Xu Hong, Zheng Hao, Dabu Xilite, Hou Lihua, Xue Lihua, Wang Yajing, Miao Shan, Xia Zhongyuan, Shi Xiaoguang
Medical Department of General Surgery, The 1st Medical Center, Chinese PLA General Hospital, Beijing, China.
Department of General Surgery, The 3rd Medical Center, Chinese PLA General Hospital, Beijing, China.
Gland Surg. 2025 Aug 31;14(8):1473-1482. doi: 10.21037/gs-2025-99. Epub 2025 Aug 26.
Plasma cell mastitis (PCM) is a chronic inflammatory breast disease that presents challenges in achieving both effective disease control and satisfactory cosmetic outcomes. Layered breast defect reconstruction (LBDR) is a technique that may reduce recurrence and improve breast aesthetics. This study aimed to evaluate the clinical value of LBDR compared to traditional surgical repair in PCM patients.
We conducted a retrospective cohort study of 90 female PCM patients treated at the Third Medical Center of Chinese PLA General Hospital between 2002 and 2018. Patients with histologically confirmed PCM who underwent surgical treatment and completed at least 3 years of follow-up were included. Based on the surgical technique, patients were divided into two groups: traditional surgery (n=24) and LBDR (n=66). Baseline clinical characteristics-including age, body mass index (BMI), disease duration, and comorbidities-were collected and compared between groups. The primary outcomes were postoperative recurrence and aesthetic satisfaction. Secondary outcomes included operative time, intraoperative blood loss, and complication rates. Logistic regression was used to identify independent predictors of favorable outcomes.
The two groups were generally comparable in baseline characteristics, including BMI, smoking history, breastfeeding history, and clinical symptoms (all P>0.05). However, patients in the LBDR group were significantly older (P=0.003), and lesion locations differed between groups (P=0.02). Compared to traditional surgery, LBDR significantly reduced the recurrence rate (4.55% 45.83%, P<0.001) and improved aesthetic satisfaction (100% 8.33%, P<0.001). Multivariate logistic regression analysis identified LBDR as an independent protective factor for favorable breast appearance [odds ratio (OR) =0.00, 95% confidence interval (CI): 0.00-0.03, P=0.001] and reduced recurrence (OR =0.06, 95% CI: 0.01-0.25, P<0.001). Although LBDR involved a longer operative time, there were no significant differences in intraoperative bleeding nor postoperative complications.
LBDR may provide favorable oncologic and cosmetic outcomes in selected PCM patients without increasing perioperative risks. However, given the retrospective, non-randomized design, further prospective studies are needed to validate these findings.
浆细胞性乳腺炎（PCM）是一种慢性炎症性乳腺疾病，在实现有效疾病控制和令人满意的美容效果方面都面临挑战。分层乳房缺损重建术（LBDR）是一种可能降低复发率并改善乳房美观的技术。本研究旨在评估LBDR相较于传统手术修复在PCM患者中的临床价值。
我们对2002年至2018年在中国人民解放军总医院第三医学中心接受治疗的90例女性PCM患者进行了一项回顾性队列研究。纳入经组织学确诊为PCM且接受手术治疗并完成至少3年随访的患者。根据手术技术，将患者分为两组：传统手术组（n = 24）和LBDR组（n = 66）。收集并比较两组患者的基线临床特征，包括年龄、体重指数（BMI）、病程和合并症。主要结局指标为术后复发率和美容满意度。次要结局指标包括手术时间、术中出血量和并发症发生率。采用逻辑回归分析确定良好结局的独立预测因素。
两组患者在基线特征方面总体具有可比性，包括BMI、吸烟史、哺乳史和临床症状（均P>0.05）。然而，LBDR组患者年龄显著更大（P = 0.003），且两组病变部位存在差异（P = 0.02）。与传统手术相比，LBDR显著降低了复发率（4.55%对45.83%，P<0.001），并提高了美容满意度（100%对8.33%，P<0.001）。多因素逻辑回归分析确定LBDR是乳房外观良好的独立保护因素[比值比（OR）=0.00，95%置信区间（CI）：0.00 - 0.03，P = 0.001]以及复发率降低的独立保护因素（OR = 0.06，95%CI：0.01 - 0.25，P<0.001）。尽管LBDR手术时间较长，但术中出血量和术后并发症方面无显著差异。
LBDR可能为部分PCM患者提供良好的肿瘤学和美容效果，且不增加围手术期风险。然而，鉴于本研究的回顾性、非随机设计，需要进一步的前瞻性研究来验证这些发现。
