保留乳头乳晕复合体的一期硅胶假体乳房再造在乳腺肿瘤手术中的应用

目的：探讨保留乳头乳晕复合体（NAC）的一期硅胶假体乳房再造在乳腺良恶性肿瘤乳房切除术后乳房缺损中应用的可行性。 方法：选取2008年1月—2012年11月乳腺良、恶性肿瘤患者各15例,行乳房切除术后一期胸大肌包裹硅胶假体乳房再造,术中保留NAC;术后随访13~48个月,观察患者乳房美容效果、并发症及临床疗效。 结果：30例患者中28例对术后乳房外形满意,术后1.5、2年出现假体包膜挛缩、假体渗漏各1例,无与保留NAC相关的肿瘤残留、复发或转移。 结论：保留NAC的乳腺肿瘤乳房切除术后一期硅胶乳房假体再造能在治愈患者乳腺肿瘤的同时又满足了患者乳房外形美观的要求,且不增加并发症、肿瘤残留、复发或转移的发生率。     

保留乳头乳晕的乳房全切术后带蒂大网膜联合假体乳房一期重建23例

目的探讨保留乳头乳晕的乳房全切术后带蒂大网膜联合假体一期乳房重建的可行性和效果。 方法选择湖南省肿瘤医院乳腺二科2013年8月至2015年9月收治的0、Ⅰ、Ⅱ期乳腺癌患者23例,所有患者按肿瘤切除原则先行保留乳头乳晕的乳房全切术,取上腹部小切口游离带蒂大网膜联合凝胶假体植入胸大小肌之间行乳房一期重建。 结果23例大网膜组织瓣全部成活,随访3~25个月,无一例假体移位、破裂,重建乳房外观自然、柔软、形态良好,其中2例导管内癌患者因术后预留乳头乳晕部位皮肤较薄出现了乳头缺血,颜色变黑,随访3个月,未见坏死。随访期间未见一例复发。 结论保留乳头乳晕的改良根治术后带蒂大网膜联合假体一期乳房重建是一种安全可行且美容效果良好的手术方法。     

乳房皮下切除与自体组织即刻乳房再造

目的探索乳房皮下切除与几种方法的乳房再造术，即腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣等即刻再造乳房的方法。方法选择乳腺导管内原位癌10例和巨大乳腺良性肿瘤5例，顺乳晕切口活检，病理检查确立诊断后，采用经乳腺切口行乳癌或巨大肿瘤的乳房皮下切除术，若乳癌或良性肿瘤体积较大，另于腋窝部加做顺腋下皱襞的附加切口，以便于取出切除的组织及切除乳腺的腋尾部，同时可以切取腋淋巴结行冰冻切片活检。然后，应用腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体或局部皮瓣即刻行再造乳房，充填乳房切除后的空间，仅以少量的肌皮瓣皮肤修复乳头、乳晕切除后的缺损，并在此转移皮瓣上再造乳头、乳晕。结果经过多专科协作共完成15例，随访结果良好，无肿瘤复发。此法再造的乳房易与健侧乳房对称，保留了原有乳房皮肤的良好感觉，外观形态自然，再造乳房瘢痕较少，且手术切口瘢痕隐蔽。结论在严格选择手术适应证防止乳腺癌复发的前提下，乳房皮下切除与即刻乳房再造法，对乳腺导管内原位癌和巨大乳腺良性肿瘤患者I期完成肿瘤切除和乳房再造术，具有积极有效的意义。     

内镜辅助治疗乳腺癌16例临床分析

目的:探讨内镜下腋窝淋巴结清扫并保留乳头、乳晕的皮下全乳腺腺体切除术治疗乳腺癌的可行性及其优势。方法:为16例Ⅰ、Ⅱ期乳腺癌患者行内镜腋窝淋巴结清扫术,同时行保留乳头、乳晕的皮下全乳腺腺体切除术。结果:16例均成功完成保留乳头、乳晕的皮下全乳腺腺体切除术;内镜下行腋窝淋巴结清扫术的每例患者取出淋巴结8～26枚,平均15.6枚,6例发现1～5枚转移淋巴结。术后患者常规综合治疗,随访1.2～4.1年,死亡1例,失访2例,出现乳腺癌远处转移3例,其他病例无局部复发、患肢水肿及严重感觉运动障碍等并发症发生。结论:借助内镜器械,通过腋窝处微小隐蔽切口即可完成腋窝淋巴结清扫术,同时可行保留乳头、乳晕的全乳腺腺体皮下切除术,以此术式代替常规乳腺癌根治术,在保证疗效的前提下,极大地减少了并发症的发生率,有良好的功能和美容效果。     

探讨保留乳头乳晕乳腺癌改良根治术的方法及疗效

目的探讨保留乳头乳晕乳腺癌改良根治术的临床方法及疗效。方法对25例非中央区乳腺癌患者行腔镜下腋窝淋巴结清扫加小切口保留乳头乳晕乳腺癌改良根治术,一期假体乳房重建。术中行乳头乳晕下多点病理检查,术后按时按期放化疗。结果 25例患者均顺利完成手术,无明显手术并发症,术后随访15~51个月,中位平均随访时间为39个月,全组无局部复发和转移。美体效果满意。结论对非中央区乳腺癌行保留乳头乳晕乳腺癌改良根治术,美体效果好,未增加乳腺癌术后复发转移机会,可作为乳腺癌一种好的手术方法选择。     

保留乳房皮肤的乳腺切除与即刻乳房再造

目的　探讨保留乳房皮肤的乳腺切除与腹直肌肌皮瓣、背阔肌肌皮瓣加乳房假体 ,即刻再造乳房的方法。　方法　 1997年 6月～ 2 0 0 2年 6月 ,对 11例乳腺导管内原位癌和巨大乳腺良性肿瘤患者 ,经顺乳晕切口切取肿瘤活检 ,病理检查明确诊断。采用保留乳房皮肤的乳晕环形切口行乳腺或巨大肿瘤的乳腺皮下切除术 ;应用腹直肌肌皮瓣或背阔肌肌皮瓣加乳房假体即刻再造乳房 ,充填乳房的内容 ,仅以少量的肌皮瓣皮肤弥补切除后的乳头乳晕部位。再次手术时在移位后的皮瓣上再造乳头。　结果　经多科协作完成了 11例手术 ,随访 1个月始至 1～ 6年 ,效果良好 ,无肿瘤复发。其再造乳房与健侧乳房对称 ,保留了原有乳房皮肤的感觉 ,外观形态自然 ,瘢痕较少且隐蔽。　结论　在严格手术适应证防止乳腺癌复发的前提下 ,此法为一较完善的乳房再造方法。     

乳腺癌改良根治术后的缺损再造

目的：介绍对早期乳腺癌既达到肿瘤根治性切除,又保留乳房美观外形的一种手术方法。方法：对早期乳腺癌患者在保留乳头的基础上,经腋下切口行肿瘤根治切除术,同时切除肿瘤表面皮肤,用背阔肌肌瓣（或背阔肌岛状皮瓣）行一期乳房再造。结果：1995－1997年共治疗10例,术后随访2年以上6例,3年以上4例,均无肿瘤复发及转移,外观效果优7例,良3例。结论：本手术方法简单,损伤小,达到了肿瘤根治性切除,且切口隐蔽,保留了乳头、乳晕,使再造乳房外形美观逼真,手感良好。手术适应证较宽,对I、Ⅱ期乳腺癌除肿瘤侵犯乳头、乳晕或胸肌、皮肤等外均可采用。     

乳腺癌腺体全切除联合一期乳房重建手术的评估及实施

目的:探讨乳腺癌患者行腺体全切除联合一期乳房重建的术前、术中评估及具体实施。方法:对近2年行保留皮肤及保留乳头乳晕复合体(NAC)的乳腺癌切除术联合一期重建患者,术前完善数字化乳腺机及MRI,CT等检查,术中完善病理学检查,术后完善重建乳房美学及患者满意度评估并随访。结果:9例患者成功保留NAC,1例因肿瘤切缘与乳晕距离小于2 cm,切除NAC,行保留皮肤的乳腺癌切除术;9例采用假体植入一期重建,1例假体联合背阔肌皮瓣一期重建,术后随访1～24个月,患者主客观评价好,未出现局部复发及远处转移。结论:严格掌握乳腺癌腺体全切除联合一期乳房重建的适应证,操作简单易行,手术治疗美容效果佳,无严重不良并发症,不影响乳腺疾病的治疗。     

乳腺全切后硅凝胶假体即刻乳房再造48例

目的 探讨对良性乳腺疾病进行乳房皮下腺体全部切除与即刻硅凝胶假体乳房重建的方法及意义.方法 自2006年1至2009年8月,对48例(88只乳房)乳房腺体良性病变的患者采用乳晕周围弧形切口或附加延长切口,行皮下乳腺全部切除术,术后即刻于胸大肌下置入硅凝胶乳房假体行乳房重建术.结果 所有患者的切口均愈合良好,多数患者的乳房外形对称.术后随访48例患者1～24个月,无纤维包膜挛缩出现,医患均较满意.结论 该方法具有操作简单、效果明显、安全性高、恢复较快等优点,能改善乳房外形,避免了乳房缺损、畸彤造成的心理障碍,值得临床广泛应用.     

早期乳腺癌经皮下乳腺切除假体乳房重建术后不同切口的效果比较

目的:探讨保留乳头乳晕复合体经皮下腺体切除即刻假体乳房重建术不同切口的临床效果。方法:回顾性分析2013年6月至2020年12月在首都医科大学附属北京同仁医院乳腺中心完成保留乳头乳晕复合体腺体切除即刻乳房重建术的92例患者的临床资料。患者均为女性,年龄（42.0±7.5）岁（范围：27~64岁）,原发肿瘤0期12例,Ⅰ...     

Cancer of the breast and breast prostheses

Plastic surgery operations designed to modify the breast volume do not increase the risk of cancer. Xeroradiography provides the best images of operated breasts. The least interfering prostheses are the most radiolucent and, in particular, retropectoral prostheses. The diagnosis of cancer is based on the detection of microcalcifications and star-shaped images. It is guided by clinical examination which is precise as the content of the breast is thin an lies on top of the anterior surface of the implant. The complications of prostheses (shells, collapse, rupture, displacement) have been well studied. After breast reconstruction examination of the contralateral breast is therefore of prime importance due to the risk of bilateral cancer.     

Association of breast cysts and breast cancer

A review of 915 consecutive patients with breast cancer and 812 with breast cysts showed that an association between the two is uncommon--5% of breast cancers were associated with cysts and 4% of cysts were associated with breast cancer. Four types of association were identified: (a) cystic cancers--easily diagnosed because of the characteristic features of the aspirate, failure of the mass to disappear and early recurrence in a patient whose age and menstrual status were not usually associated with cysts; (b) cancers occurring simultaneously with breast cysts--recognized because they did not contain cyst fluid; (c) cysts occurring after breast cancer--diagnosed by aspiration of the mass in premenopausal women; (d) cancers in patients who have had breast cysts--usually occurring many years after the cyst aspiration when menses had ceased. These associations were not sufficiently frequent to justify specific follow-up, but all suspected cysts should be successfully aspirated to confirm the clinical diagnosis.     

Calcifications in the breast and digital breast tomosynthesis

Our study was to compare the clarity with which calcifications are seen on conventional mammography (CM) with the same calcifications on digital breast tomosynthesis (DBT). We define clarity as the sharpness, contrast, and diagnostic quality by which the calcifications were depicted. In a HIPPA compliant Institutional Review Board approved study, 3,000 women volunteered to have both a screening mammogram and a DBT study. A total of 119 sequential cases with relevant calcifications (not clearly benign) were reviewed. Two board certified, dedicated, breast imaging radiologists reviewed the CM and DBT images in an unblinded paired comparison. Only the mediolateral oblique (MLO) projection was available for the DBT studies. The MLO and craniocaudal projections were reviewed using the 2D images. Window and leveling, and electronic zoom were permitted. Unlimited time was allowed to provide a subjective assessment as too how well the calcifications were seen, from a diagnostic perspective, when the two studies were evaluated side-by-side. In 41.6% of the cases, the readers felt that calcifications were seen with superior clarity on DBT. In 50.4% of the cases, the visibility of calcifications was the same for DBT and CM, and in 8% of the cases, calcifications were seen with greater clarity on CM than DBT. In 92% of the cases, the clarity with which calcifications were seen on DBT was equal to or better than for CM and in almost half, the clarity on DBT was judged to be better than for CM. Our analysis shows that calcifications can be demonstrated with equal or greater clarity on DBT as on CM, thus allowing for comparable, and, perhaps, improved interpretive analysis of detected calcifications.     

Interstitial fluid pressure in breast cancer,benign breast conditions,and breast parenchyma

Background: Interstitial fluid pressure (IFP) in rodent malignant tumors is reportedly much higher than in surrounding normal tissue. We hypothesized the same may be true in human invasive breast tumors. Methods: We measured IFP in the operating room in 25 patients undergoing excision breast biopsy under local anesthetic for diagnostic purposes. Results: In patients with invasive ductal carcinomas IFP was 29 ± 3 (SE) mm Hg, compared with ?0.3 ± 0.1 mm Hg in those with normal breast parenchyma (p < 0.001), 3.6 ± 0.8 mm Hg in those with benign tumors (p < 0.003), ?0.3 ± 0.2 mm Hg in those with noninvasive carcinomas (p = 0.034), and 0.4 ± 0.4 mm Hg in those with other benign breast conditions (p = 0.002). There was a direct correlation between IFP and tumor size (R ² = 0.3977; p = 0.021). No correlation was found between IFP and nuclear grade, angiolymphatic invasion, systemic blood pressure, metastasis to lymph nodes, or estrogen and progesterone receptors. Conclusions: IFP measurements may facilitate radiographic or ultrasound localization of small or nonpalpable malignant tumors in those patients undergoing needle aspiration cytology or stereotactic core needle biopsy.     

Endoscopy mastectomy and breast reconstruction: Endoscopic breast surgery

This article describes a new method of external traction elevation which is applied to the breast in order to perform an oncologically thorough glandular removal and axillary dissection followed by immediate autologous reconstruction while significantly reducing wound morbidity and greatly improving cosmesis.     

Tuberous breast and predisposition to breast deformity in consanguineous

Tuberous breast deformity is a pathologic condition of the breast consisting of a constricting ring at the breast base, reduction in the volume of the breast parenchyma, and herniation of breast tissue through the nipple‐areola complex with areola enlargement. This pathology is generally congenital and has an unknown etiopathogenesis. We report the first observation of tuberous breast deformity in consanguineous. This report suggests the potential role of a genetic base in the development of this deformity. Between May 2008 and March 2011, we observed six female patients from two different families, aged between 18 and 55 years, affected by tuberous breast deformity. The breast deformity was characterized by breast asymmetry in all six cases. Four patients underwent surgery to correct the deformity. Standardized objective measurements of breast and chest were taken. A Visual Analog Scale was used to evaluate patients' and physicians' satisfaction. The first three patients were consanguineous; two were first cousins, and the third was second cousin with one of the above. The other three patients were also from the same family: two sisters and their mother. According to Von Heimburg's classification, the patients presented different degrees of breast deformity. In all operated cases, a good esthetic result with a high satisfaction (average visual analog scale score 9) was achieved. The results remained stable over time and no revisions were needed after the 1‐year follow‐up. The possibility of a parental consanguinity for breast deformities such tuberous breast has never been described in the literature. This report suggests the possible genetic role in the development of tuberous breast deformity. Further studies and genetic tests are required to prove this hypothesis.     

Benign breast disease and breast cancer risk: morphology and beyond

Evidence from clinical follow-up studies has indicated that there is a relationship between the presence of histologically proven benign breast disease and breast cancer risk and that the level of risk varies according to the histologic category of benign breast disease. In particular, proliferative lesions without atypia are associated with a 1.5- to 2-fold increase in risk, whereas atypical hyperplasias are associated with a fourfold to fivefold increase in breast cancer risk. A number of clinical factors appear to modify the risk associated with these lesions, including the time since biopsy, menopausal status, and family history of breast cancer. Recent studies have begun to evaluate the potential role of biologic, molecular, and genetic markers in assessing breast cancer risk in patients with benign breast disease. Additional information derived from clinicopathologic follow-up studies, epidemiologic studies, and molecular and genetic studies will provide new insights into benign breast disease and breast cancer risk.     

乳腺癌癌前病变及早期乳腺癌诊断与治疗

近年来乳腺癌癌前病变及早期乳腺癌的诊断及治疗取得了显著进展。目前公认的癌前病变有：（1）小叶及导管不典型增生；（2）柱状上皮不典型增生；（3）小叶原位癌；（4）乳头状病变；（5）异常增生放射状疤痕。p53和HER2可用于监测其转变为癌的过程。切除癌前病变是最有效的治疗方法。早期乳腺癌可通过普查、乳腺检查、影像学检查、导管内窥镜、肿瘤标志物及病理学检查诊断。局部切除加放疗、单纯乳房切除、局部切除加根据激素受体情况酌情内分泌治疗是原位癌主要治疗方法。早期浸润性乳腺癌推荐保乳根治术＋术后放疗、酌情化疗和／或内分泌治疗，可以避免致残性的手术，获得好的生活质量及长期存活。     

Angiosarcoma of the breast following breast preservation therapy and local radiation therapy for breast cancer

Abstract: This is a case of angiosarcoma following breast preservation therapy and local radiation therapy over a 3-year period.