Breast conservation therapy with concomitant breast reduction in large-breasted women

Cosmetic results from radiation following breast-conserving surgery and radiation therapy are generally poorer in women with large or heavy breasts. Breast reduction carried out at the time of definitive surgery allows this group of women to undergo breast-conserving surgery and radiation with excellent cosmetic results. Four cases are presented in which partial mastectomy was carried out in conjunction with immediate bilateral breast reduction. All patients had clear margins and all had excellent cosmetic results following radiation therapy. Immediate breast reduction should be considered in women with large or heavy breasts who otherwise qualify for breast-conserving surgery.     

双环形切口乳房缩小整形术

目的:探讨乳房缩小整形术中手术方法及术后效果影响因素。方法:应用改良双环法进行乳房缩小整形术85例,术中切除腺体组织150～1200g,将外上侧腺体组织楔形切除后,将乳头-乳晕-腺体组织瓣置于正常解剖位置,以乳头为中心向内侧适度旋转,并适当固定塑形使乳房的上极保持丰满;并对手术后效果进行初步评价。结果:80例患者接受随访,手术后74例患者双侧乳房形态及乳头乳晕对称,乳房上极较丰满,乳头乳晕感觉良好,患者满意,总满意率为92.5%。结论:改良双环法乳房缩小整形术手术后乳房形态良好,患者满意度高,简易调查表显示患者手术后关心的问题首先是乳房形态及乳头乳晕感觉。     

Acute toxicities after proton beam therapy following breast‐conserving surgery for breast cancer: Multi‐institutional prospective PCG registry analysis

We investigated adverse events (AEs) and clinical outcomes for proton beam therapy (PBT) after breast‐conserving surgery (BCS) for breast cancer. From 2012 to 2016, 82 patients received PBT in the prospective multi‐institutional Proton Collaborative Group registry. AEs were recorded prospectively at each institution. Median follow‐up was 8.1 months. Median dose was 50.4 Gy in 28 fractions. Most patients received a lumpectomy bed boost (90%) and regional nodal irradiation (RNI)(83%). Six patients (7.3%) experienced grade 3 AEs (5 with dermatitis, 5 with breast pain). Body mass index (BMI) was associated with grade 3 dermatitis (P = .015). Fifty‐eight patients (70.7%) experienced grade ≥2 dermatitis. PBT including RNI after BCS is well‐tolerated. Elevated BMI is associated with grade 3 dermatitis.     

应用垂直双蒂缩乳术治疗巨大乳房良性肿瘤

目的 应用垂直双蒂缩乳术治疗乳房巨大良性肿瘤，使术后乳房有较好形态。方法 应用垂直双蒂缩乳术原理，设计切除乳房肿瘤的切口，在切除乳房肿瘤的同时进行乳房整形手术。结果 1993年以来，为11例患乳房巨大良性乳腺囊性增生病和乳腺纤维病女性病人进行了这一手术，取得良好整形效果。结论 对影响乳房形态的巨大良性肿瘤，用经典的整形外科缩乳技术可以有效地保持乳房形态。     

Contribution of intraoperative radiotherapy (IORT) for therapeutic de‐escalation in early breast cancer: Report of a single institution's experience

The spread of systematic screening and the emergence of oncoplastic techniques allow more breast conservative treatment associating lumpectomy and external beam radiation therapy. In order to furthermore facilitate the patient's treatment, intraoperative radiation therapy (IORT) has been developed. The oncological safety of this technique has been studied, and is considered acceptable. Many questions remain unsolved in regard of the toxicity of this procedure as well as the patient's selection criteria. In this study, we present the first results and complications rate of patients treated by IORT in a single French institution. Between 2012 and 2015, all patients with breast cancer treated in a one‐step procedure associating lumpectomy and IORT were retrospectively included in a monocentric cohort. Acute and long‐term toxicities were evaluated using CTCAE v4.0 classification. 280 breast cancers were treated using IORT procedure. Additional external beam radiation therapy was requested for 45.7% patients. The acute complications rate was 14.6%, with 5 surgical revisions needed (1.78%). With a median follow up of 911 days, the long‐term grade‐3 toxicity rate was 1.1%. The only risk factor for local fibrosis was external beam radiation therapy (EBRT) (OR = 1.99; IC95 [1.05–3.81], P = 0.036). Three patients (1.07%) were diagnosed with local recurrence. The results from this cohort confirm the low complication and recurrence rate of IORT procedure. A good selection of patients is necessary in order to lower the EBRT rate and allow therapeutic de‐escalation. The classification of tumors into IHC subsets seems a good selection gate. Intraoperative radiation therapy appears to have a low toxicity rate with an acceptable local recurrence risk, and should therefore be considered as an option in the treatment of early breast cancer.     

巨乳缩小术常见手术方法的选择

目的:比较巨乳缩小术常用的临床手术方法,探讨各自的适应证。方法:对15例巨乳症患者行手术治疗,其中垂直双蒂法7例,双环法8例。观察术后乳头乳晕血运及乳房外形。结果:所有患者全部恢复良好,无乳头乳晕坏死,乳房外形均满意。结论:垂直双蒂法较适用于中重度巨乳症,双环法较适用于轻中度巨乳症。     

Survival after Breast‐Conserving Surgery with Whole Breast or Partial Breast Irradiation in Women with Early Stage Breast Cancer: A SEER Data‐base Analysis

Randomized clinical trials have demonstrated equivalency in survival outcomes for early stage breast cancer patients treated with either mastectomy or breast‐conserving surgery (BCS) with radiation. Recent, state‐level data confirm comparable survival outcomes. Using Surveillance Epidemiology and End Research (SEER) data, we sought to evaluate survival outcomes among patients with early stage breast cancer treated with mastectomy, BCS with whole breast irradiation (BCS + WBI), or BCS with accelerated partial breast irradiation (BCS + APBI). Data on women 50 years or older diagnosed with a node negative invasive breast cancer (≤3 cm in size) between 1995 and 2009 were extracted from the SEER data base. Women treated with mastectomy alone or BCS with radiation were eligible for analysis. Kaplan–Meier estimates and Cox proportional hazard models were used to compare overall survival (OS) and cancer‐specific survival (CSS) among the treatment groups. 150,171 women fulfilled inclusion criteria. OS was significantly improved among women treated with BCS and WBI or BCS and APBI compared to mastectomy alone. Adjusted hazard ratios for death in BCS with WBI or APBI (versus mastectomy alone) were 0.73 (95% CI: 0.71, 0.76) and 0.68 (95% CI: 0.58, 0.79), respectively. Adjusted CSS was also significantly improved in patients treated with BCS and WBI (HR 0.80, 95% CI: 0.76, 0.85) as compared to mastectomy. BCS with radiation (WBI or APBI) was associated with significantly improved OS and CSS, versus mastectomy alone. These results support the use of BCS with WBI or APBI (in well selected patients) for the treatment of breast cancer.     

Breast cancer in reduction mammaplasty specimens: case reports and guidelines

Increasing numbers of women of all ages are electing to have reduction mammaplasty for very large breasts. Breast cancer can be an incidental finding in reduction mammaplasty specimens. We report here the discovery of breast cancer in specimens from four patients who underwent elective breast reduction, three of whom had not had recent mammograms. All four patients underwent modified radical mastectomy. The role of mammography, surgical options, specimen evaluation, and practical guidelines are discussed.     

保留乳头感觉的改良McKissock乳房缩小术

为保留乳头感觉,用改良 McKissock 垂直双蒂法行乳房缩小术4例(7只乳房),改良重点在于保留主要支配乳头感觉的第4肋间神经外侧皮支。另对术前设计及手术操作作了一些改进,因而术后乳房切口平整,两侧对称,外形挺拔。     

Accelerated partial breast irradiation—Redefining the treatment target for women with early stage breast cancer

Following breast conserving surgery, the standard of care has been to deliver adjuvant radiation therapy directed to the whole breast (WBI) over a period of 3‐7 weeks. Over the past decade, increasing data have supported the concept that treatment to the whole breast may not be required in selected patients, allowing for the emergence of partial breast irradiation (PBI). Multiple randomized trials with 5‐10 years of follow‐up have been published documenting the safety and efficacy associated with PBI using multiple techniques. Questions that remain to be answered include (a) what is the optimal PBI technique for each clinical scenario, (b) are there additional patients that can be effectively managed with PBI approaches, and (c) are there different techniques/dose schedules that allow for further reduction in treatment duration and/or toxicities? Partial breast irradiation represents a standard approach for appropriately selected patients. PBI provides comparable clinical outcomes to WBI while allowing for a reduction in the duration treatment and the potential for reduced toxicities. Future studies may also help to better define which patients require no radiation, PBI, hypofractionated WBI or conventional WBI, based upon patient, clinical, pathologic features as well as potentially using tumor genetics.     

保留乳头感觉的改良McKissock乳房缩小术

为保留乳头感觉，用改良ＭｃＫｉｓｓｏｃｋ垂直双蒂法行乳房缩小术４例（７只乳房），改良重点在于保留主要支配乳头感觉的第４肋间神经外侧皮支。另对术前设计及手术操作作了一些改进，因而术后乳房切口平整，两侧对称，外形挺拔。     

外侧上蒂式旋转乳房缩小成形术

目的:对女性巨乳症患者,采用一种矫正新术式,以达到乳房外形更加谐调完美的效果。方法:从1989年至2004年对26例52只女性巨乳症者,应用外侧上蒂式旋转乳房缩小成形术治疗。结果:术后随访26例患者6月至2年,乳房肥大下垂得到理想矫正,乳头勃起功能正常,未出现乳头乳晕感觉异常,切口瘢痕隐蔽不明显,整体外形美观。结论:通过该术式治疗实践,该法简单灵活、安全可靠、术后功能和形态满意。     

乳腺癌保乳手术的体会

目的　总结和探讨乳腺癌保乳手术保持乳房良好外形 ,在术前、术中和术后应注意的问题。方法　 3 7例患者接受了乳腺癌保乳手术。术后从乳头外观、双乳头水平差距、双乳头距同侧腋前线垂直距离之差距和瘢痕对乳房外形影响等四个方面的量化标准 ,评估保留乳房的外形美观效果。四项指标积分≥ 2 1分为优 ,13～ 2 0分为良 ,<13分为差。结果　术后保留乳房外形优良者 3 0例 ( 81.1% ) ,乳房外形较差者 7例 ( 18.9% )。常见问题是因切口瘢痕致乳房变形、乳头歪斜、乳头不自然挺立 ,以及与对侧乳头水平高度差距明显。结论　术前认真设计手术切口、术中注意术区皮瓣和保留乳腺组织的彻底游离以及切除、缝合技巧 ,术后切口包扎时注意避免压迫乳头等 ,将有助于保持保留乳房的外形美观效果     

早期乳腺癌36例行保乳手术治疗体会

目的 总结早期乳腺癌施行保留乳房的根治术的治疗效果。方法 分析2002年1月～2005年12月我科选择开展的保乳手术的36例乳腺癌Ⅰ、Ⅱa患者的近期治疗效果。结果 本组患者均行保留乳房的乳腺癌根治术，术后联合化疗、放疗、内分泌治疗均获得较满意的效果。结论 早期乳腺癌行保乳手术联合放、化疗可达到与传统根治手术相同的近期效果，并具有患者心理打击小、美容效果好的优点。     

The Relative Benefits of Tamoxifen in Older Women with T1 Early‐Stage Breast Cancer Treated with Breast‐Conserving Surgery and Radiation Therapy

Small, hormone receptor‐positive breast carcinomas in older women are associated with low local recurrence rates. The relative benefits of adjuvant hormonal therapy remain unclear in elderly women with small, node‐negative breast cancer after breast‐conserving surgery and adjuvant radiation therapy. From our institutional data base, 224 patients ≥65 years of age with T1N0M0 breast cancer treated with BCS+RT were identified. Of these, 102 patients (45.5%) received tamoxifen (TAM) and 122 patients (54.5%) did not (no‐TAM). The median follow‐up time was 62.6 months. The 10‐year local relapse‐free survival (LRFS) was 98% in both the TAM and no‐TAM cohorts (p = 0.58); the 10‐year DMFS was 83% TAM vs. 89% no‐TAM (p = 0.91). There was no difference in 10‐year contralateral breast relapse or overall survival (OS) between the two cohorts. In univariate and multivariate analysis, use of TAM was not associated with LRFS, distant metastases‐free survival (DMFS), OS, or a reduction in contralateral breast cancers when compared with the no‐TAM cohort. In this large cohort of T1N0 elderly breast cancer patients treated with CS+RT, the use of TAM did not appear to decrease ipsilateral breast relapse, contralateral breast relapse, distant metastasis, or OS.     

乳房肿胀吸脂在双环法缩乳术中的临床应用

目的：探讨乳房肿胀吸脂在双环法缩乳术中的临床优点和推广应用。方法：在109例双环法缩乳术中首先行乳房肿胀吸脂（单纯乳腺组织增生,皮下脂肪少者除外）,而后行缩乳术。结果：乳房肿胀吸脂后行缩乳术,比原缩乳术有明显优点：手术时间明显缩短;出血明显减少;乳腺组织切除定量准确;解剖层次清晰;缩乳效果明显。结论：乳房肿胀吸脂后双环缩乳术,是对原术式的进一步改良,值得临床推广应用。     

乳房整形技术在乳腺癌保乳手术中的应用效果分析

目的：探究分析在乳腺癌保乳手术当中,乳房整形手术的应用临床效果。方法：选自我院2010年～2012年收治的在保乳手术当中应用乳房整形手术的患者共50例,对其,I盘床资料进行回顾性分析,对患者术后美容效果进行调查。结果：全部患者均成功完成手术,术后对患者进行随访,随访时间为（6～12）个月,无患者出现局部或者区域淋巴结肿瘤复发迹象;患者手术后乳房美容效果优良率为92％（46／5O）。结论：乳腺癌患者可以通过乳房整形技术进行保乳治疗,该手术方法有着安全高效的优点,手术之后患者乳房外形以及整体美容整体满意程度较高,值得临床推广。