逆行序贯内镜手术与传统双侧保留乳头乳晕皮下腺体切除加即刻乳房假体植入重建的临床疗效及美学效果——单中心116例患者的初步分析

Clinical outcomes and aesthetic results of reverse sequence endoscopic versus traditional bilateral nipple-sparing mastectomy with immediate implant-based breast reconstruction-an analysis of initial 116 patients from single institution.

作者信息

Zhang Qing, Liang Faqing, Li Juan, Xie Yanyan, Feng Yu, Qiu Mengxue, Zhou Jiao, Yang Huanzuo, Lv Qing, Du Zheng-Gui

机构信息

Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China.

Breast Center, West China Hospital of Sichuan University, Chengdu, China.

出版信息

Front Oncol. 2025 Mar 10;15:1496592. doi: 10.3389/fonc.2025.1496592. eCollection 2025.

BACKGROUND

Endoscopic or robotic surgeries can minimize and hide the scars compared to conventional breast reconstruction but are considered unsuitable for bilateral procedures due to the extended operation time. This study explored a novel time-shortening endoscopic technique, namely reverse-sequence endoscopic nipple-sparing mastectomy (R-E-NSM) with bilateral implant-based breast reconstruction (BIBR), and compared it with conventional open surgery in clinical and cosmetic outcomes.

METHODS

We retrospectively analyzed patients who underwent BIBR in the West China Hospital from January 2017 to June 2022. Patient characteristics, operation time, postoperative complications, breast satisfaction, and Scar-Q scores were compared between endoscopic and conventional open groups.

RESULTS

Among 116 patients, 76 underwent R-E-NSM with BIBRs (R-E-BIBR group), and 40 underwent conventional open BIBRs (C-O-BIBR group). The demographics and clinical data were similar primarily (P > 0.05). Compared with the C-O-BIBR group, the R-E-BIBR group had lower rates of total (32.5% versus 6.6%, P < 0.001), major (13.8% versus 2.0%, P < 0.001) and minor (23.8% versus 3.9%, P < 0.001) complications. The operation time between the two groups is not statistically significant (290.2 ± 95.2 mins versus 271.9 ± 95.3 mins, P = 0.327). The Harris scale scored breast satisfaction, and the excellent rate of the C-O-BIBR group was 32.5% while the R-E-BIBR group was 58.0% (P < 0.001). The mean Scar-Q scores were 35.17± 9.6 in the C-O-BIBR group and 81.32 ± 12.3 in the R-E-BIBR group, respectively (P < 0.001).

CONCLUSION

The innovative R-E-NSM with implant-based breast reconstruction makes up for the long operation time of previous endoscopic surgeries and has significant advantages in reducing complication rates and improving the cosmetic results of the postoperative breasts.

LEVEL OF EVIDENCE

Level III, Retrospective study.

背景

与传统乳房重建相比，内镜手术或机器人手术可以使疤痕最小化并隐藏起来，但由于手术时间延长，被认为不适合双侧手术。本研究探索了一种新型的缩短时间的内镜技术，即反向顺序内镜保留乳头乳房切除术（R-E-NSM）联合双侧植入式乳房重建（BIBR），并在临床和美容效果方面将其与传统开放手术进行比较。

方法

我们回顾性分析了2017年1月至2022年6月在华西医院接受BIBR的患者。比较了内镜组和传统开放组的患者特征、手术时间、术后并发症、乳房满意度和疤痕质量评分（Scar-Q）。

结果

116例患者中，76例行R-E-NSM联合BIBR（R-E-BIBR组），40例行传统开放BIBR（C-O-BIBR组）。人口统计学和临床数据基本相似（P>0.05）。与C-O-BIBR组相比，R-E-BIBR组的总并发症发生率（32.5%对6.6%，P<0.001）、主要并发症发生率（13.8%对2.0%，P<0.001）和次要并发症发生率（23.8%对3.9%，P<0.001）均较低。两组的手术时间无统计学差异（290.2±95.2分钟对271.9±95.3分钟，P = 0.327）。采用哈里斯量表对乳房满意度进行评分，C-O-BIBR组的优良率为32.5%，而R-E-BIBR组为58.0%（P<0.001）。C-O-BIBR组的平均Scar-Q评分为35.17±9.6，R-E-BIBR组为81.32±12.3（P<0.001）。