Wise pattern mastectomy with immediate breast reconstruction

A new technique of immediate breast reconstruction is presented. This technique uses a silicone implant placed in a subpectoral pocket, using de-epithelialised skin from the lower breast to augment the submuscular pocket, thus producing a compound myodermal flap. The technique is simple, and the resulting scar is cosmetically satisfactory; when combined with reduction mammoplasty on the opposite breast, this technique produces satisfactory breast symmetry.     

保乳手术与改良根治术治疗乳腺癌的体会

【摘要】 目的 探讨保乳手术与改良根治术治疗乳腺癌的临床效果。方法 对我院从2005年1月到2007年6月期间乳腺癌治疗的临床资料进行回顾性分析。选择60名经手术治疗的乳腺癌患者,分为观察组和对照组,每组各30例,对照组给予改良根治术治疗,观察组给予保乳手术治疗,随访5年观察临床效果。 结果 观察组患者在手术时间、住院时间、术中出血量及并发症发生率方面明显优于对照组(P<0.05)。两组5年生存率比较差异无统计学意义(P>0.05)。结论 保乳手术治疗乳腺癌的效果确切,优点多,临床医师应根据患者的适应证合理应用。     

保留皮肤的乳腺癌改良根治术后即时乳房再造

目的　介绍保留皮肤的乳腺癌改良根治术后即时乳房再造的经验。方法　对早期乳腺癌 ,保留乳房皮肤 ,切除乳腺组织和腋窝淋巴结 ,应用下腹部横行腹直肌肌皮瓣或扩大背阔肌肌皮瓣即时乳房再造。结果　应用该方法治疗 37例 ,再造乳房形态良好。结论　保留皮肤乳腺癌根治术后即时乳房再造 ,切口隐蔽 ,再造乳房形态效果好 ,对早期乳腺癌患者值得推广应用     

乳腺癌改良根治术与乳房即时再造

目的探讨乳腺癌改良根治术后乳房缺损的解决方法. 方法总结17例乳腺癌术后乳房自体组织移植、保留乳头和不保留乳头的人工假体填充乳房即时再造的经验,介绍病例选择、皮瓣设计和手术方法. 结果应用下腹部横形腹直肌肌皮瓣(transverse rectus abdominis myocutaneous,TRAM)进行即时乳房再造4例,盐水-硅凝胶乳房假体进行即时乳房再造13例,其中4例为保留乳头的乳房再造,效果满意. 结论Ⅰ、Ⅱ期乳腺癌在改良根治术的同时行乳房再造是安全可靠的,可减少皮下积液和上肢水肿的发生率.TRAM可同时进行腹部整形,假体的植入简便易行.     

术中导航系统在腔镜乳腺癌保乳根治术中的应用：病例报告

背景 中国乳腺癌患者年轻化,年轻患者术后生活质量成为关注焦点。乳腺癌保乳手术在根治乳腺癌的同时保持乳房外形,我们中心是国内最早开展乳腺癌保乳精准手术的单位之一。腔镜微创技术是乳腺癌手术领域的新热点,但目前腔镜乳腺癌保乳手术的发展遭遇阻碍——难以精确勾画癌肿边缘。传统保乳手术中,癌肿切缘由术者手指触摸判断,这在腔镜操作下无法实现。为此,作者开展了全球首例腔镜下术中导航乳腺癌保乳术,应用术中导航系统精准定位癌肿边缘。患者信息 患者为46岁女性,确诊为左侧乳腺癌,cT2N1M0 IIB期。患者保乳意愿强烈并要求术后乳房外形美观。方法 应用乳房MR结果构建三维图像、术前O臂扫描乳房空间位置,再通过Medtronic Stealth Station S7手术导航系统将二者融合,构建出实时乳房三维模型。随后在导航系统的引导下,可用探针精准勾画肿瘤边缘,在腔镜下沿探针位置切下癌肿。结果 病理结果提示肿瘤切缘组织未见癌,术后乳房两侧基本对称、正面观无伤口,患者对外形满意。讨论 腔镜下术中导航乳腺癌保乳术提高了腔镜保乳手术的可操作性和切缘一次阴性率,有望将腔镜保乳手术大范围推广。     

乳腺癌切除术后乳房再造

目的 探讨乳腺癌切除术后乳房再造的方法及时间.方法 总结30例不符合保乳条件的乳腺癌病例,乳房切除术后假体置人乳房再造16例,下腹部横行腹直肌肌皮瓣(TRAM瓣)乳房再造10例,背阔肌肌皮瓣乳房再造4例.其中即刻乳房再造27例,延期乳房再造3例.结果 16例假体置入乳房再造术后外观评价均为良,未出现术后并发症.10例TRAM瓣乳房再造术后发生皮瓣部分坏死2例,腹壁疝1例,术后外观评价7例为良.2例为较好,1例为差.4例背阔肌肌皮瓣再造术后外观评价为良.结论 乳房再造术是乳腺癌综合治疗不可忽视一部分,对于有强烈的保乳愿望,而又不符合保乳条件的患者,乳房再造术是一种较好的选择.即刻乳房再造优于延迟乳房再造.乳房再造的方法选择要因人而异.局部晚期乳腺癌患者可以选择性进行即刻乳房再造术.     

乳癌术后的乳房再造

目的 探索乳癌根治术后3种不同乳房再造方法的最佳外观效果.方法 (1)乳癌切除Ⅱ期行扩大背阔肌肌皮瓣乳房再造.(2)乳癌切除即时腹直肌横行皮瓣乳房再造.(3)保留胸大肌乳癌切除,Ⅱ期乳房假体置入并行乳头、乳晕再造;对不保留胸大肌乳癌切除者,Ⅱ期皮肤扩张后乳房假体置入再造.结果 共计治疗12例,10例皮瓣全部成活,外观形态满意,优良率较高.2例不满意,其中1例扩张后,因局部皮肤皮下组织较薄,扩张程度不足,勉强置入140 ml乳房假体,外观形态明显偏小;另1例腹直肌肌皮瓣大部分坏死,经再次修复创面愈合,乳房再造失败.结论 乳房再造的方法选择得当,可使乳房形态更为自然.普通背阔肌皮瓣改用扩大的背阔肌皮瓣后,软组织量比前者增加1倍以上,使再造乳房与对侧相近.假体置入乳房成形后,Ⅱ期行单蒂乳头、乳晕再造,可给患者以心理和外观上的更多抚慰.     

保留皮肤的乳腺癌根治术后即时乳房及乳头再造

目的　介绍保留皮肤的乳腺癌根治术后即时乳房乳头再造经验。方法　对早期乳腺癌 ,保留乳房皮肤 ,切除乳腺组织和腋窝淋巴结 ,应用下腹部横行腹直肌肌皮瓣即时再造乳房乳头。结果　应用该方法治疗 12例 ,再造乳房形态良好。结论　保留皮肤乳腺癌根治术后即时乳房再造 ,切口隐蔽 ,再造乳房形态效果好 ,对早期乳腺癌患者值得推广应用。     

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目的用安全、简便的方法解决乳腺癌根治术后乳房缺损问题。方法2002年4月至2004年9月,在行保留皮肤的乳腺癌改良根治术后同期于胸大肌后植入Meter或Beck假体,即时再造乳房。根治术时根据冰冻结果决定是否保留乳头乳晕复合体。结果32例病人中,23例行Meter单囊假体植入,9例行Beck双囊可扩张假体植入,5例保留乳头乳晕复合体,均获得满意效果。32例病人中经病理证实15例为浸润性导管癌,11例为浸润性小叶癌,4例为浸润性导管癌同时合并浸润性小叶癌,1例为乳管内乳头状瘤病伴部分癌变,1例为浸润性小叶癌保乳术后复发。结论保留皮肤的乳腺癌改良根治术后运用假体植入法行Ⅰ期乳房再造,创伤小、安全、快速,恢复期短,手术操作简单易行,即时效果满意。     

Technique of subcutaneous mastectomy and immediate reconstruction in hypertrophic or ptotic breasts

Summary A method for subcutaneous mastectomy approaching from an incision directly below the mamilla is described. It allows complete resection of the gland under full vision. By preparing two dermis flaps, one from above carrying the mamilla and one from below, based at the submammary fold, a double-layered cover for the silicone implant, which replaces the gland, can be secured. — The indication for a subcutaneous mastectomy with subsequent reconstruction of the breast is considered to be present if the preliminary investigations, i.e. palpatory, mammographic and cytological findings, reveal a preliminary stage of cancerous degeneration of the breast (Mastopathia Type III, according to Prechtel [11]). The operation should always be performed bilaterally. — The author rejects subcutaneous mastectomy as a prophylactic measure in women with indefinite carcinophobia without foregoing conscientious triple diagnosis. He also considers it as absolutely contraindicated in the presence of even minimal but invasively growing carcinoma.     

Multiple re-excisions versus mastectomy in patients with persistent residual disease following breast conservation surgery

BACKGROUND: Persistently involved margins following breast conservation surgery (BCS) create a diagnostic dilemma regarding the recommendation of further BCS or mastectomy. METHODS: A retrospective review of 276 breast cancer patients who underwent BCS and required additional surgical treatment between 1990-2002 was performed. RESULTS: For treatment of persistently involved margins, 63% of subjects underwent re-excision the first time, 49% the second time, and 37% the third time. The incidence of residual carcinoma increased linearly with the number of initially involved margins (P = .03). Ductal carcinoma-in-situ (DCIS) or infiltrating lobular carcinoma (IFLC) primary histology was associated with a higher rate of residual cancer compared to invasive ductal carcinoma (IFDC) (62% vs. 69% vs. 54%, respectively, P = .56). A trend towards an increased risk of residual cancer in primary tumors > or =2 cm versus tumors under 2 cm was also evident (63%% vs. 50%, respectively, P = .38). CONCLUSIONS: Approximately half of patients repeatedly selected BCS over mastectomy. It is important to realistically discuss the probability of definitive resection with patients who are undergoing breast conservation with re-excision.     

乳腺癌保留皮肤改良根治并即刻假体再造与传统改良根治术的疗效比较

目的 比较乳腺癌保留皮肤改良根治并即刻假体再造和传统改良根治术的治疗效果.方法 对2004年1月至2008年12月手术治疗的530例0～Ⅲa期女性乳腺癌患者病例资料进行回顾性分析.530例中,91例行乳腺癌保留皮肤改良根治并即刻假体再造,439例行传统改良根治术.通过比较两组患者术后并发症、局部复发率、远处转移率、病死率的差异,评价乳腺癌保留皮肤改良根治并即刻假体重建与传统改良根治术的疗效.结果 即刻假体再造组随访患者84例,中位随访时间35个月,局部复发率2.4%,远处转移率8.3%,病死率6.0%;改良根治组随访患者439例,中位随访时间36个月,局部复发率3.3%,远处转移率9.5%,病死率6.5%.随访期间两组复发率、转移率、病死率的差异均无统计学意义(P＞0.05).即刻假体再造组术后美观效果随访12个月,医生和患者评估的良好率分别为93%、87%.结论 乳腺癌保留皮肤改良根治并即刻假体再造可以达到和传统改良根治术相当的疗效,并可显著改善患者术后乳房外形美观及生活质量.

Abstract：

Objective To compare the therapy efficiency of immediate implanting breast reconstruction after skin sparing mastectomy and modified radical mastectomy in breast cancer. Methods The data of 530 female patients with early of stage 0 to Ⅲ a breast cancer was retrospectively analyzed, from January 2004 to Decembet 2008. Among the patients,91 patients operated with skin sparing mastectomy and immediate implanting breast reconstruction ( Group of immediate implanting reconstruction), and 439 patients were with modified radical mastectomy (Group of modified radical mastectomy ). By comparing complications, local recurrence, distant metastases and mortality rates between the two groups, the research was done to evaluate the therapy efficiency. Results In the group of immediate implanting reconstruction,84 patients completed follow-up with the median follow-up time of 35 months ( 14-72 months) while the local recurring rate was 2. 4%, distant metastasis rate was 8. 3% and mortality rate was 6. 0%. In the group of modified radical mastectomy, 398 patients completed follow-up with the median follow-up time of 36 months ( 12-74 months) while the local recurring rate was 3.3%, distant metastasis rate was 9. 5% and mortality rate was 6. 5%. Therefore there was no obvious statistic difference between the two groups in local recurring rate, distant metastasis rate and mortality rate (P ＞ 0. 05 ). Evaluation of aesthetic results was done in the 84 patients after immediate implanting reconstruction for 12 months which was 93% as good or excellent by surgeons while 87% by patients. Surgeons and patients were both satisfied with the breast appearance. Conclusions For patients with early stage breast cancer, combining standard postoperative therapy, skin sparing mastectomy and immediate implanting reconstruction could achieve the same effect as the traditional modified radical mastectomy, while reconstruction would bring about better appearance and higher quality of life.     

Immediate or delayed breast reconstruction after mastectomy: what do women really want

Breast reconstruction, especially immediate reconstruction after mastectomy has increased over the last decades, at present being regularly offered in many centres worldwide. Despite obvious benefits and the evident oncological safety of primary breast reconstruction, the majority of women still receive a delayed procedure or even no reconstructive surgery. The objective of the present study was to determine the preference of women for breast reconstruction—immediate or delayed—and in the case of rejection of treatment to find out the reasons for this reluctance. In a prospective study a sample of 200 women—divided into two groups—were evaluated by an oral interview on the subject. The two-formed groups of participants consisted of randomly chosen women (n=100) and non-surgical nurses (n=100). The questionnaire surveyed personal data including marital status and educational level, as well as information about the preferred timing, the method of and the reasons for or against breast reconstruction. The evaluation of all data showed that 66% of the participants voted for additional surgery after mastectomy. Young age and high education level were significantly correlated (age r=0.56, P<0.01; education r=0.25, P<0.01) to the wish for reconstruction. The mean age of all participants was 39 years (range 20–69), with a significant difference between the two groups (P<0.01), the group of nurses being younger (mean age 35, range 20–62) and the other women being older (mean age 43, range 20–69). Concerning the timing of reconstruction, 21% of women elected to have an immediate and 27% a delayed operation. Yet, 52% could not come to a decision as to whether they should prefer a primary or secondary procedure. For the surgical procedure—autologous versus non-autologous tissue—about 23% of the participants could not decide spontaneously, while 40% preferred autologous tissue, 14% implants and 23% would choose a combination of both. The main reason in favour of reconstruction was that it would enhance the physical appearance (96%), whereas an important reason for general rejection was the fear of additional surgical risk (19%). For primary reconstruction, a high percentage of women also were highly concerned that reconstruction could mask cancer recurrence (62%). Although the majority of women—unaffected with breast cancer—are interested in breast reconstruction, more than half of them cannot decide spontaneously about the timing and mode of surgery, including the medical women. The collected data emphasize the urgent necessity to systematically inform women and the whole population about the options of breast reconstruction. Equally important is for the involved surgeons to know the individual wishes and fears of women unexpectedly confronted with the diagnosis of breast cancer in order to provide comprehensive preoperative counselling with respect to cancer therapy including breast reconstruction.     

Immediate autologous latissimus breast reconstruction after skin sparing mastectomy

A technique of immediate breast reconstruction, combining skin sparing mastectomy and autologous latissimus breast reconstruction, is presented. In this study, 50 patients underwent this procedure between May 1993 and May 1997. The most frequent indication (62%) was ductal carcinoma in situ (multifocal, high grade or larger than 3 cm). In 38% of cases, the patients had a contraindication to the TRAM flap; in the other cases (62%) the patients preferred the dorsal donor site to the abdominal site. Reduction of the contralateral breast was done in 20% of cases of unilateral reconstruction. The aesthetic results, evaluated by two others surgeons, were rated as very good in 88% of cases, good in 8% and poor in 4%. Study of patient satisfaction showed 84% of patients to be pleased, 12% satisfied and 4% poorly satisfied. Dorsal sequelae were rated as slight in 96% of cases, intermediate in 4% and marked in none. The main disadvantage was dorsal seroma which occurred in 62% of cases but was easily managed by repeated aspiration. No patient developed a local recurrence or distant metastases. This technique represents a significant advance in breast reconstruction, giving a breast of natural shape and consistency with no transverse scar or patch effect due to the flap. Received: 13 October 1997 / Accepted: 16 November 1998     

Persistent pain after mastectomy with reconstruction

Study Objective

To determine the prevalence of persistent postsurgical pain (PPSP) and its influence on functional status, and to examine associations between PPSP and single nucleotide polymorphisms of the catechol-O-methyltransferase (COMT) gene and the guanosine triphosphate cyclohydrolase 1 (GCH1) gene following mastectomy and reconstruction.

Design

Retrospective study.

Setting

Two teaching hospitals.

Patients

From the population of women who had undergone breast reconstruction following mastectomy for breast cancer over a 6-year period, 42 women agreed to participate in the assessment (55.3% of the total sample).

Interventions

The Rand 36-Item Health Survey 1.0, the Patient-Specific Functional Scale, the McGill Pain Questionnaire (long form), visual analog scales for anxiety and pain, and the Hospital Anxiety and Depression Scale were administered. Blood was taken for genetic analysis. Quantitative sensory testing was performed using a standard electrical stimulus.

Measurements

Surgical procedures, perioperative analgesic requirements, pain scores, and adjuvant therapies were noted. Height, weight, menstrual status, and arm circumference also were recorded.

Main Results

42 (55.3%) patients took part in the assessment, and 18 (43%) reported PPSP. Those with PPSP achieved lower scores on the Patient-Specific Functional Scale (P = 0.040) and had been given more morphine perioperatively. A trend was noted between occurrence of PPSP and the val158met polymorphism of the COMT gene (P = 0.06).

Conclusions

Persistent pain after mastectomy and breast reconstruction has a high prevalence (43%). Genetic mutations may contribute to the development of persistent pain following surgery; however, larger studies are required for confirmation.     

日间乳腺癌皮下单纯切除术后一期假体重建的华西经验

背景与目的:乳腺癌术后一期乳房重建在不影响患者治疗效果的同时,能显著改善患者的生活质量,因此已经成为乳腺癌手术治疗的一种重要方式.由于乳腺癌重建手术相对于乳房其他手术而言更复杂,耗时也更长,因此大多乳腺癌需乳房重建患者都是收入住院部手术,术后适当观察数天,本文总结华西医院14例乳腺癌行日间乳房重建手术的相关经验,并探讨...     

乳腺癌保乳手术切除范围的探讨

目的 探讨乳腺癌保乳手术的局部切除范围.方法 回顾性分析南京医科大学第一附属医院乳腺外科、镇江市人民医院乳腺外科和常州市中医医院行保乳手术的275例连续病例,所有患者均按统一的手术步骤操作,并采用相同的术后辅助治疗,定期随访患者局部和全身情况.结果 271例患者获得随访,随访率98.5％.随访时间1个月～9年9个月,中位随访34个月.2例局部复发,6例发生远处转移死亡.患者1年、3年、5年总生存率分别为99.5％、98.1％、95.7％.结论 切除肿瘤周围1 cm乳腺组织,冰冻切片证实边缘无肿瘤浸润,术后辅助化疗、内分泌治疗及放疗,手术是安全的,有益于提高患者生存质量.以钼靶片结合体检确定有无多中心、多灶性病变是安全、有效的.