Objective: To investigate the satisfaction and well-being of Chinese women with breast deficiency, and to analyze the relevant influencing factors. Methods: A cross-sectional study was conducted using a self-designed questionnaire to investigate the women with breast deficiency, visiting the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from November 2013 to August 2018. The BREAST-Q BR (breast reconstruction) pre-operation and post-operation modules were used to assess the quality of life. Results: A total of 139 effective questionnaires were collected, including 83 patients before BR surgery and 56 post. There was no difference in quality of life in different ages, marital status, education levels, working status, and causes of breast deficiency. Mean scores of satisfaction with breasts, psychosocial well-being and sexual well-being of patients after breast reconstruction were significantly higher than those of patients without reconstruction (P=0.000), but there was no statistical difference in physical well-being-chest score. The physical well-being abdomen scores of patients with abdominal flap reconstruction was lower than that of the patients without reconstruction (P=0.007). With regard to analysis of specific items, compared with preoperative patients, patients with abdominal flap reconstruction reported lower scores in the items related to abdominal muscle weakness (P<0.05). Conclusions The breast deficiency resulting from Poland syndrome, breast cancer and other causes, can lead to a significant decrease in quality of life. Breast reconstruction can improve satisfaction with breast, psychosocial and sexual well-being in women with breast deficiency. The abdomen well-being of patients with abdominal flap reconstruction is decreased. Therefore, more attention should be paid to retain abdominal muscles to maintain abdominal shape and motor function during operation.

Objective:The purpose of this study was to introduce an endoscopic approach to harvest latissimus dorsi muscle(LDM)flap using a single transverse axillary incision and evaluate its safety and efficacy to repair the chest deformities of Poland syndrome.Methods:Poland syndrome patients were recruited prospectively to repair the thoracic wall deformity plus breast reconstruction(combined with breast implant insertion) using the endoscopic approach to transfer LDM flap with single transverse axillary incision in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from October 2015 to January 2018. Information including patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time(endoscopic time for LDM flap harvesting, endoscopic anterior subcutaneous pocket creating time and total time), the survival of LDM flap, deformity of thoracic wall and back and post-operative complications were collected. The pain visual analog scale was used to assess the severity of postoperative pain. The Breast-Q reconstruction module was used to evaluate patients’ psychosocial well-being and satisfaction with the outcome. The disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. A paired t-test was utilized to analyze the difference between the preoperative and postoperative score of the Breast-Q and DASH questionnaire. Results:Twenty-eight patients were recruited in this study, including 11 males and 17 females aged (22.5±3.9) years old with a body mass index of (20.5±6.1) kg/m 2. Two patients received contralateral implant augmentation and two received fat grafting for breast symmetry. The postoperative follow-up time was (50.4±23.1) months. All the reconstructed breasts or thoracic walls was in a good shape. All the LDM flap survived with good blood supply. The postoperative pain was mild, and there was no obvious abnormality of the thoracic wall and back. The area of harvested LDM flap was (437.2±110.0) cm 2. The size of the implant used for breast reconstruction was (240.4±46.0) ml. Total operation time was (169.4±16.1) minutes for patients without contralateral symmetrical surgery. The endoscopic time for LDM flap harvesting was (69.0±13.9) minutes. The endoscopic anterior subcutaneous pocket creating time was (32.8±6.0) minutes. The postoperative drain time was (7.6±1.4) days. The postoperative complications included one case of early seroma, one case of wound dehiscence, one case of flap malposition. The pain visual score of the patient was 2.7±0.5 on the first day after the operation and decreased to 0.8±0.4 after 1 week. The score of satisfaction with breast before surgery was 27.8±20.8, psychosocial well-being score was 49.6±17.0. The postoperative score of satisfaction with breast was 63.1±11.6, and psychosocial well-being score was 68.1±16.7. The postoperative score of satisfaction with breast ( t=-9.000, P=0.008) and psychosocial well-being ( t=-6.543, P<0.001) were significantly higher than those before surgery. The score of DASH was 3.7±3.3 before surgery and 4.0±3.7 after surgery respectively, with no statistically significant differences ( t=-1.160, P=0.276). All patients were highly satisfied with the result of the surgery. Conclusions:The endoscopic approach to transfer latissimus dorsi muscle flap using a single transverse axillary incision provides a safe and efficient way to repair thoracic wall deformities in Poland syndrome patients with a high satisfaction rate, a better aesthetic outcome, and a minimal complications rate.

Objective:To explore the safety and efficacy of prophylactic superdrainage using superficial inferior epigastric vein (SIEV) in delayed single-pedicled deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:The clinical data of all patients who underwent single-pedicle DIEP flap delayed breast reconstruction in Department of Comprehensive Breast Plasty Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2018 to August 2022 were retrospectively analyzed. According to whether SIEV-internal thoracic vein anastomosis was performed, they were divided into superdrainaged group and non-superdrainaged group. The diameter of SIEV and the time required for anastomosis were recorded. The total operation time, flap ischemia time, hospital stay, the rates of flap diffuse congestion, overall complications and second operation were compared between the two groups. The relative risks of flap diffuse congestion, complications and second operation were calculated. SPSS 24.0 software was used for data analysis. Measurement data was expressed as Mean±SD, independent sample t test was used for analysis. Counting data was expressed as %, and χ2 test was used for analysis. P<0.05 was considered statistically significant. Results:A total of 45 patients were included, including 26 patients in the non-superdrainaged group and 19 patients in the superdrainaged group. The total operation time was (7.7±1.9) h and (8.4±1.5) h, the flap ischemia time was (89.5±10.4) min and (92.6±12.3) min, and the hospital stay was (6.6±1.8) d and (6.6±2.0) d, respectively. There were no significant differences ( P>0.05). In the superdrainaged group, the diameter of SIEV was (2.5±0.3) mm, and manual suture was used. The time required for anastomosis of one SIEV was (12.2±2.3) min. The rates of diffuse congestion, recipient site complications, donor site complications and second operation were 7.7%(2/26), 15.4%(4/26), 7.7%(2/26) and 15.4%(4/26) in the non-superdrainaged group, and 0(0/19), 5.3%(1/19), 10.5%(2/19) and 5.3%(1/19) in the superdrainaged group, respectively. There were no significant differences between the two groups ( P>0.05). The relative risks were 3.7, 2.9, 0.7 and 2.9, respectively. Conclusion:Prophylactic superdrainage using SIEV is safe and effective. It can minimize the potential rate of diffuse venous congestion and secondary surgery, and not at the expense of increased flap ischemia time and abdominal complications in the meanwhile.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

Objective:To explore the safety and efficacy of prophylactic superdrainage using superficial inferior epigastric vein (SIEV) in delayed single-pedicled deep inferior epigastric perforator (DIEP) flap breast reconstruction.Methods:The clinical data of all patients who underwent single-pedicle DIEP flap delayed breast reconstruction in Department of Comprehensive Breast Plasty Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from May 2018 to August 2022 were retrospectively analyzed. According to whether SIEV-internal thoracic vein anastomosis was performed, they were divided into superdrainaged group and non-superdrainaged group. The diameter of SIEV and the time required for anastomosis were recorded. The total operation time, flap ischemia time, hospital stay, the rates of flap diffuse congestion, overall complications and second operation were compared between the two groups. The relative risks of flap diffuse congestion, complications and second operation were calculated. SPSS 24.0 software was used for data analysis. Measurement data was expressed as Mean±SD, independent sample t test was used for analysis. Counting data was expressed as %, and χ2 test was used for analysis. P<0.05 was considered statistically significant. Results:A total of 45 patients were included, including 26 patients in the non-superdrainaged group and 19 patients in the superdrainaged group. The total operation time was (7.7±1.9) h and (8.4±1.5) h, the flap ischemia time was (89.5±10.4) min and (92.6±12.3) min, and the hospital stay was (6.6±1.8) d and (6.6±2.0) d, respectively. There were no significant differences ( P>0.05). In the superdrainaged group, the diameter of SIEV was (2.5±0.3) mm, and manual suture was used. The time required for anastomosis of one SIEV was (12.2±2.3) min. The rates of diffuse congestion, recipient site complications, donor site complications and second operation were 7.7%(2/26), 15.4%(4/26), 7.7%(2/26) and 15.4%(4/26) in the non-superdrainaged group, and 0(0/19), 5.3%(1/19), 10.5%(2/19) and 5.3%(1/19) in the superdrainaged group, respectively. There were no significant differences between the two groups ( P>0.05). The relative risks were 3.7, 2.9, 0.7 and 2.9, respectively. Conclusion:Prophylactic superdrainage using SIEV is safe and effective. It can minimize the potential rate of diffuse venous congestion and secondary surgery, and not at the expense of increased flap ischemia time and abdominal complications in the meanwhile.

Objective:This study aimed to explore the clinical application value of the indication selection criteria for bi-pedicled deep inferior epigastric arterial perforator flap(DIEP) versus pedicled transverse rectus abdominis myocutaneous flap(TRAM) combined with DIEP for breast reconstruction.Methods:The clinical data of patients who underwent delayed bi-pedicled abdominal flap breast reconstruction after breast cancer surgery in the Department of Oncoplastic and Reconstructive Breast Surgery and Department of Mammoplasty, Plastic Surgery Hospital, Chinese Academy of Medical Sciences from January 2008 to April 2022 were retrospectively analyzed. According to the indications for each procedure, corresponding blood supply source was selected. Subsequently, patients were divided into two groups: bi-pedicled DIEP group and pedicled TRAM+ DIEP combined flap group according to the type of blood supply source. The indication selection criteria for pedicled TRAM+ DIEP combined flap was as follows: lack of two groups of recipient vessels; no dominant perforator in the abdominal donor site; previous abdominal liposuction or abdominal surgery with large dissection range and severe scar; patients were unable to tolerate prolonged surgery or had high risk factors for microsurgery. A comparison of breast reconstruction surgery characteristics was conducted between the two groups. Independent-samples t-test, rank sum test, Chi-square test and Fisher’s exact probability method were used to analyze various data including age, body mass index (BMI), time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy, history of chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length, preoperative and postoperative conditions, as well as postoperative complications. Statistical significance was defined at P<0.05. Results:A total of 54 patients who underwent unilateral breast reconstruction were included in this study with a mean age of 42.2 years (range, 30-59 years). The pedicled TRAM+ DIEP combined flap group consisted of 21 patients with a mean age of 42.7 years (range, 33-56 years) while the bi-pedicled DIEP group comprised 33 patients with a mean age of 41.8 years (30-59 years). Out of the 54 patients, a total of 38 were eventually followed up, comprising 14 in the pedicled TRAM+ DIEP combined flap group and 24 in the bi-pedicled DIEP group. The average follow-up duration for the pedicled TRAM+ DIEP combined flap group was 42 months (range, 6-69 months). Abdominal bulge occurred in one patient, while another patient experienced abdominal hernia. The average follow-up duration for the bi-pedicled DIEP group was 47 months (6-179 months), with no reported cases of abdominal bulge or abdominal hernia. There were no statistically significant differences observed between the two groups regarding age, BMI, time interval between breast cancer surgery and breast reconstruction surgery, history of radiotherapy or chemotherapy, history of smoking, history of lower abdominal surgery, history of hypertension, original surgical incision type, length and width of flap, hospitalization length or time to ambulation (all P>0.05). However, there was a statistically significant difference noted in duration of surgery between the pedicled TRAM+ DIEP combined flap group and bi-pedicled DIEP group [6.0(5.5-6.5) hours vs. 8.5(8.0-8.8) hours] ( P<0.01). Comparison analysis revealed no statistically significant differences in terms of partial flap necrosis (0/21 vs. 1/33), abdominal incision dehiscence (2/21 vs. 2/33), abdominal bulge (1/14 vs. 0 /24) or abdominal hernia (1/1 vs. 0/24) between the two groups ( P>0.05). Conclusion:For patients who needed bilateral vascular pedicled lower abdominal wall for breast reconstruction, utilizing a pedicled TRAM+ DIEP combined flap did not increase surgical complication risks. The proposed indication selection criteria for using a pedicled TRAM + DIEP combined flap outlined in this study could serve as guidance when choosing methods for bi-pedicled abdominal flap breast reconstruction.

Objective:The purpose of this study was to introduce an endoscopic approach to harvest latissimus dorsi muscle(LDM)flap using a single transverse axillary incision and evaluate its safety and efficacy to repair the chest deformities of Poland syndrome.Methods:Poland syndrome patients were recruited prospectively to repair the thoracic wall deformity plus breast reconstruction(combined with breast implant insertion) using the endoscopic approach to transfer LDM flap with single transverse axillary incision in the Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences, from October 2015 to January 2018. Information including patient demographics, LDM area, implant size, contralateral symmetry surgery, operative time(endoscopic time for LDM flap harvesting, endoscopic anterior subcutaneous pocket creating time and total time), the survival of LDM flap, deformity of thoracic wall and back and post-operative complications were collected. The pain visual analog scale was used to assess the severity of postoperative pain. The Breast-Q reconstruction module was used to evaluate patients’ psychosocial well-being and satisfaction with the outcome. The disabilities of the arm, shoulder, and hand (DASH) outcome questionnaire was used to evaluate patient upper extremity disabilities. A paired t-test was utilized to analyze the difference between the preoperative and postoperative score of the Breast-Q and DASH questionnaire. Results:Twenty-eight patients were recruited in this study, including 11 males and 17 females aged (22.5±3.9) years old with a body mass index of (20.5±6.1) kg/m 2. Two patients received contralateral implant augmentation and two received fat grafting for breast symmetry. The postoperative follow-up time was (50.4±23.1) months. All the reconstructed breasts or thoracic walls was in a good shape. All the LDM flap survived with good blood supply. The postoperative pain was mild, and there was no obvious abnormality of the thoracic wall and back. The area of harvested LDM flap was (437.2±110.0) cm 2. The size of the implant used for breast reconstruction was (240.4±46.0) ml. Total operation time was (169.4±16.1) minutes for patients without contralateral symmetrical surgery. The endoscopic time for LDM flap harvesting was (69.0±13.9) minutes. The endoscopic anterior subcutaneous pocket creating time was (32.8±6.0) minutes. The postoperative drain time was (7.6±1.4) days. The postoperative complications included one case of early seroma, one case of wound dehiscence, one case of flap malposition. The pain visual score of the patient was 2.7±0.5 on the first day after the operation and decreased to 0.8±0.4 after 1 week. The score of satisfaction with breast before surgery was 27.8±20.8, psychosocial well-being score was 49.6±17.0. The postoperative score of satisfaction with breast was 63.1±11.6, and psychosocial well-being score was 68.1±16.7. The postoperative score of satisfaction with breast ( t=-9.000, P=0.008) and psychosocial well-being ( t=-6.543, P<0.001) were significantly higher than those before surgery. The score of DASH was 3.7±3.3 before surgery and 4.0±3.7 after surgery respectively, with no statistically significant differences ( t=-1.160, P=0.276). All patients were highly satisfied with the result of the surgery. Conclusions:The endoscopic approach to transfer latissimus dorsi muscle flap using a single transverse axillary incision provides a safe and efficient way to repair thoracic wall deformities in Poland syndrome patients with a high satisfaction rate, a better aesthetic outcome, and a minimal complications rate.