Impact of Subcutaneous Mastectomy under Laparoscopy with In Situ Prosthetic Reconstruction on Aesthetic Appearance in Breast Cancer Patients

Summary

Here, we explore the impact of subcutaneous mastectomy under laparoscopy combined with in situ prosthetic breast reconstruction on breast cancer patients' aesthetic appearance. It details patient selection, preoperative preparation, surgical process, and postoperative outcomes. This approach effectively removes tumors while preserving breast shape, improving patients' self-esteem and quality of life.

Abstract

Breast cancer remains one of the most widespread malignant tumors affecting women, with a range of treatment options available, among which surgical intervention holds a central position. Traditional mastectomy, while effective in removing tumors, often results in severe damage to the breast's appearance, triggering significant psychological stress and emotional distress for patients, which in turn may affect their post-treatment quality of life and recovery process. Thanks to advancements in medical technology, a novel approach-laparoscopic subcutaneous mastectomy combined with in situ prosthetic breast reconstruction-has emerged. This innovative surgical method not only ensures thorough tumor resection but also maximizes the preservation of the breast's natural structure and contour, thereby significantly improving the overall aesthetic outcome for breast cancer patients. This study aims to explore the specific impact of this surgical approach on the overall aesthetic appearance of breast cancer patients. It will detail critical elements such as patient selection criteria, comprehensive preoperative preparation, meticulous surgical approach planning, step-by-step surgical procedures, and comparative analyses of postoperative breast appearance. Through this exploration, the study seeks to offer practical references and guidance for clinical practice.

Introduction

Breast cancer is one of the most prevalent malignancies among women, affecting millions globally each year^1. The treatment landscape for breast cancer has evolved significantly, with surgery remaining a cornerstone of therapy². While traditional mastectomy effectively removes the tumor, it often results in significant alterations to the breast's appearance, leading to substantial psychological distress and body image issues for patients³. Given these limitations, this study aims to explore a new surgical method, namely subcutaneous mastectomy under laparoscopy combined with in situ prosthetic reconstruction, to improve patients' appearance and psychological state. This emotional burden underscores the importance of integrating aesthetic considerations into breast cancer treatment protocols⁴.

The overall goal of this study is to explore the impact of subcutaneous mastectomy under laparoscopy combined with in situ prosthetic breast reconstruction on the overall aesthetic appearance of breast cancer patients. We aim to provide valuable insights for clinical practice by detailing the patient selection criteria, preoperative preparation, surgical approach, and postoperative outcomes. The advent of subcutaneous mastectomy under laparoscopy combined with in situ prosthetic breast reconstruction represents a significant advancement in addressing these concerns⁵. This innovative approach not only ensures the complete removal of the tumor but also maximizes the preservation of the breast's natural shape and appearance⁶. The use of laparoscopy allows for a less invasive procedure, reducing postoperative pain and recovery time, while the in situ prosthetic reconstruction provides a stable and aesthetically pleasing breast contour⁷.

Moreover, the psychological benefits of this technique are profound⁸. Studies have consistently shown that breast reconstruction can significantly improve patients' self-esteem, body image, and overall quality of life⁹. By minimizing visible scarring and restoring a natural breast appearance, this surgical approach helps patients regain a sense of normalcy and confidence post-treatment¹⁰. The rationale behind the development of this technique is to address the limitations of traditional mastectomy, which often leaves patients with significant physical and psychological burdens. Subcutaneous mastectomy under laparoscopy combined with in situ prosthetic breast reconstruction not only ensures the complete removal of the tumor but also maximizes the preservation of the breast's natural shape and appearance. This approach aims to improve patients' quality of life by reducing postoperative pain and recovery time while providing a stable and aesthetically pleasing breast contour.

Despite these advantages, the implementation of this technique requires careful patient selection and meticulous surgical planning. Factors such as age, tumor stage, breast shape, and patient willingness must be thoroughly evaluated to ensure the best possible outcomes. Furthermore, ongoing research and advancements in surgical techniques continue to refine and enhance the aesthetic and functional results of breast reconstruction.

In this paper, we explore the impact of subcutaneous mastectomy under laparoscopy combined with in situ prosthetic breast reconstruction on the overall aesthetic appearance of breast cancer patients. Compared to traditional mastectomy, subcutaneous mastectomy under laparoscopy combined with in situ prosthetic breast reconstruction offers several advantages. It is less invasive, resulting in reduced postoperative pain and faster recovery. Additionally, this technique minimizes visible scarring and restores a natural breast appearance, significantly improving patients' self-esteem and body image. Studies have consistently shown that breast reconstruction can enhance patients' overall quality of life. The use of laparoscopy in breast cancer surgery represents a significant advancement in the field. This technique has been widely studied and shown to be effective in preserving breast aesthetics while ensuring oncological safety. Ongoing research continues to refine and enhance the aesthetic and functional results of breast reconstruction, contributing to the broader body of literature on breast cancer treatment. The implementation of this technique requires careful patient selection and meticulous surgical planning. Factors such as age, tumor stage, breast shape, and patient willingness must be thoroughly evaluated to ensure the best possible outcomes. This paper aims to provide detailed guidance on patient selection criteria and surgical approach, helping clinicians determine whether this method is suitable for their specific applications. By addressing these key elements, we hope to contribute to the ongoing dialogue on improving patient care in breast cancer treatment and provide valuable insights for clinical practice.

Protocol

The study was approved by the Ethics Committee of  Suzhou Wu Zhong People's Hospital [approval number: 2025lw03]. Written informed consent for participation in the study and for publication of anonymised clinical data and images was obtained from all patients.

1. Patient selection

1. Select patients aged between 18 and 65. This age group has better physical functions and stronger postoperative recovery capabilities. They also typically have higher demands for breast aesthetics.
   NOTE: This procedure is suitable for early-stage breast cancer patients, such as those in Stage I and II. At these stages, the tumor has not metastasized and is relatively small, allowing for complete removal through subcutaneous mastectomy under laparoscopy.
2. Select patients with moderate or full breast shapes for this surgical approach. The prosthesis requires sufficient breast tissue to envelop and support it for good reconstruction.
   NOTE: Moderate or full breast shapes can provide sufficient tissue to envelop and support the prosthesis, resulting in better reconstruction outcomes. The assessment of breast shape can be determined through clinical examination and imaging studies (such as breast ultrasound or MRI) to ensure that patients meet the surgical requirements.
3. Select patients who have a strong desire for breast reconstruction and reasonable expectations for the surgical outcome. Make the patient understand the potential risks and ensure the patient is willing to cooperate with postoperative rehabilitation.

2. Preoperative preparation and surgical approach planning

1. Conduct imaging exams like mammography, breast ultrasound, and MRI to assess tumor size, location, and relationship with surrounding tissues. Perform lab tests, including routine blood tests, coagulation function, and liver and kidney function, to assess overall health and exclude contraindications.
2. Communicate with the patient to understand their psychological state. Help the patient eliminate fear and anxiety about the surgery. Enhance confidence and cooperation in the patient.
3. Choose an appropriate surgical approach based on tumor location and breast shape. Common approaches include axillary, areolar, and inframammary fold. Select the axillary approach for this case (Figure 1A).
4. Choose a prosthesis based on breast shape, volume, and patient expectations. Select a 311 model 260 cc silicone gel prosthesis. Ensure prosthesis size matches the patient's breast tissue for optimal results.

3. Subcutaneous mastectomy under laparoscopy

1. Use general anesthesia to ensure pain relief and muscle relaxation.
2. Have the patient lie supine with arms abducted and fixed. Fully expose the surgical area.
3. Disinfect and drape the surgical area. Establish a sterile environment (Figure 2A).
4. Dilute methylene blue 20 times. Inject 2 mL subcutaneously along the marked edge and massage for 5 min (Figure 2B).
5. Make a 5 cm incision below the right axillary apex. Incise the skin and superficial fascia. Locate and remove sentinel lymph nodes (Figure 2C).
6. If sentinel nodes show cancer, perform axillary lymph node dissection. Preserve the thoracodorsal nerve and vessels. Dissect the axillary tissue and send it for pathology.
7. Establish CO₂ pneumoperitoneum at 8 mmHg. Dissect breast tissue and pectoral fascia. Preserve the capillary network layer (Figure 2D).

4. In situ prosthetic breast reconstruction

1. Using a 50 mL syringe, irrigate the cavity with 2000 mL of normal saline. After irrigation, check for no obvious bleeding. Implant an 180 cc prosthesis (model 311) prepectorally, adjust the prosthesis position satisfactorily, and observe good breast shape (Figure 3A,B).
2. Place F15 disposable spiral negative pressure drainage tubes in the prosthesis cavity and axillary wound. Lead out from the lateral chest wall to drain the effusion.
3. Check instruments and gauze. Using a 4-0 absorbable suture, suture the adipose tissue and subcutaneous layer with interrupted sutures according to the anatomical layers. Perform continuous intradermal suture on the skin to smooth the skin and diminish scars.
4. Dress the wound with sterile dressings. Fix the drain to prevent shifting.

5. Postoperative breast appearance comparison in breast cancer patients

1. Preoperative appearance: Ensure the patient has a normal breast shape. Ensure the nipple-areola is in a normal position. Ensure smooth skin with no obvious deformities.
2. Immediate postoperative appearance: Ensure the breasts have achieved a similar breast volume. Present a full shape with minimal changes to the nipple-areola. Keep incisions hidden for a natural look.
3. Postoperative appearance at 3 months: Check for improvement in the breast shape. Check if there is a gradual recovery of skin laxity. Check if the nipple-areola color normalizes. Check if the aesthetic appearance is enhanced.
4. Postoperative appearance at 6 months: Check if a stable breast shape is maintained. Check if the visible scars are minimal. Ensure a natural breast touch. Check if the nipple-areola shape is good. Check if the patient is satisfied with the outcome.

Results

A total of 13 patients (mean (SD) age 45 (10.5) years) underwent laparoscopic subcutaneous mastectomy with immediate in situ prosthetic reconstruction. The mean surgery duration was 173.1 ± 38.8 min, the mean anesthesia duration was 200.0 min (± 40.6 min), and the mean intraoperative blood loss was 40.4 mL (± 10.1 mL). At 3 days after surgery, most patients displayed mild swelling, slight asymmetry, and visible but well-concealed scars, with satisfaction generally reported as moderate. By 3 months, breast contou...

Discussion

The integration of subcutaneous mastectomy under laparoscopy with in situ prosthetic breast reconstruction represents a significant advancement in the surgical management of breast cancer, particularly in terms of aesthetic outcomes¹¹. This approach addresses the longstanding challenge of balancing oncological safety with cosmetic satisfaction, which has been a critical concern for both patients and surgeons.

One of the most notable advantages of this technique...

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Braided Absorbabale Suture	Ethicon LLC	GL-34-MG	Sterile, 4-0 1.5 Metric 5 ´ 18 45 cm
CPG Silicone Gel Breast Implants	Mentor Medical Systems B.V	334-1101	Sterile, CPG(311)
Disposable single-incision port	Xiamen Surgaid Medical Device Co., LTD	5012186068	Sterile, ethylene oxide sterilized, disposable
Disposable spiral negative pressure drainage pipeline	Jiangsu Yangtze River Medical Technology Corp.	25014711	Sterile, single-use, F15
Electric hook	YiDa Medical Device Co., LTD	19040747	Sterile, dry heat sterilized, reusable
Laparoscopic mirror	KARLSTORZ Germany	26003BA	Sterile, dry heat sterilized, reusable