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.     

Breast reconstruction after mastectomy.

Reconstruction of the breast contour and areolanipple complex can be undertaken in patients who have had mastectomy for carcinoma of the breast. Although the reconstructed breast is not normal, the restored contour and simulation is gratifying for those patients who have sought this procedure.     

Breast reconstruction following mastectomy: current status in Australia

Background: Although breast reconstruction provides some advantages for women following mastectomy, few Australian breast cancer patients currently receive reconstruction. In Australia, the routine provision of breast reconstruction will require the development of specific health service delivery models. The present paper reports an analysis of the provision of breast reconstruction in eight sites in Australia. Methods: A semi-structured telephone interview was conducted with 10 surgeons offering breast reconstruction as part of their practice, including nine breast or general surgeons and one plastic surgeon. Results: Surgeons reported offering breast reconstruction to all women facing mastectomy; the proportion of women deciding to have breast reconstruction varied between sites with up to 50% of women having a reconstruction at some sites. Most sites offered three types of reconstruction. Two pathways emerged: either the breast surgeon performed the breast surgery in a team with the plastic surgeon who undertook the breast reconstruction or the breast surgeon provided both the breast surgery and the reconstruction. Considerable waiting times for breast reconstruction were reported in the public sector particularly for delayed reconstruction. Surgeons reported receiving training in breast reconstruction from plastic surgeons or from a breast surgery team that performed reconstructions; a number had been trained overseas. No audits of breast reconstruction were being undertaken. Conclusions: Breast reconstruction can be offered on a routine basis in Australia in both the private and public sectors. Women may be more readily able to access breast reconstruction when it is provided by a breast surgeon alone, but the range of reconstruction options may be more limited. If access to breast reconstruction is to be increased, there will be a need to: (i) develop effective models for the rural sector taking account of the lack of plastic surgeons; (ii) address waiting times for reconstruction surgery in the public sector; (iii) review costs to women in the private sector; (iv) develop a better understanding of women's views and how best to communicate about breast reconstruction; and (v) improve training in breast reconstruction.     

Breast reconstruction after mastectomy

The mastectomy patient presenting to the plastic surgeon often relates a profound sense of deformity. The current state of the art in breast reconstruction allows the plastic surgeon to intelligently address this deformity with procedures capable of achieving pleasing aesthetic results. If adequate soft tissue is present, implantation in the submuscular plane has proved satisfactory. However, if soft tissue deficiencies exist, highly acceptable results have been consistently achieved using the latissimus dorsi myocutaneous flap.     

乳腺癌术后乳房即刻再造152例报告

目的探讨乳癌根治术后即时应用单纯假体植入、可调式双囊假体植入和自体组织移植乳房再造术的适应证及疗效。方法101例在保留皮肤的乳腺癌改良根治术基础上于胸大肌下方植入Mentor假体再造乳房，39例在胸大肌下方植入Becker可调式假体再造乳房，10例用单蒂下腹部横行腹直肌肌皮瓣移植至乳房缺损区再造乳房。2例采用扩大的背阔肌肌皮瓣移植再造乳房。结果随访152例3—65个月，中位时间28个月，2例13个月后肿瘤局部复发，取出假体。术后乳房外观评价优良率达94％。结论单纯假体植入适用于乳房较小的患者，可调式假体植入乳房再造适用于乳房较大，或根治术时皮肤缺损较多的患者。     

Breast reconstruction following prophylactic or therapeutic mastectomy for breast cancer: Recommendations from an evidence-based provincial guideline

The side effects of mastectomy can be significant. Breast reconstruction may alleviate some distress; however, there are currently no provincial recommendations regarding the integration of reconstruction with breast cancer therapy. The purpose of the present article is to provide evidence-based strategies for the management of patients who are candidates for reconstruction. A systematic review of meta-analyses, guidelines, clinical trials and comparative studies published between 1980 and 2013 was conducted using the PubMed and EMBASE databases. Reference lists of publications were manually searched for additional literature. The National Guidelines Clearinghouse and SAGE directory, as well as guideline developers’ websites, were also searched. Recommendations were developed based on the available evidence. Reconstruction consultation should be made available for patients undergoing mastectomy. Tumour characteristics, cancer therapy, patient comorbidities, body habitus and smoking history may affect reconstruction outcomes. Although immediate reconstruction should be considered whenever possible, delayed reconstruction is acceptable when immediate is not available or appropriate. The integration of reconstruction and postmastectomy radiotherapy should be addressed in a multidisciplinary setting. The decision as to which type of procedure to perform (autologous or alloplastic with or without acellular dermal matrices) should be left to the discretion of the surgeons and the patient after providing counselling. Skin-sparing mastectomy is safe and appropriate. Nipple-sparing is generally not recommended for patients with malignancy, but could be considered for carefully selected patients. Immediate reconstruction requires resources to coordinate operating room time between the general and plastic surgeons, to provide supplies including acellular dermal matrices, and to develop the infrastructure needed to facilitate multidisciplinary discussions.     

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乳腺癌的早期发现、早期诊断、早期治疗 ,可提高治愈率 ,使越来越多的病人长期生存。但由于手术切除一侧或双侧乳房给她们的身心造成了严重的创伤和痛苦。如何弥补这一缺陷提高乳腺癌病人手术后的生存质量 ,使病人不仅有健康的身体 ,而且还要有健康的心理 ,乳房再造术是解决这一难题的较好途径 ,且经数十年的临床验证 ,确实取得了较满意的效果。我国开展此项技术较晚 ,近年来随着早期病例的增多和病人对提高生存质量意识的增强 ,加之医疗技术的进步 ,乳房再造术已引起人们的关注。1　乳房再造术的发展现代乳房再造术始于 2 0世纪 6 0年代 ,…     

Breast reconstruction after mastectomy. The Cape Town experience

As methods have advanced, trends in breast reconstruction after mastectomy have changed considerably with more emphasis being placed on reconstruction by means of tissue expansion. Indications for using the various methods available are discussed and their advantages and disadvantages enumerated. By May 1987, 95 breasts in 88 patients had been reconstructed at Groote Schuur Hospital with few complications. The challenge remains one of improving the appearance of reconstructed breasts.     

Breast cancer: value of postoperative locoregional irradiation following mastectomy

A CRUCIAL STEP: Locoregional control is a crucial step in the achievement of cancer cure. After mastectomy, locoregional irradiation (RT) clearly reduces the incidence of chest wall and nodal relapse, especially with initial lesions measuring more than 5 cm or with nodal involvement and/or large lymphatic or vascular emboli. CLINICAL PROOF: Two recent randomized trials have confirmed the benefit of well-adapted locoregional irradiation. In the Danish trial, including premenopausal "high-risk" women treated by mastectomy and chemotherapy (CMF protocol), RT reduced locoregional relapses from 32% to 9% (p < 0.01) and increased the 10-year survival rate from 45% to 54% (p < 0.01). These results are now confirmed in postmenopausal women with an increase in the 10-year survival rate from 36% to 45% (p < 0.001). In the Canadian trial, locoregional relapses decreased from 25% to 13% and the 10-year survival rate increased from 56% to 65%. The meta-analysis published in 1995 by the EBCTCG showed only a modest benefit due to locoregional irradiation in breast cancer. However, when small trials and old trials started before 1970 were excluded because of imperfect methodologies and inadequate irradiation techniques, the benefit of "modern" radiotherapy appeared as significant in 7,840 patients selected in this way. IN CLINICAL PRACTICE: Thus, since locoregional irradiation can avoid some metastatic evolution developed only after "local" or "nodal" relapse, it must be integrated into a multidisciplinary strategy. Nevertheless, this treatment must be safe. This can be achieved with new irradiation techniques including the definition of anatomical volumes and previsional dosimetry. The most important point concerns the treatment of internal mammary nodes, especially when previous chemotherapy including anthracyclines has been performed. The use of a direct field, with at least 40% of the dose delivered by electrons in an alternating scheme is recommended to ensure very good protection of the heart and lungs.     

Breast reconstruction following nipple-sparing mastectomy: clinical outcomes and risk factors related complications

Background: The aim of this study was to investigate clinical outcomes and risk factors related complications in patients who had undergone nipple-sparing mastectomy (NSM) followed by implant-based or autologous reconstruction.

Methods: Between 2004–2014 a single-institution retrospective review was collected on NSMs reconstruction. Patient demographics, comorbidities, breast morphological factors, type and timing of radiotherapy, type of incision, reconstruction type and timing, implant volume and complications were collected.

Results: A total of 288 patients had undergone 369 NSMs, 81 (28.1%) of which were bilateral while 207 (71.9%) unilateral. One-hundred mastectomies were performed for prophylactic purposes whereas 269 were therapeutics. Thirteen (4.5%) patients were active smokers, while 2 (0.7%) were diabetics. Fifty-five breasts (14.9%) were previously irradiated and average time elapsed between radiotherapy and NSM was 9-year, (range, 5–15 yrs). Total complication rate was 13.5% at mean follow-up of 47.98?months (range, 6–114?months). Partial-thickness and full-thickness mastectomy skin flap and NAC necrosis occurred in 39 (78%) and in 10 (20%) breasts, respectively. Previous radiotherapy and implant volume were significant predictors of complications (OR: 10.14, 95% CI: 3.99–27.01; OR?×?100?g: 3.13, 95% CI: 1.64–6.33). Overall mastectomy type incision was not predictive of complications (p?=?.426). No association was observed between radiotherapy and mastectomy type access (p?=?.349).

Conclusions: From our experience NSM followed by implant-based and autologous reconstruction had a relative high rate of complications comparable to previous reports. Despite this, it should be carefully offered to patients in whom potential risk factors are identified.     

Breast reconstruction following mastectomy for invasive breast cancer is strongly influenced by demographic factors in women in Victoria, Australia

This study explored factors associated with the likelihood of reconstruction after unilateral mastectomy and the wellbeing of women after reconstruction. Data were from a questionnaire completed on average 1.8 years after diagnosis by 1429 women in the BUPA Health and Wellbeing After Breast Cancer Study. Logistic regression was used to model factors associated with reconstruction. The Psychological General Wellbeing Questionnaire was used to assess wellbeing. A total of 25.4% of 366 women who had a unilateral mastectomy had undergone a reconstruction nearly two years after diagnosis. Being younger (p<0.001), educated beyond school (p<0.04), living in the metropolitan area (p<0.001), having private health insurance (p=0.003), not having dependent children (p=0.004) and not having radiotherapy (p<0.001) explained just over 40% of the variation in reconstruction status. There was a modest difference between women who did and did not have a reconstruction in terms of wellbeing. Demographic factors strongly influence the likelihood of reconstruction after mastectomy.