Immediately Breast Reconstruction After Skin Sparing Mastectomy For Breast Cancer:A Clinical Application

Objective To explore the clinical significance of immediately breast reconstruction after skin sparing mastectomy for breast cancer.Methods1.A total of 183 patients with breast cancer who underwent surgical treatment at the Affiliated Tumor Hospital of Guangxi Medical University from January 2008 to December 2015 were enrolled in the study.clinical date of 96 patients suffered with breast cancer who underwent SSM plus SLND or ALND plus immediately breast reconstruction was analyzed as a study group,Among them,49 cases of prosthesis implantation,29 cases of latissimus dorsi myocutaneous flap,4 cases of denture combined with latissimus dorsi muscle flap,14 cases of rectus abdominis myocutaneous flap.clinical date of 87 patients suffered with breast cancer who underwent SSM plus SLND or ALND during the same period was analyzed as a control group.2.To compared 5-year local recurrence rate,5-year regional recurrence rate,5-year distant metastasis rate,5-year disease free survival rate,5-year overallsurvival rate,cosmetic results,healing time of wound and the incidence of postoperative complications between study group and control group.3.Data were analyzed using the statistical package for the social sciences to test the statistical significant difference between the two groups.Student t-test was conducted to investigate quantitative data between the two groups.Chi-square test was conducted to investigate qualitative data.The 5-year recurrence rate,5-year metastasis rate,5-year disease-free survival rate and5-year overall survival rate were calculated by Kaplan-Meier method,and the recurrence rate,disease-free survival rate and overall survival rate of the two groups were compared by log-rank test.The mean ± standard deviation and frequency and proportion describe the qualitative data.The 5-year survival rate was analyzed by single factor analysis.The COX regression model(Backward Wald)was used to analyze the risk factors of the patients with age,menopause,tumor stage and immunohistochemistry.Multivariate analysis was included in the Logistic regression model for factors that may be associated with complications.Significant level of P value is < 0.05.Evaluation of aesthetic satisfaction after breast reconstruction with Harris criteria.Results The median follow-up time was 69 months in the study group and 58 months in the control group.1.In the study group,there was 1 case of local recurrence in 5 years.In the control group,there were 3 cases of local recurrence in 5 years,The 5-year local recurrence rates were 1.0% and 3.4% in the study group and the control group,the difference was not statistically significant(p=0.537).There were 2 cases of Regional lymph node metastasis in study group and 1 cases of Regional lymph node metastasis in control group,The regional lymph node metastasis rate of the study group and the control group was 2.1% and 1.2% respectively,thedifference was not statistically significant(p=1.000);5 years distant metastasis rate was 5.2% and 10.3%,the difference was not statistically significant(p=0.184);The 5-year disease-free survival rates were91.7% and 85.1%,respectively.The difference was not statistically significant(p=0.135).5-year survival rates were 97.9% and 98.9%,respectively.The difference was not statistically significant(p=0.695).2.According to Harris evaluation of aesthetics,the excellent rate of satisfaction was 90.5%.3.In the study group,the time of extubation was 5 ~ 113 days,the median extubation time was 13 days,the control group was 5 to 71 days after extubation time,the median extubation time was 9 days,the difference between the two was statistically significant(P = 0.001).In the study group,the incision healing time was 6 ~ 141 days,the median healing time was 13.5 days.The incision healing time in the control group was 6 to 74 days,and the median healing time was 10 days.Statistically significant(P = 0.005).4.The incidence of postoperative complications: postoperative complications of the study group was 20.8%,12 cases of back seroma,1 cases of skin flap infection,2 cases of partial flap necrosis,2 cases of fat liquefaction,3 cases of partial dehiscence of incision,2 cases of flap atrophy,abdominal hernia in 1case.the control group total complications after surgery was 8.1%,of which 4cases of subcutaneous effusion,1 cases of nipple areola necrosis,1 cases of skin margin necrosis,wound dehiscence and II suture in 2 cases.There was significant difference between the two groups(P=0.016).Conclusion Breast cancer after complete gland resection of breast reconstruction and simple total mastectomy compared to local recurrence rate,distant metastasis rate increased,tumor-free survival rate,the overall survivalrate did not decline.In addition,immediately after breast reconstruction surgery cosmetic effect is better,but the incision healing time is relatively long,the incidence of postoperative complications is relatively increased.