Huang Junying, Sin Tat-Hang, Nie Longzhu, Zhou Yidong, Zhang Fan, Ma Jia, Shi Xiaoguang, Chen Linlin, Niu Kunying, Zhang Xiaohui, Sun Qiang, Huang Hanyuan
Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Breast Surgery, Beijing Dangdai Hospital, Beijing, China.
Front Surg. 2023 Jun 16;10:1187811. doi: 10.3389/fsurg.2023.1187811. eCollection 2023.
Granulomatous lobular mastitis (GLM) is characterized by nonspecific chronic inflammation concentrated in breast lobules. Surgical resection is one of the most common treatment options for GLM. On the basis of our previous use of Breast Dermo-Glandular Flap (BDGF), we designed a new surgical approach for GLM, especially for cases where the focus is close to the nipple. Here we describe this new treatment approach.
In Peking Union Medical College Hospital (PUMCH) and Beijing Dangdai Hospital during January 2020-June 2021, we enrolled all 18 GLM patients who underwent surgery with the use of Dermis-Retained BDGF. All patients were women; most of the patients were 18-50 years old (88%); and the most common clinical manifestation of GLM was breast mass (60%). Then, we collected and analyzed data about the surgery and outcomes (drainage tubes moving time, relapse, patients' shape satisfaction). We regarded GLM recurrence on the same side as relapse. If there was no complication and the patient's satisfaction was excellent or good, we rated the surgery as successful. We recorded the occurrence of all common postsurgical complications of the breast.
The debridement area was 3-5.5 (4.3 ± 0.7) cm; surgery time was 78-119 (95.6 ± 11.6) min; and mean debridement time (27.8 ± 8.9 min) was shorter than the time to obtain and transplant the flap (47.5 ± 12.9 min). Blood loss was less than 139 ml. As for bacterial culture, two patients had positive results, but they had no symptoms. No surgery-related complications happened. In terms of the outcomes, all of the drainage tubes were removed in less than 5 days, and only one patient experienced relapse after 1 year of surgery during the follow-up. The patients' satisfaction with the breast shape was as follows: excellent (50%), good (22%), acceptable (22%), and poor (6%).
For GLM patients refractory to conservative therapy or former unsatisfactory surgical management whose lesion is in the vicinity of the nipple and larger than 3 cm, Dermis-Retained BDGF is a suitable approach to fill the after-debridement defect below the nipple-areola and achieve a relatively satisfactory cosmetic outcome.
肉芽肿性小叶性乳腺炎（GLM）的特征是集中在乳腺小叶的非特异性慢性炎症。手术切除是GLM最常见的治疗选择之一。基于我们之前对乳腺真皮-腺体瓣（BDGF）的应用，我们设计了一种针对GLM的新手术方法，特别是对于病灶靠近乳头的病例。在此我们描述这种新的治疗方法。
在2020年1月至2021年6月期间，在北京协和医院（PUMCH）和北京当代医院，我们纳入了所有18例行保留真皮BDGF手术的GLM患者。所有患者均为女性；大多数患者年龄在18 - 50岁之间（88%）；GLM最常见的临床表现是乳腺肿块（60%）。然后，我们收集并分析了有关手术及结果（引流管拔除时间、复发情况、患者对乳房外形的满意度）的数据。我们将同侧GLM复发视为复发。如果没有并发症且患者满意度为优或良，我们将手术评定为成功。我们记录了所有常见的乳腺术后并发症的发生情况。
清创面积为3 - 5.5（4.3±0.7）cm；手术时间为78 - 119（95.6±11.6）分钟；平均清创时间（27.8±8.9分钟）短于获取和移植皮瓣的时间（47.5±12.9分钟）。失血量少于139ml。细菌培养方面，两名患者结果呈阳性，但他们没有症状。未发生与手术相关的并发症。在结果方面，所有引流管均在5天内拔除，随访期间仅1例患者在术后1年复发。患者对乳房外形的满意度如下：优（50%）、良（22%）、可接受（22%）、差（6%）。
对于保守治疗无效或既往手术治疗效果不满意、病灶位于乳头附近且大于3cm的GLM患者，保留真皮BDGF是一种合适的方法，可填补乳头乳晕下方清创后的缺损并取得相对满意的美容效果。
