Comparative study of layered breast defect reconstruction and traditional surgery in the treatment of plasma cell mastitis: a single-center study.

Background: Plasma cell mastitis (PCM) is a chronic inflammatory breast disease that presents challenges in achieving both effective disease control and satisfactory cosmetic outcomes. Layered breast defect reconstruction (LBDR) is a technique that may reduce recurrence and improve breast aesthetics. This study aimed to evaluate the clinical value of LBDR compared to traditional surgical repair in PCM patients.

Methods: We conducted a retrospective cohort study of 90 female PCM patients treated at the Third Medical Center of Chinese PLA General Hospital between 2002 and 2018. Patients with histologically confirmed PCM who underwent surgical treatment and completed at least 3 years of follow-up were included. Based on the surgical technique, patients were divided into two groups: traditional surgery (n=24) and LBDR (n=66). Baseline clinical characteristics-including age, body mass index (BMI), disease duration, and comorbidities-were collected and compared between groups. The primary outcomes were postoperative recurrence and aesthetic satisfaction. Secondary outcomes included operative time, intraoperative blood loss, and complication rates. Logistic regression was used to identify independent predictors of favorable outcomes.

Results: The two groups were generally comparable in baseline characteristics, including BMI, smoking history, breastfeeding history, and clinical symptoms (all P>0.05). However, patients in the LBDR group were significantly older (P=0.003), and lesion locations differed between groups (P=0.02). Compared to traditional surgery, LBDR significantly reduced the recurrence rate (4.55% vs. 45.83%, P<0.001) and improved aesthetic satisfaction (100% vs. 8.33%, P<0.001). Multivariate logistic regression analysis identified LBDR as an independent protective factor for favorable breast appearance [odds ratio (OR) =0.00, 95% confidence interval (CI): 0.00-0.03, P=0.001] and reduced recurrence (OR =0.06, 95% CI: 0.01-0.25, P<0.001). Although LBDR involved a longer operative time, there were no significant differences in intraoperative bleeding nor postoperative complications.

Conclusions: LBDR may provide favorable oncologic and cosmetic outcomes in selected PCM patients without increasing perioperative risks. However, given the retrospective, non-randomized design, further prospective studies are needed to validate these findings.