May 31, 2024Open Immersive ReaderEditor’s Note: From April 19 to April 20, 2024, the 11th Sino-French (International) Advanced Breast Cancer Forum (SFBCS) was grandly held in Chongqing, where domestic and international experts shared vital content on basic breast cancer research, pathology diagnostics, surgical operations, and systemic treatment. In the surgical session, Professor Hongyuan Li from The First Hospital affiliated with Chongqing Medical University analyzed the “hot issues in subcutaneous mastectomy combined with breast reconstruction” based on his real-case follow-up experiences. “Oncology Frontier” took this opportunity to interview Professor Li on-site, providing guidance on breast reconstruction.
Oncology Frontier: Could you discuss the advantages and disadvantages of breast cancer reconstruction?
Professor Hongyuan Li : In recent years, breast reconstruction has become a hot topic in the surgical field in China. After more than a decade of development, breast reconstruction has become relatively common in breast surgery, including autologous breast reconstruction (such as latissimus dorsi myocutaneous flaps, rectus abdominis myocutaneous flaps, and free tissue flaps) and implant reconstruction. These methods significantly benefit patients, enhancing their quality of life and enabling them to return to society more quickly.
When choosing a type of breast reconstruction, we must understand the indications and precautions. For instance, professional women may prefer implant reconstruction for a quicker recovery and return to work. For patients with cancer on the right side, especially those who use their right hand for work and need to lift their arms, choosing a latissimus dorsi flap for reconstruction might affect arm function. Therefore, we must carefully weigh the pros and cons of each surgical method to ensure the most suitable choice for the patient. Autologous reconstruction may leave scars, and implant reconstructions might not look as natural as autologous ones. We need to create the most appropriate surgical plan based on the specific needs, condition, and preferences of each patient.
Oncology Frontier: How crucial is the pathological biopsy of the tissue behind the nipple-areola complex (NAC) in deciding whether to perform subcutaneous mastectomy combined with breast reconstruction, and how would you assess the safety of this procedure?
Professor Hongyuan Li : Subcutaneous mastectomy for breast cancer includes both preserving and not preserving the nipple-areola complex. Preserving the NAC can provide better visual results, which is very important for women; however, losing the NAC, despite maintaining the shape of the breast, can be regrettable and might require secondary nipple-areola reconstruction.
Ensuring the safety of the NAC is a clinical focus. Deciding whether to preserve the NAC requires intraoperative pathological examination to confirm whether there is any tumor or cancer cells behind it. Previous studies suggested preserving the NAC only if the tumor is more than 2 cm away. However, more recent studies believe it can be preserved if the margins behind the nipple are negative. The choice of surgical method must be based on the specific situation of the patient. If there is a high risk or pathology confirms cancerous invasion in the NAC, it is not suitable to preserve it in subcutaneous mastectomy. Regarding the safety of tumor treatment, subcutaneous mastectomy is relatively safe for early-stage patients.
From our summary of over 700 cases and 89 months of follow-up at the First Hospital affiliated with Chongqing Medical University, subcutaneous mastectomy (both preserving and not preserving the NAC) is safe, with a near 90% five-year survival rate, which is very promising. This data reconfirms the safety and efficacy of subcutaneous mastectomy, whether preserving the NAC or not, and highlights its positive significance for breast reconstruction.
Professor Hongyuan Li
Ph.D. in Surgery, Chief Physician, Professor
Director of the Breast and Thyroid Surgery Department (Chongqing Breast Cancer Center) at the First Hospital affiliated with Chongqing Medical University
Vice Chair of the Breast Surgery Specialist Group, Chinese Association of Surgeons
Standing Committee Member of the Breast Cancer Professional Committee, Chinese Anti-Cancer Association
Standing Member of the Breast Cancer Committee, Chinese Society of Clinical Oncology
Chair of the Breast Surgery Specialist Committee, Chongqing Medical Association
Chairman of the Western Breast and Thyroid Specialist Alliance
Deputy Editor of the Chinese Journal of Endocrine Surgery
