保留皮肤的乳腺癌改良根治术后即时乳房再造15例

目的探讨一种既达到肿瘤根治性切除,又保留乳房美观外形的乳房再造的手术方法。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。结果应用下腹部横行腹直肌肌皮瓣乳房再造10例,扩大背阔肌肌皮瓣再造5例。优11例（73．3％）,良4例（26．7％）。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。对早期乳腺癌患者是一种安全可行的治疗方法。     

乳腺癌改良根治术Ⅰ期扩大背阔肌肌皮瓣乳房再造

背景与目的:乳腺癌手术治疗给患者带来的形体残损和心理创伤已成为临床医生和患者越来越关心的问题, 越来越多的乳腺癌患者有接受乳房重建尤其是Ⅰ期重建的意愿.本研究旨在探讨一种既达到肿瘤根治性切除,又保留乳房美观外形的乳房再造的手术方法.方法:2006年1月-2007年4月共收治早期乳腺癌患者15例.所有患者均行扩大背阔肌肌皮瓣再造乳房的手术治疗,手术过程中,保留乳房皮肤,切除乳腺组织并对腋窝淋巴结进行清扫. 结果:术后评价优11例(73.3%),良4例(26.7%).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,对早期乳腺癌患者是一种安全可行的治疗方法.     

保留皮肤的乳腺癌改良根治术后即刻乳房再造的临床应用

目的探讨保留皮肤的乳腺癌改良根治术后即刻再造乳房的适应证、方法、效果及可行性。方法2002年1月至2007年11月本院对94例乳腺癌患者行保留乳房皮肤皮下乳腺组织切除加腋窝淋巴结清扫术后，应用下腹部横行腹直肌肌皮瓣（transverse rectus abdominis myocutaneous flap，TRAM）、背阔肌肌皮瓣（latissimus dorsi myocutaneous flap，LDM）联合或不联合假体、单纯乳房假体植入4种方式即刻再造乳房。结果再造手术均取得成功。带蒂TRAM再造47例，LDM再造共42例（其中联合假体28例），单纯乳房假体植入5例。4例出现轻微术后并发症（4．25％）。经过3～67个月随访，局部区域复发率为0，再造乳房形态自然，效果满意，术后外观评价优良率97．87％。结论合理选择病例行保留皮肤或保留乳头乳晕乳腺癌改良根治术后即刻乳房再造是安全可靠的，切口隐蔽并能够保留原有乳房皮肤的感觉，从而获得最佳美容效果，值得广泛推广和应用。     

乳腺癌保留乳房治疗后乳房美容效果的影响因素探讨

目的回顾性分析早期乳腺癌患者保留乳房治疗后影响美容效果的相关因素。方法本院于1999年11月至2008年12月对162例临床0、Ⅰ、ⅡA期的乳腺癌患者实施保留乳房治疗,将乳头横向移位距离、乳头纵向移位距离、体表凹陷程度、乳房质地与弹性及皮肤色泽作为保留乳房治疗后的评判指标,于放射治疗后6个月综合评分判断美容效果。良好率差异比较采用卡方检验。结果共实施保留乳房手术162例,占同期乳腺癌手术患者的12．8％（162／1266）,术后病理分期为0期32例,Ⅰ期83例,ⅡA期47例。全部病例获随访,复发率为9．9％（16／162）。保留乳房治疗后美容效果良好占61．1％（99／162）,一般占35．2％（57／162）,差占3．7％（6／162）。采用双切口、保留皮肤、肿瘤广泛切除及适形放射治疗等技术者美容效果良好率显著高于单切口、切除皮肤、象限切除及非适形放射治疗组（P〈0．01）,而肿瘤分期和术后放射治疗开始时间是否早于12周对美容效果无影响（P〉0．05）。结论乳腺癌患者保留乳房治疗后美容效果良好,采用双切口、保留皮肤和肿瘤广泛切除等手术技巧以及适形放射治疗可提高保留乳房治疗的美容效果。     

乳腺癌改良根治同时以背阔肌瓣乳房形成术32例

目的：为消除根治手术对乳腺癌患者所致的形体破坏，改善患者的心理、生理状况及生活质量，探讨一种既达到肿瘤根治性切除，又保留乳房美观外形的简便省时、安全可靠的手术术式。方法：选肿瘤≤4cm，距乳头≥3cm，未侵及皮肤及胸肌的乳腺癌患者，经腋后线纵形切口并切除肿瘤表面皮肤，行保留乳头乳晕的改良根治术，术中乳头后乳腺组织断面快速病检为阴性，即刻取部分背阔肌瓣行乳房再造。结果：手术32例，1例因背阔肌瓣坏死失败，31例乳房再造成功，其中优22例（71．0％），良5例（16．1％），差4例（12．9％）；仅1例再造失败（背阔肌瓣坏死予以切除）。随访3年以上9例，随访2－3年11例，2年以下12例。除1例腋淋巴结转移17枚患者术后38个月出现骨转移及锁骨下复发外，其余均无瘤生存。结论：本手术切口稳蔽，且保留了乳头乳晕，再造乳房外形美观、逼真，手感良好。手术简便省时，安全可靠，损伤较上。     

乳腺癌术后Ⅰ期乳房再造(附150例报告)

目的探讨乳腺癌根治术后即时乳房再造的肿瘤治疗和形体完美双重效果。方法对1999年1月至2005年7月病理证实为乳腺癌的150例患者[均为女性，年龄49±15岁，肿瘤大小（1．6±1．2）cm，腋窝未及淋巴结]行乳腺全切除（包括传统改良根治11例，保留乳房皮肤的改良根治12例，保留乳头、乳晕的改良根治127例）后，即时行乳房再造[Ⅰ期背阔肌皮瓣再造139例，下腹横形腹直肌皮瓣（TRAM）再造11例]。结果手术成功149例，失败1例（损伤血管），术后并发腹壁疝1例，乳房出现脂肪结节6例，脂肪液化3例，腹部切口延迟愈合3例，背部血肿28例，切口边缘局部皮肤坏死7例，移植物缺血坏死1例（再次手术切除），乳头坏死4例。本组随访到123例，随访率82％，平均随访时间36．6个月，发生腋窝淋巴结转移2例，骨转移1例，锁骨上淋巴结转移1例，死亡1例（因转移自杀），无局部复发，术后外形改变（按JCRT标准）：优、良、中、差分别为11．5％、49．3％、36．7％、2．6％。结论乳腺癌根治术后即时乳房再造联合辅助治疗对早中期乳腺癌是可行的，能达到治疗和美容效果。     

乳腺癌术后一期乳房再造

背景与目的：乳房再造使乳腺癌全乳切除患者重获完整的乳房外形。本文介绍乳腺癌术后应用带蒂背阔肌肌皮瓣联合或不联合假体和带蒂横向腹直肌肌皮瓣（TRAM）行一期乳房再造的经验，并探讨适合中国乳腺癌患者的乳房再造方式。方法：2000年1月-2005年7月，74例乳腺癌患者乳房切除后，应用背阔肌肌皮瓣或带蒂TRAM行一期乳房再造。结果：再造手术均取得成功，背阔肌肌皮瓣再造62例（83．8％），其中联合假体13例、带蒂TRAM再造12例、联合假体1例。经过2～66个月随访，局部区域复发率4．1％。患者满意度高，可接受度96％。而且这两种自体再造方式在是否需要联合假体上没有差别（P=0．440）。结论：乳腺癌术后一期乳房再造能同时满足肿瘤治疗和形体美容的要求，提高患者生活质量，背阔肌肌皮瓣再造对中国女性适用性好，值得推广。     

背阔肌脂肪瓣一期乳房再造术的临床研究

目的：研究一种既达到肿瘤根治性切除目的,又保留乳房美观外形的简便省时、完全可靠的手术方法。方法：选临床Ⅰ、Ⅱ％期乳腺癌患者,经腋后线切口行肿瘤根治切除术,切除肿瘤表面皮肤,保留乳头乳晕,以部分背阔肌脂肪瓣行Ⅰ期乳房再造。结果：４６例接受乳房再造患者成功４５例,再造乳房美观效果为优者３４例（７５.6%),良７例（１５.5%),差４例（８.9%);随访满１,２,３年者分别为９,１１和１６例,除１例腋淋巴结转移１７枚患者术后３８个月出现骨转移及锁骨下复发外,其余均无瘤生存．结论：使用背阔肌瓣重建乳房,组织量适中,组织量适中,损伤小,外形美观,适合应用于中国女性．     

双侧乳腺切除加假体植入一期乳房重建治疗青年早期乳腺癌患者

目的探讨保留皮肤和乳头乳晕复合体的双侧乳腺切除及假体植入一期乳房重建在青年早期乳腺癌治疗中的临床应用。方法回顾性分析2006年1月至2011年3月接受保留皮肤及乳头乳晕复合体双侧乳腺切除加假体植入一期乳房重建术的21例青年早期乳腺癌患者临床资料。结果21例患者手术成功,术后美容效果优良。随访12—72个月（中位随访期为34个月）,无局部复发和远处转移。结论对青年早期乳腺癌患者,在切除患乳同时预防性切除对侧乳房,即行保留皮肤和乳头乳晕复合体的双侧乳腺切除加一期假体植入重建乳房,美容效果好,临床疗效满意。     

早期乳腺癌保留乳头乳晕复合体的改良根治术--Ⅰ期腹直肌肌皮瓣重建乳房

背景与目的：改良根治术目前已成为早期乳腺癌主要外科治疗方法之一,但术后如何重建乳房及保留乳头乳晕复合体一直是争论的焦点。本研究探讨早期乳腺癌保留乳头乳晕复合体的改良根治术——Ⅰ期腹直肌肌皮瓣重建乳房的方法及临床应用。方法：对早期乳腺癌患者行皮下乳腺切除,腋窝淋巴结清除,腹直肌肌皮瓣Ⅰ期乳房再造,最大限度地保留乳房皮肤以及乳头乳晕复合体。结果：应用该方法治疗10例早期乳腺癌,术后随访24～48个月,所有病例均无肿瘤局部复发及远处转移,重建乳房外形良好,乳头乳晕区皮肤无坏死,皮肤无明显萎缩、变硬,半年后乳头感觉恢复,供区无腹壁疝形成。结论：保留乳头乳晕复合体的乳腺癌改良根治术——Ⅰ期腹直肌肌皮瓣重建乳房,外形效果良好,对早期乳腺癌要求保持乳房外形的患者可能是一种较好的治疗方法;因本研究例数较少,该技术的疗效有必要行更大样本的研究来证实。     

Carcinoma of the axillary breast

A review of the world literature regarding carcinoma of ectopic breast tissue along with the addition of one cases is reported. A total of 90 cases of carcinoma of ectopic breast tissue were found, 64 of which occurred in the axilla. The combined survival beyond the 4-year post-treatment period was 9.4%. No survival advantage was found for radical or modified radical mastectomy over that of local excision combined with axillary dissection or radiation. The addition of radiation therapy to either type of mastectomy provided no additional benefit. The correct preoperative diagnosis was rarely made. Outcome was reported in 42 cases; 28 survived longer than 1 year, with 12 recurrences at the time of reporting, and 6 were alive with no evidence of disease at 4 years or longer. Improved prognosis requires diagnostic suspicion and early biopsy of unidentified lesions of the axilla or embryonic milk line.     

Breast implant‐associated anaplastic large cell lymphoma,an under‐recognised entity

Breast implant‐associated anaplastic large cell lymphoma (BIA‐ALCL) is a rare form of T‐cell lymphoma, recently linked to the use of certain types of breast implants. Although rare, BIA‐ALCL is being increasingly recognised and radiologists can play an important role in its early diagnosis. BIA‐ALCL is thought to be related to chronic inflammation from indolent infection of the biofilm surrounding implants leading to malignant transformation of activated T cells in genetically susceptible individuals. Clinical features include breast enlargement or asymmetry, discomfort, heaviness and/or a palpable mass in the context of long‐standing implant(s). Ultrasound is the primary imaging modality, and the presence of more than a trace of peri‐implant fluid should prompt consideration of aspiration for cytology, flow cytometry and microbiological analysis. This article reviews the clinical, imaging and pathology features of BIA‐ALCL. In addition, the current recommended management guidelines for suspected cases are discussed.     

Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness

Breast cancer is the most common cancer in women in the industrialized world and a leading cause of death. Breast self-examination (BSE) is one of the methods for an early detection of breast cancer. In the present study the effectiveness of a campaign promoting BSE and breast awareness was analysed. Seminars were conducted in 2003 in Lower Saxony, Germany by a female gynaecologist and a social pedagogue and included a lecture, an individual training in BSE in a separate room and a talk about the importance of regular BSEs. Questionnaires were handed out immediately after the seminar and were sent by post 1 year later. Attendance of the seminar resulted in a significantly higher percentage of monthly BSEs (21.4% before vs. 61.9% after the teaching). Furthermore, 92.1% of the women who did not perform a monthly BSE stated that at least they examined their breasts more frequently after attending the seminar. The data demonstrate that the seminars in BSE had profound effects on the compliance of women in carrying out BSE regularly and correctly, without influence of age or education.     

保乳手术在乳腺癌治疗中的应用

目的 :研究保乳手术在Ⅰ、Ⅱ期乳腺癌中的治疗效果。方法 :从 1990年 3月到 2 0 0 4年 3月 ,对直径≤3cm ,肿瘤边缘距乳晕≥ 2cm的部分患者施行保乳手术 ,部分肿瘤直径 >3cm的患者先行术前化疗 ,肿瘤缩小后再做保乳手术。手术切除肿瘤周围约 2cm的正常组织 ,达到切缘阴性 ,腋窝清扫范围为Ⅰ、Ⅱ水平淋巴结。开始时应用 1切口设计 ,后来改为 2切口。术后先进行放疗 ,再进行化疗和 (或 )内分泌治疗。结果 :2 6 5例保乳手术腋窝淋巴结清扫数目为 5～ 2 9个 ,平均 16个。本组患者局部复发部位均为乳腺 ,无腋窝复发者 ,三年、五年、十年生存率分别为 99%、94 %、80 % ,局部复发率为 5 .4 %、7%、7.7% ,乳房保留率为 97.8%、93%、88% ,保留乳房的美容效果满意率为 83.2 %。结论 :保乳手术适用于Ⅰ、Ⅱ期乳腺癌患者 ,可以取得良好的生存率、局部控制率和美容效果 ,是乳腺癌治疗的首选术式。     

The anatomy of the arteries and veins of the breast

Textbook accounts of this subject are inadequate. This review considers the work of Cooper and Salmon and reproduces some of their figures. Applications in the diagnosis and treatment of cancer are discussed. The largest mammary arteries are the lateral (from the axillary) and the anterior medial and posterior medial (from the internal thoracic). The branches of these arteries do not follow the duct system, but instead form a plexus in the anterior fat layer. Normally there are no hypervascular or hypovascular areas. The contribution of the mammary branches of the posterior (aortic) intercostal arteries is minor. There are superficial and deep sets of veins, the latter associated with arteries. Mammary vessels of living women are demonstrated by infrared photography, thermography, and mammography. In the diagnostic use of these methods there is a tendency to rely upon the concept of normal vascular symmetry, but this is a fallacy.     

Breast reduction and cancer in the gland remnant: a review

Aims The main aims of this paper are: (1) to evaluate the impact of partial breast gland removal, for cosmetic or functional reasons on cancer incidence in the long-term post-surgical follow-up; (2) to define the incidental cancer finding during breast reduction; (3) to examine the oncological perspective of contralateral breast reduction in women with post-mastectomy breast reconstruction, (4) to consider the impact of breast reduction techniques as first choice procedure in the treatment of cancers in megalomastia. Methods. We reviewed the clinical articles published in the last 20 years addressed to the relationship between the amount of tissue removed and cancerogenesis of the remnant gland. The review has been also extended to published papers outlining the future trends of breast reduction procedures from an oncological perspective, potentially as specific choice of selected cancer treatment in megalomastia. Results. Assessment of the literature data reveals that breast reduction does decrease the risk of breast and other types of cancers. The actual risk lowering for patients older than 40 is related to the amount of tissue removed. Conclusion. This study illustrates that breast reduction surgery should be encouraged, besides the known aims, as a preventive operation in those patients presenting degrees of breast hypertrophy and a family history of breast cancer.     

Trends in the management of breast cancer

Responses of general surgeons to a questionnaire on breast cancer were analyzed to determine the current trends in the management of this disease. A 21-item questionnaire was mailed to members of the New Jersey Chapter of the American College of Surgeons in 1982 and the responses, received on noncoded, anonymous answer sheets, were analyzed for frequency distribution. These responses were compared to previously recorded responses to the same questions for 1971 and 1977. Seventy-six percent of the respondents in 1982 performed needle aspirations often or always, compared to 36% in 1971 and 80% in 1977. The use of routine mammography has increased from 16% in 1971 and 20% in 1977 to 38% in 1982. Modified radical mastectomy is now the most common type of procedure employed in the management of stage I breast cancer, with 89% of respondents in favor of this approach compared to 15% in 1971 and 60% in 1977. Fifty-nine percent of the respondents are not opposed to breast reconstruction following mastectomy versus 14% in 1971 and 49% in 1977. For patients with axillary nodes, chemotherapy with multiple agents was recommended by 76% of general surgeons in 1982, compared to 58% in 1977. These results indicate a continuing trend towards increasing use of needle aspiration and routine mammography for diagnosis and for employment of chemotherapy with multiple agents in the adjuvant treatment of patients with positive axillary nodes. Furthermore, modified radical mastectomy is the operation of choice for stage I cancer of the breast for increasing numbers of surgeons.     

Decreased rates of advanced breast cancer due to mammography screening in The Netherlands

The effect of the implementation of the Dutch breast cancer screening programme during 1990-1997 on the incidence rates of breast cancer, particularly advanced breast cancer, was analysed according to stage at diagnosis in seven regions, where no screening took place before 1990. The Netherlands Cancer Registry provided detailed data on breast cancer incidence in 1989-1997 by tumour stage, age and region. Annual age-adjusted incidence rates of all breast cancers and advanced cancers, defined as large tumours T2+ with lymph node and/or distant metastases, were compared with rates in 1989. In general, breast cancer incidence rose strongly in the early 1990s, especially in the age category 50-69 years (estimated annual percentage change (EAPC) 4.25; 95% CI 1.70, 6.86). The increase was mainly due to the increase in small T1 cancers and ductal carcinoma in situ. However, in women aged 50-69, advanced cancer incidence rates showed a significant decline by 12.1% in 1997 compared with 1989 (EAPC -2.14, 95% CI -3.47, -0.80), followed by a breast cancer mortality reduction of similar size after approximately 2 years. We confirm that breast cancer screening initially leads to a temporary strong increase in the breast cancer incidence, which is followed by a significant decrease in advanced diseases in the women invited for screening. It is evident that breast cancer screening contributes to a reduction in advanced breast cancers and breast cancer mortality.     

Breast cysts: Pitfalls in sonographic diagnosis

Ultrasound examination of the breast is extensively carried out to differentiate cystic from solid masses. Ten atypical cysts are presented that do not fulfil all the criteria for the ultrasonic diagnosis of breast cysts. These had internal echoes and some showed irregular contours or diminished through transmission. Diagnostic aspiration confirmed the cystic nature of these lesions. None showed cytologic evidence of malignancy or haemorrhage. The purpose of this paper is to bring this entity to the attention of radiologists so that echogenic cysts are considered in the differential diagnosis of well defined, solid appearing breast masses seen on ultrasound.