Dr. Li Zhu's Team of the Thyroid and Breast Surgery Department Completed the First Laparoscopic-assisted Radical Mastectomy + immediate Breast Reconstruction with Prosthesis at Shanghai General Hospital

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https://mp.weixin.qq.com/s/sSNLHnEVoaIoqdYNvJFwJw

The MDT team of of Breast Cancer at Shanghai General Hospital has taken full advantage of multidisciplinary cooperation to perform the first Laparoscopic-assisted radical mastectomy + immediate breast reconstruction with prosthesis for breast cancer patients by adopting the new concept of "breast reconstruction in front of the pectoral muscle". 

Recently, the MDT team of breast cancer led by Dr. Li Zhu, the director of the Department of Thyroid and Breast Surgery (North) of our hospital, gave full play to the advantages of multidisciplinary cooperation, with experts from the departments of General Surgery, Medical Ultrasound, Radiology and Nuclear Medicine, Pathology, Oncology and Clinical Pharmacy each showing their abilities. We performed the first Laparoscopic-assisted radical mastectomy + immediate breast reconstruction with prosthesis. While ensuring the effectiveness of tumor treatment, it minimized the patient's distress of losing her breast and also reduced the trauma and risk of complications associated with conventional surgery. The patient has now been successfully discharged.

Ms. Ding, 39 years old, is a white-collar worker in a foreign-funded enterprise. Last year, she had medical checkup and found a lump in her left breast. The mammogram suggested that Ms. Ding's left breast lump might be malignant, and the hospital recommended surgery after neoadjuvant treatment. However, due to the multifocal nature of the tumor, breast conserving surgery was not possible. So she came to the MDT team of breast cancer led by Dr. Li Zhu, director of the Department of Breast Surgery (North) of Shanghai General Hospital for help.

Faced with the patient's strong demand of preserving breast shape and not accepting the more invasive autologous flap reconstruction surgery, our breast cancer MDT team worked hard to find the best treatment plan for the patient. Members of the team from the medical ultrasound, radiology and nuclear medicine departments carefully evaluated the efficacy of neoadjuvant therapy, experts from oncology and pathology department analyzed the biological characteristics of the tumor, and pharmacists from the clinical pharmacy department were involved in targeted drug supply and side effect monitoring. Finally, the MDT team surgeons decided to perform a Laparoscopic-assisted radical mastectomy + immediate breast reconstruction with prosthesis after full communication with the patient, which can reduce the trauma caused by conventional surgery and make the surgical incision smaller and more concealed, and further improve the aesthetic appearance of the patient's breast.

After six months of neoadjuvant treatment, Ms. Ding was finally ready to undergo surgery. On the day of surgery, Dr. Li Zhu led Dr. Guiming Chen, Dr. Min Wang and Dr. Zhaoqi Zhang to perform a Laparoscopic-assisted radical breast cancer treatment + immediate breast reconstruction with prosthesis, with the active cooperation of the anesthesia department.

Since there is no natural cavity in the breast, the operation is more difficult. This Laparoscope adopted a more concealed axillary incision, which not only reduced the breast trauma, but also ensured a clear intraoperative view and avoided vascular and nerve damage. The mastectomy and reconstruction done in one operation minimized the patient's sense of physical disability after surgery. At the same time, this procedure does not create tension on the wound after implantation reducing the chance of implant exposure due to non-healing wounds.

In previous reconstructive surgery, the prosthesis was usually placed behind the pectoralis major muscle, requiring disconnection of the inferior border of the pectoralis major muscle. It might cause some damage and was prone to movement deformity. The surgical team adopted a new concept of "breast reconstruction in front of the pectoral muscle" by placing a titanium mesh wrapped prosthesis immediately after the removal of the breast. This way, the pectoral muscle is not damaged and the anatomical integrity is preserved, which not only provides a more aesthetic result, but also reduces the risk of surgical trauma and complications. The surgery was very successful and the patient was very satisfied with the post-operative results and reconstructed appearance, and returned to society in good health, both physically and mentally.

At present, more than 80% of breast cancer patients, especially early cases, can basically meet the cancer cure standard after standardized diagnosis and treatment. Therefore, patients' demands for postoperative appearance and survival quality are getting higher and higher. In recent years, breast reconstruction surgery for breast cancer is widely emerging, two-thirds of which are prosthesis reconstruction and the other one-third are autologous tissue reconstruction. While providing the best treatment results for breast cancer patients, our Thyroid and breast surgery department also upholds the concept of humanistic care and whole-life health management, striving to provide both physical and psychological care for patients.

Correspondent/ Thyroid and breast surgery (North) Zhaoqi Zhang

Yang Hu, Department of Publicity

Editor/Department of Publicity Shishi Cai