保留乳房的改良式乳腺癌根治术21例报告

目的 探讨保留乳房的乳腺癌根治术的适应证、手术和术后治疗。方法 回顾性分析21例早期乳腺癌患者行保留乳房改良式乳腺癌根治术的临床资料。结果 所有病例术后经过良好，乳房外形正常，随访3-20个月，无复发及并发症。结论 对早期乳腺癌，可行保留乳房的根治术，术后乳房外形正常，患者生存质量高。但术后应定期随访，以便及时发现和治疗乳腺癌复发。     

早期乳腺癌手术的乳房轮廓保留策略

乳房轮廓保留(BCP)是指通过保乳手术(BCS),乳房切除即刻乳房重建(IBR)的外科策略,保留乳腺癌患者术后乳房的轮廓。随着乳腺外科技术的发展,乳腺癌患者的术后外形和生活质量获得了明显改善,最近的研究报道中,将BCP作为一项新的指标来衡量或评价乳腺癌治疗效果。在早期乳腺癌手术中,需要根据术前对乳腺癌患者全身情况和乳房肿瘤的全面评估以及乳房的形态特点,制定个体化的手术策略,合理提高乳腺癌术后的BCP率,改善患者的术后外形效果。结合我国女性乳房的形态特点,不仅可以通过BCS和IBR保留乳房轮廓,在部分乳腺癌患者中,保留乳头乳晕复合体乳房切除术也可作为保留乳房轮廓的术式选择,从而减少乳房缺失给患者带来的身心影响。     

乳腺癌保留乳房手术的近期疗效观察

目的探讨早期乳腺癌保留乳房手术的近期疗效。方法对我院2004年1月至2007年10月收治的25例早期乳腺癌患者行保留乳房手术,并于术后进行随访。结果未见局部复发和远处转移,乳房外形保持良好。结论保留乳房手术治疗早期乳腺癌的近期疗效满意,术前严格掌握适应证,术后给予规范的综合治疗是保留乳房手术获得成功的关键。     

保留乳头的乳腺癌根治术即乳房重建术

目的：探讨早期乳腺癌行保留乳头的改良根治、即期硅胶假体植入乳房重建术的可行性.方法：利用早期乳腺癌极少侵犯乳头、乳晕及皮肤的特点，切除病灶及其上方部分皮肤后行皮下乳房切除＋腋淋巴结清扫术，并与硅胶假体植入术有机结合，达到一期重建乳房的目的.结果：对18例早期乳腺癌患者采用上述术式重建乳房后客观评价效果优良和尚好者达94.4%，主观评价效果优良和尚好者达100%，术后随访12～36个月，所有病例均无局部复发及远处转移.结论：保留乳头的非定型式乳腺癌根治与即期硅胶假体植入乳房重建术是治疗Ⅰ期及部分Ⅱ期乳腺癌安全可行的方法。     

乳腺癌术中保留功能神经的策略与思考

当今由于人们对乳腺癌生物学行为的进一步认识,以及患者对生活质量要求的进一步提高,乳腺癌外科治疗模式发生根本性的变化。保留乳房、保留腋窝（前哨淋巴结活检）和保留功能神经这“三保留”术式是目前乳腺癌外科治疗朝着美容、微创和功能方向发展的典型表现。然而相对于其他两类术式,保留功能神经手术的开展受患者条件、医院设施等客观因素的影响较小,而主要与术者对功能神经的认识和重视程度有关。     

乳腺癌保守性乳房切除联合乳房重建的研究进展

目的 了解目前关于乳腺癌保守性乳房切除联合乳房重建的研究现状,为外科医生及乳腺癌患者手术方式的选择提供参考。方法 收集近年来国内外关于保守性乳腺切除联合乳房重建相关研究的文献并进行归纳总结。结果 目前保守性乳房切除术主要有保留乳头乳晕的乳房切除术、保留皮肤的乳房切除术及缩减皮肤的乳房切除术,这3种术式均安全、有效,手术并发症在可控范围内;联合乳房重建能获得较好的美容效果,能提高患者术后满意度及生存质量。结论 对乳腺癌患者进行充分的术前评估后,保守性乳房切除术为合适的乳腺癌患者提供了一种治疗选择,切除后根据患者乳房大小、下垂度及患者个人期望制定个体化重建方式,能使患者在治疗疾病的同时获得较高的生存质量。     

早期乳腺癌保留乳房术式的探讨(文献综述)

本文概述了国外有关乳腺癌保留乳房术式的发展过程和目前状况。随着对乳腺癌研究的进展,对手术切除治疗乳腺癌的作用也有了新的认识,即乳腺癌是一种全身性疾病,手术只能起到局部治疗作用,扩大切除并非起到根治作用,所以保留乳房术式在与其它术式的比较中得以发展,其适应证和禁忌证也逐渐明确。     

乳腺癌术后即刻假体植入乳房重建

目的探讨保留皮肤的乳腺癌改良根治术后即刻乳房重建的手术技巧及术后并发症的防治处理方法。方法26例乳腺癌女姓患者实施了改良根治术＋即刻假体植入乳房重建术,术后跟踪按摩并进行必要的辅助治疗。结果术后患者的乳腺癌得到根治,同时乳房达到形体美容的功效,大大减少了患者的心理障碍,提高了患者术后的生活质量。结论乳腺癌术后即刻假体植入乳房再造术易被广大医生及患者所接受。     

乳腺癌根治术后乳房重建方法及其研究现状

乳房重建技术可以修复乳腺癌术后乳房形态缺陷，恢复身体协调性，提高患者生活质量，促进患者回归社会，现已成为乳腺癌综合治疗的重要组成部分。由于存在个体差异，乳腺癌术后选用乳房重建技术有所不同，已成为目前研究探讨的新方向，该文就乳房重建术式的选择，手术时机、美学效果和术后患者的生活质量进行回顾性分析和总结，以期为临床工作提供参考。     

保乳手术确定标本边缘的探讨

目的 探讨保留乳房的乳腺癌切除术如何确定标本边缘.方法 选择符合保留乳房标准的乳腺癌111例,实施保乳手术,手术标本边缘按照肿瘤周围1cm正常组织切除.术后根据病理、临床分期制定个体化的综合治疗,定期随访患者局部和全身情况.结果 111例乳腺癌符合保乳手术治疗标准,实施了保乳手术治疗并能接受定期随访,1例出现局部区域复发.结论 按照肿瘤周围1cm正常组织切除,取其左、右、上、下、基底5个面作冰冻切片,证实标本边缘无肿瘤浸润.绝大多数患者可获满意的美容效果,提高了早期乳腺癌患者的生存质量.     

Breast

<正>210378 Expression and significance of stromal CD10 and Ezrin inductal carcinoma in situ and invasive ductal carcinoma of breast/Zhang Rongju(张荣菊,Breast Cancer Research Key Lab Educat Minis Nation,Oncol Key Lab Tianjin,Tianjin Cancer Inst Cancer Hosp,Tianjin Med Univ,Tianjin 300060)…Chin J Exp Surg.-2010,27(6).-705～707     

Breast

<正>209026 Relationship between breast cancer-related lymphoedema and VEGF-C and VGGFR-3/He Jianye (贺建业,DeptGen Surg,Anzhen Hosp,Cap Univ Med Sci, Beijing 100029)…∥Chin J Gen Surg. -2009,24(11). -900～903 Objective To study the distributionand clinicopath-ological characteristics between VEGF-C and peritumoral lymph vessels density (PlND) in breast cancer tissue,and to investigate the development and the mechanism of breast cancer-related lymphoedema(BCRL).     

Case Report: Breast Seroma Mimicking Breast Implants

Introduction Breast seroma may be caused by a variety of factors including lymphatic disruption, continuous inflammation and foreign bodies such as breast implants. In cases of breast implants associated seroma the diagnosis of Anaplastic Large Cell Lymphoma (ALCL) should be investigated.Presentation of Case A 45-year-old Caucasian woman was referred with bilateral swelling of the breasts causing tension and pain. MRI showed accumulations compatible with bilateral silicone implants. Ultrasound-guided aspiration showed no malignancy or silicone. The patient had a history of both soy- and silicone implants. Three years prior her breast implants was removed due to capsule formation. To treat the pain and rule out potential malignancy we performed capsulectomy of only the right breast, on the wish of the patient. We found brown fluid, no breast implants and histology of fluid and tissue showed no malignancy.DiscussionBreast seroma usually develops weeks after surgery such as mastectomy or axillary lymph node dissection. This patient developed a seroma through months and years after her last surgery. In cases of late seroma malignancy should be ruled out. Diagnostic statements should not solely be based on radiology, but in conjunction with clinical findings.ConclusionWe performed capsulectomy on a patient with breast seroma mimicking breast implants. We excluded the diagnosis of breast implant-associated ALCL. Radiology has limitations and should be considered in conjunction with the patient’s statement and the clinical findings.     

Etiology of Breast Masses after Autologous Breast Reconstruction

Background

Determining the nature of a breast mass after autologous reconstruction can be difficult.

Methods

A retrospective review of all autologous breast reconstructions was performed over 10 years. All postoperative breast masses were identified. Tumor characteristics, adjuvant treatment, timing of the development of the mass, and correlation with radiology were reviewed.

Results

A total of 365 flaps were performed on 272 patients [253 deep inferior epigastric perforator (DIEP), 35 superficial inferior epigastric artery (SIEA), 22 muscle-sparing free transverse rectus abdominis myocutaneous (free MS-TRAM), 25 latissimus, and 30 pedicled TRAM]. Breast masses were identified in 66 breasts (18 %). The majority of these were from fat necrosis, occurring in 54 breasts (15 % overall; DIEP 13.4 %, SIEA 5.7 %, free MS-TRAM 15 %, latissimus 0 %, pedicled TRAM 47 %), first identified at a mean of 3 months. Recurrent carcinoma was diagnosed in 13 breasts (3.6 %). Factors associated with the postreconstruction mass representing recurrent carcinoma were later time period after reconstruction (mean 24 months), closer surgical margins, and lymphovascular invasion. Radiographic imaging accurately diagnosed recurrent carcinoma in 11 (92 %) of 12 patients in whom it was utilized and suggested a benign diagnosis in all 16 patients with fat necrosis in whom it was utilized.

Conclusions

Breast masses frequently present after autologous reconstruction. Fat necrosis is the most common cause. Recurrent carcinoma can occur in the reconstructed breast and presents later. A higher index of suspicion for recurrence should accompany any mass in which prior lymphovascular invasion was present or if original margins were <1 cm. Radiographic imaging accurately identifies the cause of these masses.     

Breast reconstruction

During the last century, breast reconstruction after mastectomy has become an important part of comprehensive treatment for patients who have breast cancer. Breast reconstruction initially was created to reduce complications of mastectomy and to diminish chest wall deformities. Now, however, it is known that reconstruction also can improve the psychosocial well-being and quality of life of patients who have breast cancer. This article reviews the techniques used for breast construction after breast surgery.