flap-based phase I breast morphogenesis via areola incision can achieve satisfactory cosmetic and therapeutic effects as well as good postoperative life quality. |
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