Objective To explore immediate implanting breast reconstruction after subcutaneous mastectomy by through breast lateral curved incision with combined muscle flap of pedicled latissimus dorsi and pectoralis major muscle covering the breast prosthesis. Methods 30 patients were selected in clinical stage Ⅰ or Ⅱ , and without involvement of skin and pectoral muscle. After subcutaneous mastectomy through breast lateral curved incision, by the same incision the latissimus dorsi muscle flap was removed and transferred, and the submuscular interspace was dissected, and the inferior border of the pectoralis major muscle was cut off. The pedicled latissimus dorsi and pectoralis major muscle flap were sutured and the combined muscle flap was formed to cover the breast prothesis.Results The shape and feeling were satisfactory in 30 reconstructive breasts, and 22 cases were excellent (73.3 %), and 8 cases were good (26.7 %). All the patients survived without tumor recurrence after following-up more than half a year. Conclusions The method has advantages of good cosmetic breast shape, without appendant incision, and larger breast prosthesis could be insertted. It is a good method of immediate breast reconstruction for the young women with early stage breast cancer without axillary lymph node metastasis.

Objective To probe the teaching method of application of problem-based learning (PBL)with computer aided technology in teaching of breast surgery clinical practice.Methods 48 students were randomly divided into two groups:control group(n=24) were taught by lecture-based learning(LBL),experimental group (n=24) were taught by method of application of problem-based learning(PBL)with computer aided technology.Questionnaire was provided to the students of experimental group to investigate the degree of recognition to the teaching method of problem-based learning (PBL)with computer aided technology.5 patients from experimental group and 5 patients from control group participating in teaching were given questionnaires to investigate if their right of privacy were violated.The theory examination score(out of 50) and comprehensive skills assessment score (out of 50) were compared between the two groups; the mean differences between the two groups were compared by t test.Result The teaching method of application of problem-based learning(PBL) with computer aided technology was recognition by 91.7 ％(22 persons) of students.20 percent(one person) of the experimental group patients felt their right of privacy violated; 60 percent(three persons) of the control group patients felt their right of privacy violated.The theory test scores of the experimental group and control group were (46.23 ± 2.45) and (45.52 ± 3.29).There was no statistical significance (t=1.230,P=0.225).The skill test scores of the experimental group and control group were(47.23± 2.45) and (36.52 t 3.29).There was statistical significance(t=12.791,P=0.000).Conclusion The teaching method of application of problem-based learning(PBL) with computer aided technology can help encourage the study interest of students,and cultivate their clinical thinking method and capacity,and protect the right of privacy of the patients,avoiding patient-hospital disputes.

Objective To conduct the comparative study of the measurement of breast volume by MRI imaging and Archimedes method in immediate implant breast reconstruction.Methods A total of 44 patients who were diagnosed as breast cancer and undergone immediate implant breast reconstruction were selected from March 2011 to March 2013.22 cases were guided to select suitable breast implants by measuring the breast volume and correlative radial line based on MRI imaging.Control group containing 22 cases were guided to select breast implants by traditional Archimedes method and clinical experience.3 breast surgeons and plastic surgeons who did not participate in the operation were selected to judge the postoperative breast shape.Data of two groups were analyzed by using chisquare test.Results All the patients recovered smoothly after operation without infection,and the wound healed well.The breast shape was evaluated.21 cases (95.5 ％) were good in test group and 1 case (4.5％) was poor;16 cases (72.7％) were good in control group and 6 cases (27.3) were poor.The comparison between the test group and control group had statistical significance (P＜0.05).Conclusions The method to measure the breast volume and correlative radial line based on MRI imaging has important values for selecting breast implants in immediate implant breast reconstruction.It could be extensively used in clinical practice.

Objective To explore the causes of secondary breast deformity after breast conservative therapy and its preventive methods.Methods 30 cases were selected from the patients with secondary breast deformity of more than 1 year after breast conservative therapy,and more than half a year after radiotherapy and chemotherapy,and no local recurrence and distant metastasis occurred.After cicatrectomy and contracture loose solution,different methods were used according to varying degrees of the secondary breast deformity to reconstruct and repair the deformity.Results Three reconstructive methods were conducted.Local mammary flaps were used in 7 patients,latissimus dorsi myocutaneous flap in 21 patients,and transverse rectus abdominal musculocutaneous flaps in 2 patients.The shape and feeling were satisfactory in 30 patients with reconstructive breasts,in which 23were excellent (76.7 ％),and 7 were good (23.3 ％).All the patients were followed-up for average 2.5 years,and they were survived without tumor recurrence.Conclusions The secondary breast deformity after breast conservative therapy could be effectively prevented,and successfully reconstructed and repaired with different procedure according to varying degrees of the secondary breast deformity.As a result,the shape and feeling of reconstructive breasts are satisfactory.

Objective:To explore and analyze the influence of thoracic types and symmetry methods on the treatment effect before operation for the breast cancer patients undergoing immediate breast reconstruction.Methods:From January to October 2018, 30 female patients with unilateral breast cancer, aged 33-48 (39.6±4.6) years, were treated in the Breast Center of Qingdao University Affiliated Hospital. Thoracic CT was used to analyze thoracic types and symmetry. The measurement indexes included the maximum transverse diameter of thorax, the maximum longitudinal diameter of left and right sides, the ratio of the maximum transverse longitudinal diameter of left and right sides, the anterior chest angle of left and right sides, the posterior chest angle and the external chest angle, and the type and symmetry of thorax were analyzed, and the choice of prosthesis was adjusted according to the measurement results.Results:All the 30 patients recovered smoothly, and no complications such as infection and prosthesis removal occurred. Anatomical prostheses were selected in 22 patients, including 12 cases with medium high protrusion prosthesis, 10 cases with low protrusion prosthesis and 8 cases with round low protrusion prosthesis. The average follow-up time was 15 months after operation. The postoperative follow-up photos were evaluated aesthetically by using the BRAST-Q questionnaire and 3 non-operative doctors, among which 22 cases were excellent, 4 cases were good, 3 cases passed and 1 case was poor. Excellent and good rate was 86.7%. Among them, 3 cases were satisfactory, 1 case was scar hyperplasia of local incision, 2 cases were mild capsular contracture, and 1 case was subject to prosthesis displacement.Conclusions:The measurement and analysis of thoracic type and symmetry before operation can help to adjust the choice of prosthesis, check the obvious thoracic deformity and avoid affecting the surgical results.