Clinical Study Of One-Step And Two-Step Methods For Breast Reconstruction In Early Breast Cancer

Objective: To investigate the efficacy of one-step breast reconstruction and two-step breast reconstruction in the surgical treatment of early breast cancer,and to summarize the operation procedures and common complications of implant-based breast reconstruction.the differences of postoperative complications,cost-effectiveness and satisfaction of breast appearance between one-step and two-step implant-based breast reconstruction were compared.To provide experience for the selection of implant-based breast reconstruction in patients with early breast cancer in the future.Methods: A retrospective study was conducted on 63 female patients with early breast cancer who underwent immediate prosthesis reconstruction(one-step method)and delayed-immediate tissue expander reconstruction(two-step method)after mastectomy in our department from September 2018 to October 2020.The social demographic information of patients and the clinical medical records related to breast reconstruction with implants were collected,and the differences of different reconstruction methods in hospital stay,hospital expenses and overall postoperative complications were compared and analyzed.Telephone follow-up and hospital follow-up were used to investigate the patients’ satisfaction with the cosmetic effect of breast appearance after reconstruction,and to evaluate the application effect of different reconstruction methods.Results: All the 63 patients in this study were reconstructed and implanted with tissue expander or prosthesis immediately after mastectomy.There was no significant difference in the overall incidence of complications between patients with one-step prosthesis breast reconstruction and patients with two-step prosthesis breast reconstruction(P=0.734).There was no significant difference between NSM and SSM in patients with immediate one-step prosthesis breast reconstruction(P=0.530).There was no significant difference in the overall incidence of complications between NSM and SSM in patients with immediate two-step breast reconstruction(P=1.000).There was no significant difference in the overall incidence of complications between NSM and SSM in all patients with implant-based breast reconstruction(P=1.000).The total hospitalization cost and total hospitalization days in the two-step tissue expander-prosthesis replacement group were(51195.37±5088.11)yuan and(21.90±2.90)days,respectively,which were significantly higher than those in the one-step prosthesis breast reconstruction group(40098.76±5862.45)yuan and(11.53±3.10)days,respectively(P＜0.05)and(P＜0.05).The excellent satisfaction of patients with one-step breast reconstruction was 78.95%,compared with 77.27% of all patients with two-step breast reconstruction,and the difference was not statistically significant(P=1.000).However,the excellent satisfaction of patients with breast reconstruction with NSM was 86.49%,compared with 61.54% with SSM,and the difference was statistically significant(P=0.022).Conclusions: 1.In immediate implant breast reconstruction,there was no difference in the overall incidence of complications between one-step prosthesis breast reconstruction and two-step breast reconstruction and NSM compared with SSM,but the breast appearance satisfaction of patients with one-step prosthesis breast reconstruction was similar to that of two-step breast reconstruction.2.The hospitalization cost and hospitalization time of two-step breast reconstruction was significantly higher than that of one-step prosthesis breast reconstruction,and it had higher time and economic burden under the condition of similar breast appearance satisfaction.3.The excellent satisfaction of patients with NSM reconstruction was significantly higher than that of SSM,suggesting that the retention of breast aesthetic unit NAC is of great significance to improve patients’ satisfaction with breast appearance after breast reconstruction.